FINANCING ARV EXPERIENCE FROM MALAYSIA

FINANCING ARV EXPERIENCE FROM

MALAYSIA

BYSHA’ARI NGADIMAN,

MD, MPH, EIP, AMMINISTRY OF HEALTH MALAYSIA

Our Structure National Strategic Plan on HIV and

AIDS Activities Impacts of the activities AIDS Expenditure ARV & Logistic Cycle Conclusion

OUTLINE

OUR STRUCTUREDeputy

Minister of Health

State Health Office : 15District Health Office : 141Government Hospital : 138 Health Center : 985

Involve in process of financing, planning, procurement , distribution, monitoring etc

Director Of Disease Control

Dep. Director (Comm.

Diseases)

Sector HIV/STI

Sector VBDCP

Sector FWB&VPD

Sector Zoonotic

Sector TB/Leprosy

Dep. Director (NCD)

Dep. Director

(Surveillance)

Dep. Director

(Env. /Occp H)

OUR STRUCTUREDirector of

Disease Control

Dep. Director (Comm. Disease)

Dep. Director (NCD)

Dep. Director

(Surveillance)

Dep. Director

(Env & Occp H)

Head Sector HIV/STI

SPAD Prevention

SPAD Treatment and

Care

SPAD Harm

Reduction

SPAD Monitoring

and Evaluation

SPAD Counselor

PAD Research

Head Sector VBDCP

Head Sector

Zoonotic

Head Sector

TB/Leprosy

Head Sector

FWD&WPD

SPAD State HIV/STI Officer

Target of NSP on AIDS 2011-15

80% MARPs reached prevention programmes

60% of MARPs use condoms consistently.

60% of IDUs use clean injecting equipment.

Able to eliminate vertical HIV transmission

80% ARV coverage for eligible PLHIV,

HIV NOTIFICATION IN MALAYSIA

Cumulatifve HIV = 98,279Cumulative deaths = 15,521PLHIV (end of 2012) = 82,758

NEW HIV CASE PER 100,000

YEAR2008 2009 2010 2011 2012 2013 2014 2015

TARGET 16.0 15.3 14.6 13.9 13.2 12.5 11.7 11.0ACHIEVED

13.3 10.8 12.8 12.2 11.7

CUMMULATIVE ON HAART AS 31 DEC 2012

15,028 on ARV in 2012

39,000 Adult Eligible for ARV in 2012 (EPP Model)39,000 Adult Eligible for ARV in 2012 (EPP Model)

Expenditure 2008 – 2012

0

10000000

20000000

30000000

40000000

50000000

60000000

2008 2009 2010 2011 2012

Global FundDomestic

ARV : 2011 – USD 16.10 mil 2012 – USD 20.41 mil USD 16.76 1st Line ARV USD 3.65 2nd Line ARV

Exp

endi

ture

(US

D)

DOMESTIC FUND FOR HIV WORKS

38%

ARV in Malaysia Eligible criteria Drugs listed in MOH Drug Formulary By specialist Available in hospitals and health centers

with specialist Also at hospitals or health centers

without specialist through follow-up by visiting specialist

Can be dispense through Integrated Dispensing Medicine System

ARV in Malaysia PLHIV above 15 yrs

1st line – 91.7% 2nd line – 8.0% 3rd line – 0.3%

PLHIV below 15 yrs 1st line – 71.0% 2nd line – 27.0% 3rd line – 2.0%

FLOW OF MOH DRUG FORMULARY REVIEW PANEL

Director-General of Health (DG) - Chairman

Deputy DG of Medical Services

Director of Pharmaceutical Services

8 Consultants in Public Services

3 Pharmacists in Public Services

List of drugs can be used by ALL MOH institutions

Serves as guide for the selection of drug therapy

First published in October 1983 Review 2 – 3 times a year 1530 drugs are listed www.pharmacy.gov.my

Objectives Provides the policy and administrative approach to :

• Control

• Promote

• Encourage rational, safe and cost effective drug prescribing and usage

MOH DRUG FORMULARY

PROCUREMENT PRINCIPLES Public accountability - Procurement should obviously

reflect public accountability entrusted with the Government

Transparency - All procurement regulations, conditions, procedures and processes need to be clear and transparent to facilitate better understanding among suppliers and contractors.

Best value for money - Government procurement should yield the best returns for every Malaysian Ringgit spent in terms of quality, quantity, timeliness, price and source.

Open and fair competition - Processes involving Government procurement should offer fair and equitable opportunities to all those participating or competing in any procurement.

Fair dealing - All acceptable bids will be processed fairly based on current rules, policies and procedures.

Policies on Drug Procurement

Local product (priority) Imported product : have to get approval

from Ministry of International Trade and Industry & Ministry of Finance

Value for money HOW?

Consession Company - Pharmaniaga Logistics Sdn Bhd (Approve Purchased Product List - APPL)

Central Contract (e-Tender/e-Bidding/Direct Negotiation)

Local Purchase by Quotation or Direct Purchase

41%

38%

21%Sales

APPLCentral ContractLocal Purchase

Drug Purchased in 2012

Importing Generic & Local Production

First Asian country issue Compulsory licensing in 2003

Local production of ARVs as part of our effort to confront the challenges of HIV/AIDS.

Currently, domestic pharmaceutical industry has capability to produce almost all dosage form and almost 80% of various categories in National Essential Drug List (NEDL) through the Malaysian Organization of Pharmaceutical Industries (MoPI).

