Access to medicines is part of the Human Right to Health. The core components of this internationally recognized right indicate that every effort should be made to ensure that all actors in the health sector take up the challenge of ensuring that medicines are available, accessible and acceptable and of proper quality to all, including the poor and marginalized. Medicines prices regulation is one policy aimed to promote social justice and universality of the health care services. But this policy has also been utilized to ensure sustainability, especially in those systems where governments help to finance the provision of health services. Here is an example of recent use of the medicines prices regulation in Colombia through the regulation “Circular” 7 of 2018”, effective on January 1st of 2019. After its publication, 902 medications decreased their costs, of which, 64 are contraceptives. On average, the reduction in the value of these drugs was 50%, which would generate an annual saving of 366 billion COP (approximately 117 million USD) for the Colombian health system. In the case of contraceptives, the savings will be equivalent to 70 billion (about 23 million USD) per year.
Starting the debate over the sensitive and critical issue of the price of medicines, was the first step for the previous Colombian government –particularly the Ministry of Health- to elevate the message of social justice in the access of health care. According to the World Health Organization (WHO), nearly 2 billion people have no access to essential medicines, causing a cascade of preventable misery and suffering. This has led to claims that the pharmaceutical industry is more interested in generating profits than contributing to the wellbeing of the Colombian people. For Alejandro Gaviria, the previous Colombian Minister of Health- achieving lower prices was vital for two reasons, the first is directly related to justice, because “for many medicines, Colombia was already paying higher prices to European and other Latin American countries and that had to be corrected.” The second reason he stressed was that price regulation is key to the sustainability of the health system.
After building a technical team exclusively focused on this issue that worked with him for five years, Gaviria went for the second step to construct a policy for medicine price regulation in the legislative and judicial system. Legislative audiences were hard to get, but an argument of sustainability and financial health of the system made a case to the Colombian Congress in 2017 to raise drug pricing policy as a State policy by incorporating it in the Statutory Health Law. On the judicial level, the Constitutional Court ratified in two important decisions of 2016 2016 that price control as a legitimate action to safeguard the adequate protection of the fundamental right to health.
Both sustainability and Human Rights constituted the Ministry of Health’s main argument to advocate for a change in the national medicines prices regulation policy. Regarding sustainability, Gaviria stated that “all health systems, without exception, face sustainability problems.” The causes are known: technological pressure, population pressure, and socio-economic pressure.” However, In Colombia, these pressures are higher than in many developing countries for a set of historical and institutional reasons. First, the demographic transition was very rapid, which implies, among other things, that the population is aging very rapidly in some regions. Second, the (excessive) judicialization of the health system has impeded the incorporation of new technologies. Finally, out-of-pocket spending is insufficient, the lowest in the entire region, leading to overconsumption and systematic abuse.
However, sustainability, as he stated, is not a whim. Unsustainable health systems are also unjust systems, in which a few receive a lot, and most receive very little. We must remember here SGD target 3.8 which states the necessity of achieving “universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” So drug prices regulation is not just a matter of sustainability (which indeed is a strong argument) but rather a matter of social justice. The regulation is going to facilitate access to medicines, especially for expensive treatments, to the people with less income.