Universal health coverage (UHC) is one of the main goals of current global health efforts, and many are advocating for UHC to be the overarching post-2015 health development goal. The intent of UHC is to guarantee access to needed health care services without placing an inordinate cost burden on patients, especially those who are disadvantaged or very poor.
Although momentum for UHC has been growing significantly over the past few years, one area that has not been adequately addressed is medicines coverage.
The financing of UHC has been a major challenge for many countries, which may explain why pharmaceuticals are often not covered or inadequately covered in benefit packages. Pharmaceuticals are responsible for a large proportion of total health care expenditures in low and middle income countries (LMIC) and often account for nearly half of all out-of-pocket costs paid by consumers in those countries.
If access to medicines under UHC is to be achieved while keeping insurance schemes financially healthy, active medicines management and sound medicines benefit policies are necessary. LMIC policy makers need to start a dialogue, and issues that need to be addressed include:
The role of medicines in UHC
- A framework for medicines management in health systems and insurance schemes
- The business case for LMIC governments to cover inpatient and outpatient medicines in UHC schemes
Medicines management and benefit policies
- Country/scheme experiences, including challenges and innovative approaches in medicines management and policy
- Considerations for designing an essential medicines benefit package
- Considerations for covering high-cost medicines that may benefit few individuals
- Policy and program options for covering care and medicines for chronic conditions
- Transparency/ethics of resource allocation in a resource-limited context
- Approaches to ensuring equity in medicines benefits
Information for decision making
- Approaches for routine assessments of fraud and medicines expenditures and utilization
- Key indicators of fraud and medicines expenditure and utilization for routinely monitoring medicines management and policy impacts in LMIC insurance schemes
- Evaluation of medicines benefit policy impacts; building a portfolio of evidence
Policy change to incorporate medicines in UHC schemes
- Political and system challenges to covering medicines in LMIC insurance schemes
- Capacity needs for pharmaceutical policy leadership and governance; UHC policy and program design, implementation and monitoring
- Securing local, national, and global commitment to medicines as a key focus of sustainable UHC expansion
As the dialogue around medicines management and UHC evolves, we will continue to update this site.