Prices of combination medicines and single‐molecule antihypertensive medicines in India's private health care sector

Abstract

More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti‐hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti‐hypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase adherence to medicine, and simplify procurement and distribution. Despite this, equivalent combinations of separate pills (SAPs) are often prescribed instead of SPCs under the assumption that SAPs are priced lower. This study compared prices of anti‐hypertensive SPCs and equivalent SAPs in the private health care sector of India. High sales volume anti‐hypertensive SPCs and SAPs were selected from 2018 private sector pharmaceutical sales data. SPCs and SAPs price information was collected from online pharmacy websites between November 2019 and January 2020. Anti‐hypertensive SPCs represent approximately 39.1% of India's private sector anti‐hypertensive drug market. Multiple manufacturers produce the same top‐selling SPCs, suggesting a viable and competitive market. A comparison of SPCs and SAPs across different manufacturers showed that the lowest prices of both SPCs and the sum of component SAPs were nearly identical across different manufacturers. An analysis of dual‐drug SPCs and SAPs by the same manufacturer showed that most manufacturers (five of six) had priced their SPCs higher than SAPs. These observations suggest that the price of SPCs could be lowered to match the combined price of the component SAPs, and manufacturing costs and market forces do not present a barrier to the implementation of anti‐hypertensive SPCs.

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“…Finally, using generic FDC of hypertension medications as opposed to combinations of single agent pills can reduce medication costs due to manufacturing or other efficiencies. A study of antihypertensives sold in the private sector in India demonstrated that the price of FDCs could be lower than their component single agent pills [ 24 ]. Similar price trends have been seen in HIV [ 25 ].…”

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“…However, Negi and colleagues identified that the price of SPCs was higher than the equivalent combinations of separate pills. 54 In India, 80 % of healthcare expenditure is borne by patients. 55 Therefore, SPCs related cost concerns need to be addressed on priority.…”

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India

“…Automated BP monitors were available in only 10 per cent of the facilities, and low-cost antihypertensives and diabetes medications were unavailable in all primary care facilities 24 . Antihypertensive drugs are cheap and readily available in India 25 . However, forecasting, budgeting and appropriate distribution are required to ensure adequate availability in most peripheral health facilities 26 .…”