Monday, December 17, 2007

The Cheaper Medicines Bill...Will it do what we want it to do?

n the 13th Congress, the Cheaper Medicines Bill failed to be passed into a law because before congressmen could vote on it for the Third and final Reading, the sessions of the 13th Congress drew to a close and both the Senate and the House of Representatives adjourned. People were disappointed because after the long wait and the series of public hearings and debates, the bill did not make the deadline in order for it to become a law of the land.

In the present 14th Congress, there is reason to rejoice because we are only in the first six months of its three year life span and yet the Cheaper Medicines Bill is already passed in the Senate and ready for Second Reading votation in the House of Representatives. TO be more specific, the congressmen are now in the period of Individual Amendments, after having gone through First Reading, public hearings, Sponsorship on the plenary floor, period of Debates and Interpellation, and period of Committee Amendments.

After the period COmmittee Amendments, where the authors and sponsors incorporate changes to the bill brought about by the interpellation and debates after spnsorship on the floor, the proposed amendments by individual legislators are taken up and considered. There are some debates conducted, with the proponent of individual amendments justifying their proposals.

This is the period where we are in now. After the Period of Individual Amendments, there will be voting on Second Reading, which is a reading of the bill with all the amendments incorporated. After that, then the final version will be voted on by the members of the House for the final Third Reading.

After all the hype and waiting, everyone is eager to have a Cheaper Medicines Law (the final name of the law, however, will most likely be changed since the name "Cheaper Medicines Law sounds..well, cheap. It gives a connotation that the quality is low). But as the cliche goes, it's so close but so far away.

The period of Individual Amendments is turning out to be a stumbling block to the bill's immediate passage. It is a period where one particular congressman's individual amendments, which he seems to have at almost every page, eat up the time since a congressman with an individual amendment is given the time to propose his amendment and explain his proposal. With congress having only three days left before it goes on Christmas break, the next time it can be taken up will be after January 21 when Congress resumes its sessions. The previous two weeks were already spent taking up his numerous proposed amendments and at this time, he is still not yet done.

There is already talk among congressmen that the bill should be railroaded and the congressman with the numerous proposed amendments should just be overwhelmed by the majority through a legislative steamroller.

I understand the concern of the congressmen about the delays. The 13th Congress was plagued by it and got blamed for the suffering that our people endured for each day that they had to swallow the bitter pill of overpriced medicines.

Imagine this...There are about 7.76 million Filipinos who suffer from hypertension (high blood pressure). That is one out of every five adults. High blood pressure is the fifth leading cause of death in the Philippines. Every year, an average of 300,000 Filipnos are lost to this disease. It strikes in all social classes, whether rich or poor.

Norvasc, a medicine for hypertension, is sold in the Philippines by a multinational pharmaceutical company for P41.41 per 5-mg tablet. In India and Pakistan, the same drug, manufactured by the same company, is priced at around P5.77 per 5-mg tablet. Plendil,also for hypertension, is priced in the Philippines at P21.82 per tablet while it costs only P2.69 in India.

Another comparison is the asthma medicine Ventolin. An inhalor costs P315.00 here while in India, it costs only P126.78. Other emdicines also show the same disparity. Ponstan, a common painkiller, costs only P3.22 in India but costs P24.92 per pill in the Philippines. Bactrim 400, priced at P17.75 per tablet in the Philippines, can be bought for only P1 in Pakistan and P0.69 in India.

The government, through the Philippine INternational Trading COrporation, is trying to help make medicines affordable by doing direct importation of medicines from other countries and injecting them into the market. But this approach cannot be done for all medicines.

What makes the prices of other medicines high, specially the medicines from the multinational companies, are the patents that they have on the formula of these medicines. Because how our Intellectual Property Law is worded, the companies holding the patents of these medicines have exclusive rights to the use of the formula and therefore, can dictate the when other companies can produce the same medicine or how much it is going to be sold.

The proposed Cheaper Medicines bill attempts to provide the legal environment similar to what India or Pakistan have which enables them to lower the price of medicines. Both the Senate and the House of Representatives versions do this approach, except that the House version incorporates the creation of a Drug Price Regulation Board, which, the authors and the sponsors say, will play an active role in making medicines cheaper since it will be given the powers to fix a maximum retail price for the medication people take.

But before we run out and join the rallies calling for the immediate passage of the bill without further amendments, or support the move to railroad it in the face of the questions being raised, let me ask this question...if passed in its present form, will the bill result in the immediate lowering of prices? This has been what the public is expecting all this time. That once passed into law, prices will immediately go down.

