Are there significant differences between the prices of the same medication across Latin American countries? What is the cost to people’s hip pockets? These are just two of the questions that Ojo-publico.com’s data analysis team sought to answer as part of The Big Pharma transnational investigation project, which brings together journalists from Colombia, Argentina, Guatemala, and Mexico. The result was a price comparison calculator for twelve of the most costly medicines in five countries, showing disproportionate differences in the cost of treatment for cancer, HIV, hepatitis C, rheumatoid arthritis, and diabetes.
Although antiretroviral therapies—essential for keeping people with the AIDS virus alive—are covered by the state, referential calculations were made in case the user has to pay.
The analysis was undertaken based on commercial medication unit prices in each country, taking into account also their patent protection status or any other relevant legal issue. In order to undertake the comparison, we converted the local currency unit value of each medication to the pared dollar. This monetary unit facilitates these types of calculation because it takes into account the purchasing power parity (PPP) conversion; that is, it homogenizes information and eliminates the variation between each country’s cost of living. The values used are taken from the World Bank’s 2015 PPP conversion rates.
To calculate the equivalences of the cost of treatment with the selected medicines we took into account three comparison variables: the minimum wage in each country, the salary of the President of the Republic, and the value of one of the best selling vehicles in the region in 2016—the Volkswagen Gol. We used data available from the Central Reserve Bank of Peru, the Bank of the Nation in Argentina, the Bank of the Republic of Colombia, the Bank of Mexico, and the Bank of Guatemala.
Sources in Peru:
- The Medicines Prices Observatory of the General Directorate of Medicines, Supplies and Drugs (DIGEMID). The prices used in the comparison calculator are derived from the average of all those which appear in the database. The information was sampled in April 2017.
- Data from the Merk Sharp & Dhome laboratory was used for the drug Atripla.
- Data from the Novartis laboratory—whose distributor in Peru is Seven—was used for the drug Glivecwere.
- Data from the Abbott laboratory—whose distributor in Peru is Pharmaris—was used for the Kaletra drug.
- The Ministry of Labor and Employment Promotion Supreme Decree on the Minimum Wage.
- The presidential salary based on the State Transparency website.
Sources in Colombia:
- The database of the Drug Observatory of the Colombian Medical Federation (OBSERVAMED). In this country some drugs have prices regulated using the Reference Price by International Comparison system. OBSERVAMED utilizes two price regimes: the Maximum Sale Price and the Adjusted Current Regulated Price.
- The former corresponds to the maximum selling price of the drug where a percentage passes to the supplier (3.5% if the price of the presentation is greater than 1 million Colombian pesos and 7% if it is less than that amount).
- The cost of unregulated drugs takes into account the average unit price reported by the pharmaceutical company to the Drug Price Information System.
- The price of the Genzyme laboratory was used for Evoltra, sold as Clolar in Colombia.
- The Adjusted Current Regulated Price of the 100 mg Avastin product of the Roche laboratory (Colombia’s most sold medication) was multiplied by four in order to calculate the price of the 400 mg tablet, whose formulation has not been sold in the last five years.
- The Adjusted Current Regulated Price was used for Enbrel medication of the Pfizer Wyeth laboratory.
- Data from the Gilead laboratory was used for the Atripla medication.
- The Ministry of Labor website was used to determine the minimum wage. The presidential salary is that reported in the news media.
- The costs of most medicines are higher in Argentina than in other countries. The pharmaceutical chemist, Javier Llamoza, attributes the sharp increase in prices to the removal of subsidies by the current government.
Sources in Argentina:
- The official drug list of the National Administration of Drugs, Foods and Medical Devices. The cost of each medicine was obtained by dividing the price of a packet by the number of units it contains.
- Data from the Gilead Sciences laboratory was used for the Atripla and Sovaldi medications, whose distributor in Argentina is Gador.
- Evoltra is sold as Clobinea in Argentina and is produced by the Dosa laboratory.
- Glivec is sold as Ziatir in Argentina and is produced by the Richmond laboratory.
- The minimum wage and presidential salary figure are published by the Office of the President in the Casa Rosada.
Sources in Mexico:
- Medication with Current Patent Report, Ministry of Economy (Maximum selling prices). The cost of each medicine was obtained by dividing the price of a packet by the number of units it contains.
- Data from the Gilead Sciences laboratory was used for the Atripla medications, whose distributor in Mexico is Stendal.
- The minimum wage was taken from the Government of Mexico’s official website and the presidential salary from the 2017 Fiscal Year Expenditure Budget of the Federation.
Sources in Guatemala:
- Medication prices were taken from the Guatecompras.gt official platform and from the Ministry of Health and Social Assistance. Publicly available purchase prices were used in this country because pharmaceutical companies did not provide the information.
- The minimum wage used appears on the official website of the Ministry of Labor and Social Welfare. The presidential salary was taken from news media reports.
- Joint Purchasing System of the Pan American Health Organization (PAHO).
Sources for the 12 medicines:
- Drug profiles were taken from information of the European Medicines Agency, the US Food and Drug Administration, and the Inter-American Development Bank's High Impact Medicine Observatory. We were also advised by two pharmaceutical chemists: Amelia Villar and Javier Llamoza.
- The Gilead Sciences laboratory does not yet sell the sofosbuvir (Sovaldi) tablet in Peru, Colombia, Mexico, and Guatemala. For the first three countries we used the prices that Mercosur countries negotiated among its member and associate states. In the case of Guatemala we used the price which the government is able to access through the Joint Procurement System of the Pan American Health Organization.
Overall Direction: Fabiola Torres López
Development and Design: Jason Martínez
Data Analysis: Perú: Mayte Ciriaco y Fabiola Torres López (Ojo Público); Colombia: Ginna Morelo, Rafael Quintero y Claudia Báez (Unidad de Datos de El Tiempo); Argentina: Catalina Oquendo; México: Daniela Guazo (Unidad de Datos de El Universal); Guatemala: Carmen Quintela and Carlos Arrazola (Plaza Pública).
Illustrations: Jugo Gástrico (Rocío Urtecho V.)