A systematic review of pharmaceutical pricing policies in developing countries

Abstract

Objective A systematic review was conducted to summarize government strategies aimed at controlling pharmaceutical prices in developing countries and their effects on relevant outcomes, and to qualitatively analyse eligible studies of pricing policy and their impact on expenditure and medicine prices.

Methods Several databases, grey literature and Google Scholar were systematically searched, and reference lists of relevant studies were screened for full‐text studies published in Arabic or English between January 2000 and March 2016. Studies describing government pharmaceutical pricing strategies in developing countries and their effect were considered eligible.

Key findings Twenty‐one studies were included in the explorative synthesis: sixteen covered Asian countries, three covered African countries and three from Latin and South America. Identified policies covered disease‐specific and essential medicines with some countries extending it to all medicine classes. Markup regulation (n = 7) was the most commonly used, followed by external reference pricing (n = 6) and cost‐plus (n = 5), promotion of generics use (n = 3), while tax exemptions were the least used policy (n = 2). Six of the twenty‐one studies were included in the qualitative synthesis. Markup regulation was similarly predominant in this latter synthesis. Although the implemented policies showed a measure of success, medicine prices appeared to be influenced by poor legislative framework, lack of pre‐/post‐implementation activities and noncompliance by various stakeholders.

Conclusion Various internationally recognized pharmaceutical pricing policies are implemented in developing countries; however, these policies are not optimally adopted. Policymakers should tailor the pharmaceutical pricing policy to the nation taking into consideration macro‐ and microeconomic factors.