Central Contract

Generic Name Category UnitProcurement Data (2012) Line of

TreatmentQuantity Value (USD)1 Efavirenz 200 mg Capsule A* pack of 90's 2,388 196,389.12 First Line

2 Efavirenz 600 mg Tablet A/KK pack of 30's 89,837 5,559,544.78 First Line

3 Lamivudine 100 mg Tablet A* pack of 28's 30,478 2,000,819.74 First Line

4 Lamivudine 150 mg Tablet A/KK pack of 60's 23,077 1,152,003.84 First Line

5Stavudine 30 mg, Lamivudine 150 mg & Nevirapine 200 mg Tablet

A/KK pack of 60's 12,190 660,288.42 First Line

6Tenofovir Disoproxil Fumarate 300 mg & Emricitabine 200 mg Tablet

A* pack of 30's 20,936 1,071,923.20 First Line

7 Tenofovir Disoproxil Fumarate 300 mg Tablet A* pack of 30's 8,827 310,710.40 First Line

8 Zidovudine 300 mg & Lamivudine 150 mg Tablet A/KK Tab/Cap 4,532,491 4,400,642.77 First Line

9 Indinavir Sulfate 400 mg Capsule A* pack of 180's 1,591 214,848.64 Second

Line

10 Lopinavir 200 mg and Ritonavir 50 mg Tablet A* pack of 120's 6,117 1,831,282.99 Second

Line

11 Ritonavir 100 mg Capsule A* pack of 168's 1,320 225,984.00 Second Line

Total 17,624,437.90

Local Purchase No Generic Name Category Unit Procurement Data (2012)

Line of TreatmentQuantity Value (USD)

1 Stavudine 40mg (Tab/Cap) A* Tab/Cap 702 471.53 First Line

2 Nevirapine 200mg (Tab/Cap) A/KK Tab/Cap 1,828,241 439,737.40 First Line

3 Lamivudine 10mg/ml Oral Solution (Bottle) A* Bottle 4,334 321,993.28 First Line

4 Stavudine 30mg (Tab/Cap) A/KK Tab/Cap 897,181 226,621.91 First Line

5 Stavudine 1mg/ml Oral Solution (Bot) A* Bottle 33 323.39 First Line

6 Zidovudine 100mg (Tab/Cap) A/KK Tab/Cap 206,831 195,948.64 First Line

7 Zidovudine 10mg/ml Syrup (Bot) A* Bottle 4,933 88,070.40 First Line

8 Efavirenz 100mg (Tab/Cap) A* Tab/Cap 0 0.00 First Line

9 Efavirenz 50mg (Tab/Cap) A* Tab/Cap 54,333 15,209.83 First Line

10 Zidovudine 1 % Inj. (Vial) A Vial 947 44,480.21 First Line

11 Zidovudine 300mg (Tab/Cap) A* Tab/Cap 328,635 34,401.33 First Line

12 Didanosine 400mg (Tab/Cap) A* Tab/Cap 24,216 34,832.29 Second Line


14 Didanosine 2g Oral Solution (Bot) A* Bottle 399 40,755.46 Second Line

15 Ritonavir 80mg/ml Oral Solution (Bot) A* Bottle 22 5,674.24 Second Line



18 Raltegravir 400mg (Tab/Cap) A* Tab/Cap 3,960 53,539.20 Second Line

19 Lopinavir/ Ritonavir Oral solution 533/13.3mg -Kaletra® (Bottle) A Bottle 2,455 712,478.75 Second Line

Total 2,522,983.16

Drugs of Special Approval

No Generic Name Unit Procurement Data (2012) Line of TreatmentQuantity Value (USD)

1 Tenofovir DF 300 mg +Lamivudine 300mg Tab Tab 18,356 30,191.95 First Line

2 Nevirapine 50mg/5ml Oral suspension (Bot) Bottle 729 14,683.24 First Line

3 Lopinavir/ Ritonavir 100/25mg (Tab/Cap) Tab/Cap 77,842 143,620.74 Second Line

4 Abacavir 300mg (Tab/Cap) Tab/Cap 54,410 44,746.78 Second Line

5 Darunavir 300mg (Tab/Cap) Tab/Cap 3,840 16,896.00 Second Line

6

Abacavir 600mg + Lamivudine 300mg Tab (listed in MOH Drug Formulary in Nov. 2012)

Tab 7,050 12,994.56 Second Line

7 Abacavir 20 mg/ml (Bot) Bottle 18 1,301.18 Second Line

8 Atazanavir 300mg (Tab/Cap) Tab/Cap 450 974.88 Second Line

Total 265,409.34 18

Logistic Cycle of ARV’s Supply

Serving Clients

Selection of ARV

Forecasting &

Procurement

Inventory Managem

ent

LOGISTIC INFORMATION

MOH Drug Formulary Review

Physician

Ministry of Health (Pharmaceutical, Medical, Public Health) Individual hospital, health center

Individual hospital, health center

Every level

• Central Contract• Local Purchase• Concession Company

LIST A* : Consultant/ Specialist for specific indications only

LIST A : Consultant/ Specialist LIST A/KK : Consultant/ Specialist/ Family Physician Specialist

LIST B : Medical Officer LIST C : Paramedics LIST C+ : Midwifery Paramedics

System for ARV procurement worked! Funded by Government (tax payers) Changing pattern of the epidemic Reaching 80% coverage for ARV Continue and enhance current funding

& activities New inovation? Review NSP 2011-15

CONCLUSION

21

TERIMAKASIH

FINANCING ARV EXPERIENCE FROM MALAYSIA

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