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CHILE: Pharma's Changing Landscape
"2014 represents an exciting time for healthcare in Chile with the implementation of a new national drug law; ensuring the creation of a system that makes access to medications easier and more transparent for patients and, moreover, assures a sufficient supply all over Chile," explains Helia Molina, a doctor specializing in pediatrics and nephrology and Chile's Minister of Health since March 2014. The 'Ley de Farmacos,' or Drugs Law, was passed by Chile's former government in January 2014; its implementation now rests with the new administration.
Cover Art by Ignacio Gana. Ignaciogana@gmail.com
"The new government of Chile has made a commitment to improving the health of the population," Molina explains, "and the Ministry of Health will expand the list of chronic diseases included in the Regime of Explicit Health Guarantees (AUGE) plan, which ensures government-funded coverage for patients regardless of age, class, and ability to pay."
This should contribute to boost a market that is already expected to grow 8.2 percent between 2012 and 2017 according IMS Health. In 2012, the Chilean pharmaceutical market was worth a total of USD 2 billion, according to the latest available data from IMS.
Helia Molina, Minister of Health
The new government plans to introduce further legislation to improve healthcare in Chile. In her paper entitled '50 Commitments for the First 100 Days of Government,' President-elect Michelle Bachelet builds the basis of her plan for better health services for the nation, committing to invest significantly in the construction of new hospitals, increase the number of specialists to combat long waiting lists in the public sector and provide patients with better access to free drugs.
As it currently stands, Chile's universal healthcare plan covers 80 percent of the population. The remaining 20 percent are entitled to pick their coverage from a number of private insurance companies known as ISAPRES. 80 percent of people in Chile should have access to free drugs under FONASA, the public health insurance system; however, the reality is that there are often shortages at hospitals, and as a result people turn to private pharmacies to fill their prescriptions out-of-pocket. As a result, despite FONASA, out-of-pocket expenditures in Chile are some of the highest in the OECD: A total 4.6 percent of the average Chilean family's budget is spent on healthcare, compared to the OECD average of 2.86 percent.
Ricardo Fabrega, director of the Public Health Institute
There is positive news on some fronts however: after years of infamously tense relations between MNCs and the government, both parties finally seem to have found a platform for dialogue. "As an industry, we have an active dialogue with the ministry regarding the expansion of access to innovative medicines, but the discussion is still young and we still have a lot to do," explains Erich Viertel, country manager at Janssen Chile. "Finding the best path to lead Chile toward economic development has been an ongoing task of Chilean governments and leaders over the last century. And if the country is able to sustain its current momentum, at the end of this decade it will probably become the first fully developed country in Latin America."
The Chamber of the Pharmaceutical Industry in Chile (CIF), which represents the international innovators, will carefully monitor the implementation of the new healthcare law, which requires prescriptions to mention the name of the chemical compound. While this is seen as positive for the customer, who will now have access to cheaper alternative products and also their personal brand preference, for, innovators there is still a major concern about bioequivalence.
Jean Jacques Duhart, executive vice president, CIF
In Chile, as in other Latin American countries, similares have high market penetration: generic drugs that do not have proven bioequivalence. "If the law would allow physicians to prescribe any generic drug including non-bioequivalents, all efforts made by previous governments would be for nothing," says Jean Jacques Duhart, executive vice president of CIF. "A large portion of products on the Chilean market cannot demonstrate quality, safety and efficacy through bioequivalence studies. Similares are neither generics nor originals and have not demonstrated their quality, efficacy and safety as recommended by the World Trade Organization."
He also warns: "This is not merely a concern in terms of health and risk for patients but it also introduces an important market distortion—different actors are competing with different standards."
Erich Viertel, country manager, Janssen