Statement made in a public consultation session on the Medicine Price Display mechanism (2 Nov 2023)

Statement by Dr. Lim Chee Han, Consumers Association of Penang and Third World Network

2 Nov 2023

Sesi Libat Urus Bersama Pihak Fasiliti Kesihatan Swasta, Farmasi Komuniti, Penyedia Insurans dan Pengguna Tahun 2023

Selamat pagi saya ucapkan kepada pengerusi majlis KSU YBhg. Dato’ Seri Ir. Dr. Zaini bin Ujang dan pembentang Puan Fatkhiah binti Haji Khalil Timbalan Pengarah Bahagian Amalan dan Perkembangan Farmasi. 

Hari ini saya mewakili persatuan Pengguna Pulau Pinang (Consumers Association of Penang) dan Third World Network untuk memberi pandangan mengenai cadangan mekanisme sebentar tadi. Memorandum bertulis saya akan dihantarkan kepada KKM nanti dengan maklumat terperinci dan data terkini. Saya seorang penyelidik dasar polisi yang telah lama mengambil berat terhadap harga ubatan, saya pun melibatkan diri dalam gabungan People’s Health Forum dan persatuan pesakit barah (Together Against Cancer). Dengan izin, saya akan teruskan ucapan saya dalam Bahasa Inggeris.

First of all, I would like to congratulate the MOH for the genuine and persistent effort to consult and engage with multi-stakeholders from the very beginning of the policy proposal on the Medicines Price Regulation Mechanism, all the way back to 2019. 

It is probably one of the best consultation processes our organisations have seen - the MOH has genuinely practised inclusivity, including the voices not only of the manufacturers and service providers who have the intention to 'sell' their products, but also of the end users, consumer groups and patient groups who have to pay for these products in order to survive or live a better quality of life. 

In every stakeholder engagement, I see the MOH leading the way in rationality and evidence-based approach. They were transparent in  the first cost-benefit analysis CBA 1.0 study conducted by the Malaysia Productivity Corporation (MPC). The study has many limitations, and MPC and MOH acknowledged the data gaps due to the industry's refusal to be transparent about prices. But the study itself at least had a credible analysis. 

However, the second CBA was funded, sponsored and essentially directed by PhAMA, with the technical committee even co-chaired by a senior member of PhAMA itself, showing a blatant conflict of interest, so it is not surprising to see the big negative results of the study - Imagine the tobacco and vape industry giving advice and technical guidance on smoking policy, how good can the policy be for public health and public interest, especially the affected groups and community? 

It is worth noting that the second industry-led CBA Steering Committee was chaired by MITI, not MOH. To date, there has been no official acknowledgement and announcement of who is the so-called independent third party consultant behind the second CBA and the full study report is not publicly available. There is nothing more ridiculous than the fact that the study claimed to have consulted patient groups, but we later found out that the patients they interviewed were from industry’s own patient assistance programme. How can these patients who benefit from PhAMA reflect the majority of patients out there? 

There are many flaws that we found in the second study, which we had submitted in a detailed response. However, the industry and vested interests continue to use the results of this CBA study to pressure the government to withhold or withdraw this Medicines price regulation mechanism policy.

On behalf of the public interest and patient groups I must express my strong disappointment at the compromise and delayed implementation of the MOH’s  policy due to industry pressure. Many lives have been lost, I personally also know a few cases, that many have died because they were unable to afford the most effective cancer medicines, and the fact that many thousands are impoverished by the unreasonably high price of medicines due to the monopolistic market prices set by patent holders and then exorbitant mark-ups by service providers and retailers. 

We are very disappointed that  the policy has been compromised at the expense of the very community, the patients, that the industry claims to be benefiting. Shame on the industry for their uncompetitive and unfair market practices and their unchecked excessive profits, which are causing suffering to many patients. 

The MOH’s medicines price regulation policy actually starts modestly , and it is not the conventional type of price control, but a control mechanism on the maximum markup for the single-source products, up to 30% markup allowance, depending on the initial price of the product. These products represent only a small segment of the total pharmaceutical market, and it is not as if retailers and the supply chain cannot make profits from the mark-up. It is the excessive mark-up profits that the government and the patient groups concerned want to curb and control. 

I would like to point out that the 12th Malaysia Plan, Strategy B2, "Ensuring Financial Sustainability for Healthcare" explicitly states: "A price control mechanism for medicines will be introduced to protect consumers from unfair pricing" (page 4-22). The government is clearly aware of the problem and is trying to address the issue of drug prices. This must be done in the public interest; the government has a duty to protect the most vulnerable and affected community, not to help industry players maintain their excessive or even obscene profits at the expense of patients.

Ideally, a truly competitive market would help solve the problem of availability and affordability of life-saving and life-enhancing products. The 2017 MyCC Market Review report on the pharmaceutical sector clearly shows that this sector is not a free and truly competitive market due to patent laws and flawed practices in granting some patents, which give the patent holders a monopoly over the products for a long period of time. Price regulation is therefore an essential countermeasure to protect the interests of consumers and patients. 

The industry must first comply with the price transparency mechanism presented today. The government cannot compromise further on this. We urge the government to go back to the original modest proposal of controlling the mark-up on single-source products. Even this may not be enough for many patients, but it is the bare minimum that our patient and consumer groups would expect from this medicines pricing policy.

Thank you very much.