00:00Hi, welcome back to Consider This. I'm Melissa Idris. Let's continue our conversation about the
00:15government's mandate that as of 1st May, that healthcare professionals or healthcare providers,
00:22private healthcare providers, are required to publicly display the prices of the medicines
00:26they sell, supply or administer. Joining us now to discuss this further is health policy researcher
00:33Dr Lim Cheehan, who is the senior researcher for the non-profit advocacy group Third World Network.
00:41Dr Lim, thank you so much for being on the show with me today. As an overview, how do you see
00:45this mandate requiring medicine price displays? Is it a positive thing or a negative thing for
00:51consumers? Thanks, thanks Melissa for having me here. Yeah, oh, that's definitely a positive move
00:58for consumers and patients alike. Why is that? Because for so long in Malaysia, medicines have
01:05been strangely exempted from having to display prices in the private healthcare sector settings.
01:11The consequences actually are quite disastrous because medicine prices in the private healthcare
01:16care settings are generally higher with very high markups on the items and a very wide variation of
01:25a price range of the same product. I just want to give you some numbers according to the medicine
01:29prices monitoring in Malaysia survey 2022. The average markup on generic medicines in private clinics is
01:37140% and in the private hospital admission which is actually 280%. That's just an average, let me remind
01:49you. And the average price variation for particular medicine can be 200% in private clinics which means
01:58you will be very often find one clinic sells a medicine at RM10 while another clinics may sell it at
02:05currently just next door. So you have to ask yourself why there is such a wide price variation and why the
02:13markup can be so high. So I would like to point out that the consumers and patients have actually have no way
02:18of knowing the selling price of medicine in these facilities. So without such information, they actually
02:24cannot compare and choose. So they cannot make an informed decision based on price. Often they only, yeah.
02:31Right. Sorry, if I may just interject here. So you're saying the transparency will benefit consumers and
02:37they can kind of shop around for a more competitive price or one that suits their budget. There are those
02:42who say that this might disproportionately affect small clinics and GPs which at the end of the day are
02:49businesses. Their consultation fees have not been revised for over 30 years. What's your response to those who
02:56worry that while it's well-intentioned, it could make it harder for the very vital primary care
03:03providers to survive? And some of the markups, while they may sound big in percentage, actually are small
03:11in amount, maybe even a few cents or ringgit. How would you respond to that, Jihan?
03:16Yeah, I do support their call for revision of the doctor's consultancy fee because it has not been revised for
03:24more than 30 years. It's rightly to do so. But I think they should not confuse that revision of the
03:32consultation fee with other item policy like drug price display because one thing is we talk about
03:42the transparency. I think it's the consumer rights to know our prices. Another is their revenue. They have
03:50to go back to the root of their problems to solve it from there. And the minister already promised
03:57that he would deal with it and promised to revise within this month. So we should wait and see.
04:06Okay, alright. So what other measures do you think should accompany the price display mandate? So you
04:11talked about revising the consultation fees. Anything else that you think would make it more effective if the
04:18primary objective of government is to tackle medical inflation, reduce medical costs?
04:25Yeah, actually before this drug price display policy, actually the government has this policy called
04:32medicine price mechanism. The original policy is actually dated back in 2019 where the cabinet under
04:40the Pakatan Harapan 1.0, under the health minister to give free, actually have the mandate to regulate the
04:45markups on the single source medicine which are mostly the patented original medicine. At the retail
04:52level and drug manufacturer and importers have to declare and set the maximum wholesale prices at the
04:57same time. But you know that because of a very strong objection from the industry, the ministry actually
05:04backing down and watering down right now just to ask the retailers and the healthcare facilities to
05:10declare prices. This is actually not a price control because they can still set the margin higher and
05:16we all understand right now because of their doctor's consultation fee and what so on. We understand
05:24they can set the margin higher. But I think as times go on, if the problems of their, for example, their
05:31consultation fee has been revised. So I think we have to go back to the policy where the fairness, the market
05:38competition should be emphasized. Yeah, so the right for the consumers to know the prices so they can make
05:45the best plan for the affordable healthcare savings. I mean, this is very important to them also.
05:53I understand. Chihal, consumers like myself, we have limited knowledge about pharmaceuticals. We don't really
06:01understand, you know, any dosage and type. I can't even name the same, the brand names of some of the
06:10medicines. So how would consumers with that, with not enough information with, without that specific
06:17knowledge, be able to use this price display to our advantage if we don't know what we're looking for?
06:30How would you advise consumers with limited medical knowledge to understand? What do we need to
06:34understand about the price of medicine and about how it's determined? Yeah, I think it's a very good
06:40time for the consumer and patients to learn about medicines because we need to know there are two
06:47kinds. One is called originator, one is called generic medicines. So usually when the medicines are new to
06:53the market, there are only one medicine available, which is the originator and visually it's the highest,
06:59command the highest premium in terms of price margin. So when there is the the the patents for the
07:05medicine expires, the generic medicine comes in and usually the prices of the originator will drop by
07:11at least half compared to the generic. So don't be worried because generic medicine in Malaysia meet
07:18very high standard and on of the regulation. So they have the same efficacy, same safety and quality
07:25features as the originator. So if you have a chance, if you have a choice to
07:29buy generics, you can actually save a lot of money. Okay, all right. So it could be to the benefits of
07:38consumers if you make informed decisions. May I ask you if this has worked in other countries?
07:45Whether the displaying of drug prices in healthcare providers, whether there has been evidence
07:55that it has led to better medical inflation control. Actually drug price, transparency policy and
08:04mechanism is actually recommended by WHO back in 2019 and Malaysia is our core sponsor to one motion at
08:12the World Health Assembly on this motion. I think it's an international good practice because without the
08:19transparency, there is no healthy and fair market competition where the practitioners can just set
08:27any price they want and the consumers and patients do not know what are the selling prices until when they
08:34receive their bills and often they receive the bill without the detailed itemized bill. So actually
08:40they know how to, in that case, you won't see the price go down because they can just do so,
08:48setting at the high prices. So price transparency is not a guarantee to keep everything, the prices low,
08:55but it's a very necessary first step because without transparency, nothing will work.
08:59I understand. So are you concerned that there could be any, I was going to say adverse reactions but
09:07that's too much of a pun, any unintended consequences from this policy if it's not implemented well, if it's
09:15not rolled out with, you know, given enough consultation with the stakeholders and allowing
09:21stakeholders to adapt or adopt it well? I want to clarify about the not enough consultation. Actually,
09:29the government has been engaging with the industry for over six years since 2019 on the various price
09:37mechanisms. So you cannot say the industry doesn't know that what is coming but I think in this policy
09:44government has given a leniency period and for education for them to make the practice right. I think
09:50once everyone's doing that it's just a norm then I think there's just the initial state you have to set up
09:58something, a template. Other than that, after that, you just adjust the prices. I think it's easy work.
10:04And when they do the good inventory stocking, I think this just comes naturally in the digital world.
10:10Okay, well thank you so much, Chihan, for giving us some of your perspective and analysis about this
10:17policy. That was Dr. Lim Chihan from the Third World Network wrapping up this episode of Consider This.
10:23I'm Melissa Idris signing off for the evening. Thank you so much for watching and good night.
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