Each day that the bill is delayed in its passage into law, is a day that we add to the suffering of our people. It goes to follow then, that once passed into law, each day that the law is delayed in its implementation, it is a day added to the suffering of our countrymen. Right?

So why is it then, that the bill proposes to suspend the powers of the Drug Price Regulatory Board for a period of one year from the time the law is passed before it can exercise its powers to regulate prices?

Why not let the Board exercise its powers immediately after the law is passed so that the people can immediately enjoy the benefits of the law? This provision is found in the bill:

"SECTION 46. Exercise of the Power of the Board - The power of the Board under Section 17 (a) 1 to regulate the retail prices of drugs or medicines listed under Section 18 shall be exercised after a period of twelve months from the effectivity of this Act."

This 12-month period only gives the pharmaceutical companies one full year to impose overpricing on the people. This provision does not benefit the people, but instead it provides a shelter for the pharmaceutical companies to extend life to their current huge profit margins.

If the bill is passed without this provision being amendmended, we cannot expect prices to immediately go down after the passage of the law. We will still have to wait AT LEAST one year before prices are fixed by the Board.

Yes, AT LEAST one year. I said AT LEAST because there is another provision in the bill which gives a loophole for prices to continue in their elevated state. This provision, found in Section 17 (a) 3, reads:

"3. No retailer shall sell drugs or medicines at a retail price exceeding the maximum retail price fixed by the Board: Provided, That, until the maximum retail price of drugs or medicines subject to price regulation is fixed by the Board, no manufacturer, importer, trader, distributor, wholesaler, or retailer of such drug or medicine shall sell the same at a retail price exceeding the price prevailing immediately before the effectivity of this Act."

At first glance, it might be said that there's nothing wrong with the provision, that in fact, it is beneficial to the consumers since it specifically provides for the maximum retail price. But a closer look will show that this provides a mechanism where the prices of medicines can remain at the current high levels for an indefinite period of time.

First, the provision states that the current prevailing price, which we all know is already overpriced, shall be the maximum retail price after the effectivity of the law. This means a status quo, or a no-change policy. In other words, the law does not mandate that prices be lowered.

Second, the provision does not give a specific time frame for the Board to fix a new maximum retail price for medicines. It says, "until the maximum retail price of drugs or medicines subject to price regulation is fixed by the Board". The time that the Board fixes the maximum retail price may come in one month, one year, or one decade.

The Board is composed of only seven individuals. If the pharmaceutical companies attempted to influence congresssmen from passing the bill, which was not even passed by the 13th congress, what more the members of a 7-man board which would be granted absolute power to fix the prices of medicines?

Why not let the law state a specific time frame to set the maximum retail price for medicines? This provision, taken in tandem with the provision on the effectivity of the powers of the Board, will give so much leeway for the pharmaceutical companies to keep imposing on us the high prices of their medicines.

I believe that these provisions negate the expectations of the people with regard to the Cheaper Medicines bill. We try to rush the passage of the bill, claiming that our people need it now, and yet the bill, when passed into law, suddenly steps on the brake and gives the pharmaceutical companies additional time to continue their overpricing ways.

These issues are the subject of my individual amendments to the bill. I have been waiting in line for the Individual Amendments for two weeks now.

My first amendment seeks to amend the provision in Section 17 (a) 3. I propose that the section be amended to provide a specific time frame, anywhere from three to six months, for the board to set the maximum retail prices for medicines. I further propose to amend the same provision by adding a mandate to set the maximum retail price to a level LOWER than the prevailing price at the time of the effectivity of the law, not to simply allow the current price levels to continue.

My second amendment seeks to delete the entire Section 46, or the provision that suspends the powers of the board for a period of one year after the passage of the law. I propose that the powers be exercised immediately after the passage of the law.

Unfortunately, I am not sure if my amendments will see the light of day. The delays caused by the numerous proposed amendments by the other congressman, who has been tagged by some as working for the benefit of the pharma companies, is providing a reason for the House of Representatives to railroad the bill. Since I am lined up to propose my amendments after that congressman, a railroading of the bill will not only run over that congressman's amendments but also mine.

It is also unfortunate that the public perception now is that anyone rising to question the bill is working in behalf of the pharma companies. In everyone's desire to rush passage of the bill, some finer points are being overlooked.

Today we start the last three session days of the year. This could mean the passage of the bill in its present form or the further delay which will definitely add to the people's frustration in Congress. Talk about being stuck between a rock and a hard place.

No comments: