Children’s medicines

PINOY KASI

Children’s medicines
By Michael Tan

Inquirer
Last updated 02:38am (Mla time) 07/25/2007

The first bill filed in the new Congress was the proposed Cheap Medicines Act. More accurately, the bill was re-filed since it had been proposed in the last Congress but didn’t make it as a law. The bill went through rough sailing, facing tough opposition from multinational drug companies.

Among those lobbying heavily for passage of the bill are advocacy organizations working with the elderly. They’ve rightly pointed out that the country’s expensive medicines have been a terrible burden especially for the elderly, and the families that have to foot their medical bills. Because the elderly are more vulnerable to chronic ailments, they have much greater dependency on medicines, many of which have to be taken on a daily basis. Even with the 20-percent discount offered to senior citizens, the monthly bills for medicines easily run into the thousands, wiping out their savings. The elderly are literally held hostage by the drug industry with a grim message: Pay up, or suffer.

How costly is costly?

But sometimes we forget that there’s another large segment of the population that’s also held for ransom: the children. About 100,000 Filipino children die each year, many from diseases that are preventable and curable.

Let’s tackle the preventable deaths first. Vaccines play a key role in preventing many of these deaths. Fortunately, the government does provide free BCG (for tuberculosis), DPT (diphtheria, pertussis or whooping cough and tetanus), OPV (oral polio vaccine) and hepatitis B vaccines. Additional vaccines for flu, chickenpox, MMR (measles, mumps and rubella) have to be paid for with private physicians, and these can run into several thousand pesos. As far as I know, they’re not reimbursable with PhilHealth or with private health maintenance organizations.

There are many other diseases that are not preventable through vaccines. The leading cause of illness and death among children are acute respiratory infections. Children are also especially at risk for gastrointestinal infections that can cause life-threatening diarrheas.

Aldrin Santiago, a pharmacist friend of mine, and his wife, a pediatrician, helped me to look at some of the costs of treating infectious diseases. The most common antibiotic used for respiratory tract infections is amoxicillin. More or less, for a seven-day treatment course, you would need two 60-ml bottles of the 125 mg/5 ml suspension, for a total cost of about P140 if you buy Amoxil, one of the brand name products.

In cases where there is resistance to amoxicillin, doctors might prescribe cefaclor, which is more expensive. A 60-ml bottle of the branded preparation Ceclor costs P274 while a 100-ml bottle is P466. For upper-class Filipinos, that may not seem a lot, but for most Filipinos, that wipes out more than a day’s wages, if they are fortunate to even have a job in the first place.

Children also have their share of chronic ailments, asthma being the most common. A 60-ml bottle of Ventolin (salbutamol) costs P108, good for about four days. That’s P25 a day. Consider yourself lucky if your child responds to the oral dose. Others have to use rotahalers, with one cap costing P80.

Even multi-vitamins can set back a family’s budget. A 250-ml bottle of Enervon-C syrup costs P165. That’s about 50 daily doses, each of which would be about P3. The poor will probably buy the smaller 60-ml bottle for P52, which works out to P4.30 for a child’s daily dose, about the price of a pack of instant noodles that poor families use as a meal.

And if they find their child isn’t gaining weight despite a voracious appetite, they’ll probably think of intestinal parasites. But a single dose of albendazole suspension, sold under the brand name Zentel, is P47.

Cutting costs

If you work out unit costs, children’s medicines are always more expensive than those for adults. This is because the medicines come as drops for infants and suspensions or syrups for older children. For example, a 15-ml bottle of Biogesic Drops costs P50. The bottle contains 1500 mg of paracetamol. This is equivalent to three Biogesic adult tablets, which cost P8.25!

My pharmacist friends say you can buy the adult preparations and then mix your own suspensions but there are problems here about making sure the ingredients are evenly mixed and giving the right dose to the patient.

A safer cost-cutting measure is to look for generic preparations, but the range of generic alternatives for children is actually smaller than that for adults. And where they are available, the differences in costs may not always be significant. For example, a 60-ml suspension of Amoxil (125 mg/5 ml) costs P69.50 while its generic equivalent from Ritemed is actually more expensive at P70.25. On the other hand, the 250 mg/5 ml version of Amoxil suspension is P102 while Ritemed’s equivalent is P99.25.

With cefaclor, you have a choice. A 60-ml bottle of Ceclor (125 mg/5 ml) is P274.50, while Ritemed-Cefaclor is P137.50, exactly half the cost of the branded preparation.

Compare the following costs of salbutamol (60 ml suspension): Ventolin is P108, Asmalin P80 and Ritemed P48. Once when I was buying Ventolin at a drugstore, the woman next to me whispered: “It’s cheaper at Children’s Medical Center.” She was referring to the parallel imports the government is doing, where the same brand name, brought in from India, costs less. These drugs are sold in government hospitals.

Parallel imports are in fact part of what the Cheaper Medicines Bill hopes to do. Before the last Congress ended, there were two versions of the bill, with different ways of dealing with patents and other controversial issues. The new Congress will have to tackle all these issues again, but in the long run, let’s hope lawmakers will also begin to look at the long-standing question of production. We still are almost totally dependent on imports of pharmaceuticals. It’s time for the government, or for a large Filipino company like United Laboratories, to come up with genuine competition against the multinationals. In Thailand and India, low-cost medicines from government and from local companies have forced multinationals to bring down the costs of their products.

The President referred to medicines in her State of the Nation Address last Monday, claiming that in 1999, only 11 percent of Filipinos said medicines were affordable, while today the figure is about a half. The President did not indicate who conducted the survey, but even if we take that 50 percent figure to be true, we still have to ask: Why does half of the population still have to suffer because they can’t afford medicines?