Medicine becoming a luxury few can afford
Medicine becoming a luxury few can afford
By Stevie Emilia
JAKARTA (JP): The crisis strikes without mercy, including the
sick. As drug prices skyrocket and people make hard decisions on
purchases, lives are at stake.
"I just hope neither of my two children get sick," said taxi
driver Kusnadi. "Living expenses are already very high now and I
don't know how I would get the money to buy drugs if my children
fell sick."
He bought several different medicines for his family after
learning about the increase in drug prices from a neighbor.
"I only bought nonprescription drugs, such as those for
fighting flu and fever," Kusnadi said. "I usually pay Rp 500 for
one strip of Decolgen, but now the drugstore sells it at Rp
1,000."
Retired businessman Santosa faces a more immediate problem.
Following his doctor's advice, he takes two daily medications --
three pills to regulate his heartbeat and one or two vitamin
capsules to keep fit.
He previously paid Rp 110 for the heart pill and Rp 875 for
each vitamin.
"But since a few weeks ago, the prices have increased to Rp
400 and Rp 1,500 respectively," he sighed.
He uses a generic brand of the cardiac drug, but there is no
generic equivalent of his vitamin. "Patented drugs cost three
times the generic ones."
With the escalating drug prices, maintaining optimum health
could become a luxury only a lucky few can afford.
Fawzi Ibrahim, a pharmacist in Blok M, South Jakarta, said his
pharmacy increased drug prices beginning last December.
"The distributors had already increased the prices up to 50
percent more than usual (in December). So, we had to make price
adjustments," he said.
Many of his customers, he said, complained about the hikes.
"But it's impossible not to raise prices even though I feel sorry
for them."
Minister of Health Sujudi has pleaded with patented drug
manufacturers to not drastically raise prices as many people are
still dependent on types unavailable in generic form.
"If the patented drugs manufacturer set a high price, people
won't be able to afford the medicine and their (the companies)
profits will decrease. More people now prefer to buy generics,"
Sujudi said.
The Ministry of Health appears to regard the crisis as a
blessing in disguise in terms of increasing promotion and usage
of generics, dismissed by the public as cheap medicines of
inferior quality since their introduction here nine years ago.
The government sets the price of generic drugs, while the
medicine manufacturers determine prices of patented products.
Although prices of patented drugs have reportedly increased by
up to 300 percent, prices of generics, which had been relatively
stable since 1993, have soared by as much as 150 percent in the
past several months.
Generics account for 80 percent of prescribed medications.
The government increased generic drug prices by 50 percent in
January and raised them again by 100 percent earlier this month.
The ministry also planned to increase drugs prices again by 15
percent in April.
But following widespread complaints over the earlier
increases, the health ministry announced it would reduce prices
of 225 generics by an average of 34 percent.
The ministry has also announced that it would subsidize
hospitals and drugstores' purchases of generic drugs and provide
subsidies worth US$116 million to help state-owned pharmaceutical
companies import raw materials to make the drugs.
Fifty-four of the 225 pharmaceutical companies operating in
the nation produce generic drugs; 47 of the firms producing the
generics are privately owned.
Under the subsidy plan, medical companies could buy raw
materials at a fixed exchange rate of Rp 5,000 to the U.S.
dollar.
Ministry of Health figures show that the government spent
$178.32 million on importing raw materials for 201 types of
generic drugs last year.
This underscores the quandary that while most of the drugs are
produced here, up to 90 percent of the raw materials used to
manufacture them are imported.
Chairman of the Jakarta chapter of the Association of
Indonesian Pharmaceutical Manufacturers, Achmad Ruhiat, said many
of his members could no longer produce medicines due to their
inability to purchase the imported substances.
He added that several foreign banks rejected association
members' letters of credits (L/Cs) issued by local banks.
"If we are unable to import materials, we will not produce
anything," he said.
The pharmaceutical industry is trying to reduce the acute
dependency on imported raw materials.
With the support of the ministry, several large pharmaceutical
manufacturers formed a consortium in 1996 to produce medicinal
ingredients, such as paracetamol, that were formerly imported.
"We have to reduce our dependency little by little," said the
president of the Association of Indonesian Pharmaceutical
Manufacturers, Anthony Sunarjo.
"We import medicines which are difficult to produce locally
due to the lack of technology, or which are newly invented."
Indonesia also exports medicines made with imported
ingredients, a market worth about $40 million last year.
But the accompanying high research expenses have prevented
some manufacturers from conducting their own studies.
Before the crisis, research for one ingredient was estimated
to cost a company between Rp 130 million and Rp 150 million, and
the research to produce a product could cost Rp 350 million.
"The high research and production costs of drugs are not
commensurate with the (annual) $5 per capita medicine consumption
in the country," Anthony said.
This consumption is by far the lowest in the region, compared
to $14 in the Philippines, $12 in Malaysia, $42 in Singapore and
$13 in Thailand.
The ravaging of the rupiah has further reduced the public's
purchasing power for drugs, a secondary expense behind food for
many consumers.
Rahmat Suharsono, a doctor in private practice in Pejompongan,
Central Jakarta, said cash-strapped people could request generic
drugs before the crisis hit.
"But they are all expensive now," he said.
He feared the high drug prices would lead people to practice
self-treatment by purchasing unprescribed medicines over the
counter.
"People's knowledge about drugs is still low, so it will be
dangerous if they try to treat themselves," Rahmat said.