Multinational medicine producers are fighting government action in Turkey to reduce medicine prices. Government regulation will definitely impact the bottom line but in the bigger picture (and from a multinational perspective) how much of it is actually relevant? A loss in Turkey is subsidised by a gain in a different country and it may require a rebalancing of the tax reporting protocols for countries in which the company operates. Government regulation may also result in job losses but why do that when your competitors may find a profitable way of operating and may absorb that labour. All it does is reduce your ability to compete and increases your costs of hiring and retraining when periods of expansion roll around. Turkey’s medicine market is set to expand as are other emerging markets so all producers will benefit in the long run, so there’s no need to fight cheap medicines. Best regards, Joao
MNCs are fighting cheap medicines in Turkey su.pr/2kTq5t
Hello,
Hi Joao Carapinha,
I happen to be an American pharmacist who lives in Turkey. I think the real reasons why the current Turkish government is lowering drug costs is to look populist to stay in power (by keeping meds cheap) and the other reason is to force retail pharmacies out of business so chain pharmacies can take a foothold in the near future. The current government is also making it next to impossible for retail pharmacies to get reimbursed and they pay very late. Later, once chains have taken over the country prices will rise. Pharmacy practice really needs to change in Turkey and they need to develop new clinical/cognitive services…..I must admit pharmacists in Turkey are partly to blame for their own predicament because knowing a drug’s price alone is not that useful in improving patient care.
Hello Mr. Carapinha,
As a Turkish citizen who is studying pharmacoeconomics, I can say that Daniel Mizzi has points on the political issues he stated, but before coming to that, we have to look at the broader aspect and evaluate the aims of these price cuts. First of all, the government has been implementing series of reforms within the frame of “Health Transformation Program”, such as gathering of state-owned hospitals under the Ministry of Health, providing everyone with access to all both state and contractual privately owned healthcare institutions, coverage for outpatient care provided to Green Card beneficiaries, etc. This project was costly since the previous health coverage system was not adequate for the whole nation (we can’t say the new coverage system works much better though). Now under the new program, with more citizens covered, the government would have to incur more and more costs and reimburse the pharmacies or other relevant institutions. We can say that the price cut here is clearly introduced to contain costs. But on the political aspect, several questions may be raised, because in a country like Turkey which the ministries are headed by misdirected politicians under influence and the politics are clearly not transparent, the reason which lies beneath this action is to increase votes for the next election. On the other hand, pharmacies were making huge profits in the past, nevertheless the increasing amount. If we would add that pharmacist certificates were sold illegally, then we can say that Daniel Mizzi has a point on the fact that pharmacists are partly to blame on this action, so part of the aim is decreasing the huge markups made my pharmacies. How will this affect the MNCs? Well, the MNCs should focus more on efficient launch sequence modeling at this point. Although Turkey is not in the EU, prices of meds are determined through countries like Italy, France, Spain, Greece and the huge reduction in the prices would challenge the balance between international price referencing by authorities in the short term. Furthermore, considering the tool “international price referencing”, this action is likely to impact other countries with similar price levels and in the referencing cycle together with Turkey.
Dear Mr. Mizzi and Mr. Carapinha,
I am a university student in Maryland who is trying to do research on access to essential medicines in Turkey. I am not able to find any resources online. Would you be so kind as to direct me to some resources?
Thank you so much!
Dear Mr. Carapinha, Dr. Mizzi and Barış Durgun,
The comments of Dr. Mizzi are quite correct but partly. Yes, the pharmacists are to blame for their own predicament because knowing pharmaceutical prices does not help patient health but Turkish pharmacists are pushed to think this way by the government. There has been an increasing attention on cognitive services. For example, Clinical Pharmacy Association (www.klinikeczader.org) has been established among many other associations such as the Oncology Pharmacists’ Association. The challenge is to survive. The current established practice does not reward but punishes pharmacists for their cognitive services if they choose to do so. I am sure it will change in the near future but currently this is the case. Second, patients and MDs do not view pharmacists despite our best efforts as part of healthcare team other than a procurer and supplier of pharmaceuticals. Added to that ongoing terrible economic conditions of decades which formed a misled vision of pharmacist in people’s minds, people wanted to become pharmacists because it was profitable, not because they were interested in medicine.
As for comments by Baris Durgun, I must state that it is absolutely a horrible idea to lower mark-up for pharmacists’ services. There is a terrible misconception that pharmacists in Turkey do not do much but make a lot of money. The naked truth is quite the contrary. There is a huge burden of bureaucratic work mounted on the shoulders of pharmacists which leaves them almost no time to conduct any cognitive services. The pharmacist in Turkey is confronted with a terrible dilemma: if the pharmacist is to conduct cognitive services, that usually translates to services that are rendered free-of-charge, and therefore, the pharmacist can not make any money out of it. On the other hand, current governmental practice views the pharmacist, despite all its glamorous, expensive, intensive and difficult educational upbringing, as a merchant! Therefore, the pharmacist is forced to choose to sell more, either dermocosmetics or pharmaceuticals. Since the pharmacists are not allowed to produce prescriptions, they tend to accumulate at locations where abundance of prescripitons are created. Thus, prescribed medicines, usually not so good for patients, are dispensed by pharmacists. Although there is quite some interest and conscious-being raised on the part of patients to request for cognitive services, even patients do not award the pharmacist by paying more visits.
