Safe, Affordable, and Effective Medicines for Ukrainians
Improving access to safe and affordable medicines for the Ukrainian population is a top priority of the Government of Ukraine. Historically, affordable medicines were out of reach for many Ukrainians—a problem that has been compounded by the high price of medicines, corruption, poorly managed medicines procurement, and inadequate supply chain systems and regulations. The Government of Ukraine is leading ambitious health reforms to ensure that medicines are affordable, accessible, and reliable.
To help meet these goals, USAID awarded a five-year contract for the Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) activity to MSH in 2017. SAFEMed applies health system strengthening best practices to create evidence-based interventions and strengthen Ukraine’s pharmaceutical system in line with the Ministry of Health’s (MOH) health care reform objectives. SAFEMed aims to improve access to appropriate, quality medicines to maximize availability within the MOH’s budgetary constraints. It works to institutionalize rational medicine selection; strengthen and systematize public procurement of pharmaceuticals and commodities; support sustainable public-sector pharmaceutical financing; and strengthen the pharmaceutical supply chain in collaboration with the Government of Ukraine, the MOH, the National Health Service, civil society, and the private sector.
SAFEMed has three objectives:
1) Strengthening governance within the pharmaceutical sector
2) Optimizing the financing of the pharmaceutical sector
3) Increasing the availability and appropriate use of medicines in Ukraine
Activities are implemented via technical, financial, and legal assistance in priority settings, procurement, reimbursement, and supply chain as well as quality assurance with a focus on bioequivalence and verification coupled with communication as cross-cutting areas.
The SAFEMed activity is built around technical areas that have the potential to make significant contributions to improve the pharmaceutical system in Ukraine and advance PEPFAR’s priorities of transparent and cost-effective procurement of HIV commodities in primary health care services and efficient supply chain management, quantification, and forecasting.
Medicines Procurement Reform and Establishment of the Central Procurement Agency
As part of procurement reforms, USAID supported the MOH to set up and fully operationalize a medical Central Procurement Agency (CPA), which is a new type of Ukrainian organization that is driven by a strong vision to improve access to medicines and is less susceptible to corruption. Established in October 2018 with support from USAID and other development partners, the CPA is working to gradually take over the procurement of medicinal products currently performed by international organizations while establishing systems for more effective use of public funds.
Health Priority Setting: HTA
Health technology assessment (HTA) is a modern tool to review technologies and provide evidence on the value these technologies can deliver to patients, health systems, and society more broadly. HTA is used in the European Union to make scientific decisions on the development of the health benefits package; selection of technologies for public coverage (e.g., essential medicines list, nomenclature, orphan diseases drugs) and public health interventions (e.g., screening, vaccination); and development of pricing, reimbursement, and clinical guidelines.
Affordable Medicines Program
After two years of implementation, the “Affordable Medicines” program is now a household name in Ukraine that serves as an example of a transparent, government-led initiative designed to improve access to medicines. USAID supported the management of the program and its transition from the MOH to the National Health Services of Ukraine, setting up a self-reliant and sustainable reimbursement function capable of managing and further advancing the program. Following the introduction of e-prescriptions in April 2019, the program plans to expand and bring more affordable medicines to Ukrainians, including those in rural and hard-to-reach areas.
Improving the Quality of Medicines in Ukraine
Medicines in Ukraine are expensive, and their cost is growing. Due to political and economic turmoil, many Ukrainians can’t afford the medicine they need. The use of generic medicines contributes to cost savings and facilitates access to effective, safe, quality, and affordable medicinal products. To provide evidence that generic medicine is as safe and efficacious as the originator product, bioequivalence must be demonstrated. Guided by a long-term strategy, USAID supports comprehensive policy and policy-monitoring changes to ensure that only quality generics are present in Ukraine.