A Dialogue on Medicines as Part of Universal Health Coverage: Top Ten Takeaways

A Dialogue on Medicines as Part of Universal Health Coverage: Top Ten Takeaways

{Photo credit: Todd Shapera}Photo credit: Todd Shapera

By Anita Katharina Wagner & Dennis Ross-Degnan

We were delighted to collaborate with our colleagues at Management Sciences for Health (MSH) and the Rockefeller Foundation, along with the Pan American Health Organization (PAHO) and the US Agency on International Development (USAID), on developing and implementing a first international dialogue dedicated to an important global issue: medicines as part of universal health coverage (UHC). 

Here are the top 10 lessons we took away from the meeting:

  1. There are compelling reasons to focus on medicines as part UHC implementation, and Dr. Jonathan D. Quick of MSH offered these: Medicines strongly impact individuals’ and populations’ health; they use scarce household resources; and they can challenge the economic viability of systems (watch video).  UHC policies must actively address medicines access, affordability, and use if they are to achieve their goals.

  2. As highlighted by Dr. Carissa Etienne of PAHO, achieving UHC without addressing medicines is not possible. Furthermore, UHC efforts have the potential to end the “travesty of countries using medicines that are not helpful”.

  3. Decisions about medicines are political as well as technical. They take place in complex, dynamic systems. Dr. Irene Agyepong eloquently called for understanding the health system and cultural contexts and values that underlie medicines decisions (view slide presentation).
    {Graphic facilitation by dpict}Graphic facilitation by dpict

  4. Although contexts differ, medicines issues across countries are similar. Representatives from Bangladesh, Costa Rica, Mexico, Myanmar, the Philippines, and South Africa shared some of their key challenges, including: fragmented decision-making across health, financing, and other authorities; inconsistent understanding of “universal access” and how to allocate limited resources; perverse incentives that contribute to wasteful medicines spending; how to ensure life-long treatment for chronic conditions; and deciding how to cover innovative, high-cost medicines.

  5. Making innovative, high-cost medicines accessible to those who need them will require agreement on what a system can afford to cover between all stakeholders—government, civil society, clinical and public health practitioners, philanthropy, academia, development organizations, and pharmaceutical companies.
    {Graphic facilitation by dpict}Graphic facilitation by dpict

  6. Effective partnerships are needed between pharmaceutical industry actors and other stakeholders committed to solving medicines and UHC challenges. Dr. Abdulkadir Keskinaslan of Novartis suggested separating industry portfolios for primary and specialty care, with risk sharing agreements between companies and UHC schemes as one approach to facilitate access to innovative, high-cost medicines.

  7. Information is needed to make informed decisions about covering medicines. Tariq Abu-Jaber of Harvard Pilgrim Health Care highlighted that medical informatics systems evolve over time (view slide presentation).  Regardless of how UHC schemes pay bills, their informatics systems must include essential data on medicines cost and use. 
    {Graphic facilitation by dpict}Graphic facilitation by dpict

  8. Even if information systems are not well-developed, essential data on medicines (procurement, stock, or dispensing records, clinic or hospital health records) can be used to assess how medicines are used in systems.

  9. UHC provides tools to effectively and efficiently focus on medicines in health systems. Dr. Andreas Seiter of the World Bank highlighted the fact that it is more straightforward to target the quality of pharmaceutical care than the quality of care overall – a key goal for successful UHC implementation.

  10. Efforts are underway to create a monitoring framework for UHC, which must include practical, reliable, and actionable indicators related to medicines. Dr. Richard Laing of the World Health Organization (WHO) gave the example of medicines stock outs as a key indicator of access to care, an issue that politicians care about.

Challenging ethical questions accompany every decision about priorities under resource constraints. Institutions and individuals shaping these decisions need in-depth discussion and practical approaches about medicines benefits as part of UHC.

A next dialogue on this topic should include an explicit focus on the values underlying medicines benefit decisions, while taking the first, highly informative discussions on UHC and medicines to the next level.

Anita Katharina Wagner, PharmD, MPH, DrPH is Associate Professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. View Dr. Wagner’s presentation.

Dennis Ross-Degnan, ScD, is Associate Professor in the Department of Population Medicine at Harvard Medical School and Director of Research at Harvard Pilgrim Health Care.