The challenge here in lies with the current system where medicinal doctors have turned out to become just prescription producers, and not healthcare professionals. All pharmaceuticals are poison at therapeutic doses. Therefore, with the onset of many drugs working towards many diseases in one patient, polypharmacy could only be prevented by careful review of the patient by a team. Since the current system puts all the power on MD’s shoulders but all the responsibility on the pharmacists’ shoulders, it is difficult to impossible to provide any cognitive services, except perhaps to suggest, “take your Euthyrox half an hour before breakfast everyday.”
What has got all these to do with prices? Big pharma is at a stall to invent new medicines. Therefore, they need to milk the cash cow, what they already have. Although primarily generics are favored in Turkey, most generic companies are invested in largely by the innovator big pharma. This raises the need to support more medicines to be dispensed in order to sell more for more profits. Since the government is the sole buyer in Turkey, and since there is absolutely no system of checks and balances as explained above that should check the vitality of a prescription made by a medical doctor, the only lever the government finds is lowering prices. In fact, lowering prices did not arrive sufficiently. There are huge discounts after even the prices are lowered. This makes the situation even a further dilemma.
How can the problem be solved? I believe Dr. Mizzi is on the right path in suggesting that pharmacists in Turkey must convert to cognitive services. Their cognitive services, if supported with some sort of rewarding system, would minimize and eventually eliminate widely incorrect use of prescriptions (such as prescribing very strong NSAIDs for patients with heart disease and hypertension). Thus, in time, pharmaceutical consumption could go down, eliminating the bargaining power of the government to lower pharmaceutical prices.
There is of course another point. When looked at spendings per capita on pharmaceuticals, the spending is much less than many countries in Turkey. The interesting point is that hospital and clinic visits are much higher and there is no chain of referring. That points to the problem of mismanagement of healthcare by current policies. Raising awareness for demand for cognitive pharmacists alone will not solve anything but is part of the solution. The other part lies in understanding that pharmaceuticals are an important and vital technologies and therefore, should be treated as such. You do not see us running amok in our Mercedes Benz cars, killing or injuring pedestrians along the way, do you? But we are never sure of what is going on with the patients because patients are seen as dumb consumers who must be milked out of their minds to sell drugs to them. Blunt, but true!
I think I forgot to mention that healthcare policies in Turkey are supported and largely influenced by the World Bank. Has anyone read the “Economic Hitman”? IMF and World Bank screwed Turkey over in the past fifty years and Turkish Republic is coming to a collapse. Hopefully not. Lowering pharmaceutical prices could be seen as one way of defending itself against the ill-willed pharmaceuticals companies in the minds of people. Like it or not, the current public opinion about pharmaceutical MNCs that operate in Turkey or even the Turkish companies is that they reaped off terrible profits in the past and they are the ones to clean after their mess. Just the messenger here, do not shoot!
Shanika,
I would like to help you but did not understand what you were looking for very well. What is exactly your research question? Are you looking at how diverse essential medicines in Turkey are or how accessible to essential medicines in Turkey is? There is a good number of associations that one could look into but I am not sure how helpful they could be. Do contact me if you will and I will try to help you out. My email: pharmemreyucel@gmail.com
I’d like to comment from the perspective of community pharmacists. Many pharmacies have suffered a lot from sharp decreases in pharmacy prices, and their gains from the past have been lost and many are still trying to pay back the bank loans that they have to purchase medicines. Many pharmacies bought the medicines for high prices and had to sell them for half price. But the government shut their mouths by threatening them by bluffing about bringing chain pharmacy system to Turkey. That scares pharmacists a lot.
On the other side, ordinary people (patients, caretakers, etc.) aren’t aware of anything or don’t care or appreciate pharmacists’ losses. They consider pharmacists as rich salesmen making a lot of money from patients and they think pharmacists deserve worse than current situation. They appreciate lower prices. But they don’t know that sharp decreases in medicines, puts a huge stress on multinational pharmaceutical companies leading them to leave the market and heading to supply problems of expensive fatal medicines. What’s more is Turkey is not self-sufficient in drug manufacturing and price decreases destroys newly improving national pharmaceutical companies too.
From the government’s aspect, as the biggest purchaser (majority of the public has health insurance by the government) of the drugs, government thinks that it has the right to alter everything in the market like a monopoly and wants to decrease the healthcare expenses. This is very anti-democratic. But there is nothing to stop the government in the real future. No one hears the screams of the pharmacists or everybody ignores. Few people must die because of not being able to reach proper medication or drug (especially OTCs) misuse without proper counselling in chain pharmacy system. Maybe then people could understand.
I am totally not against the price decreases. But it cannot be done with “I did it and it happened” or “I have an idea, let’s do it tomorrow” mentality. It must have been planned long before it was done and there must have been a transition period to also protect the pharmacists’ rights. Also, pharmaceutical industry must have been motivated with tax decreases, etc. But no, the government is so cruel, the money of the medicines are always paid few months later than it was supposed to be paid to the pharmacies, but tax men are always on time to collect the taxes and you have to pay the tax of the money you haven’t received.