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Background: Developing countries, such as the Philippines, started implementing policies to improve access to medicines, which is a vital step toward universal healthcare coverage. This study aimed to evaluate the prices, availability and affordability of prescribed medicines for diabetes, hypercholesterolemia and hypertension with the exemption of 12% value-added tax in the Philippines. Methods: The prices and availability of 50 medicines were collected in August 2019 from 36 public and 42 private medicine outlets in six regions of the Philippines, following a modified methodology developed by the World Health Organization and Health Action International. Availability is reported as the percentage of outlets in which the surveyed medicine was found at the time of visit. Medicine prices are expressed as median unit prices (MUPs) in Philippine Peso. Affordability is calculated based on the number of days' wages required for the lowest-paid unskilled government worker to purchase a monthly treatment. Results: The mean availability of surveyed medicines was low in both public and private sectors, with 1.3% for originator brands (OBs) and 25.0% for lowest-priced generics (LPGs) in public outlets, and 34.7% and 35.4% in private outlets, respectively. The MUP of medicines were higher in private outlets, and OBs have higher unit price compared to the generic equivalents. Treatments with OBs were unaffordable, except for gliclazide, but the affordability of most LPGs is generally good. Conclusion: Access to medicines in both sectors was affected by low availability. High prices of OBs influenced the affordability of medicines even with tax exemption. A review of policies and regulations should be initiated for a better access to medicines in the Philippines.

Shahid Shah,1 Muhammad Hanif,2 Hafeez Ullah Khan,3 Faiz Ullah Khan,4 Ghulam Abbas,5 Haris Khurram,6 Ahmed Khames,7 Mohamed A Abdelgawad,8 Amira SA Said,9,10 Mohammed AS Abourehab,11 Safirah Maheen,3 Usman Rashid Chand,1 Muhammad Haris1 1Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan; 2Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, Pakistan; 3College of Pharmacy, Department of Pharmaceutics, University of Sargodha, Sargodha, Pakistan; 4Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, People's Republic of China; 5Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan; 6National University of Computer and Emerging Sciences, Chiniot-Faisalabad Campus, Chiniot, Pakistan; 7Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 8Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Al Jouf, 72341, Saudi Arabia; 9Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef, Egypt; 10Clinical Pharmacy Department, College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates; 11Department of Pharmaceutics, Faculty of Pharmacy, Umm Al-Qura University, Makkah, 21955, Saudi ArabiaCorrespondence: Shahid Shah; Ghulam Abbas, Email Shahid.waris555@gmail.com; ghulamabbas@gcuf.edu.pkBackground: Pharmacogenomics (PGx) is essential for optimizing drug therapy and reducing unwanted drug side effects. Our aim was to determine the knowledge, attitude and practice of senior pharmacy students in Punjab, Pakistan towards PGx.Methods: A cross-sectional study was conducted among 511 undergraduate pharmacy students from different universities in Punjab, Pakistan. A validated and pilot-tested structured questionnaire was administered to respondents to assess their knowledge, attitude, and practice regarding PGx. Descriptive statistics and multivariate logistic regression model were used to describe the results of the study. A p-value of less than 0.05 was considered statistically significant.Results: A total of 511 students (58.9% females and 41.1% males) responded to the survey. Most (87.7%) of the students knew that the drug response could be affected by genetic variations. Mean knowledge score of the students was 12.6. Good basic knowledge positively and significantly (p=0.01) affected students' PGx test knowledge and attitudes. Most (> 70%) of students believed that human genetics affected the drug response due to interindividual variation and ethnic variation. Mean attitude score of the students was 5.23. The majority of students (> 92%) wanted to learn more about PGx and thought it could help them choose the right drug. Students' knowledge was positively and significantly (p=0.01) affected by a good attitude. Mean practice score of the students was 11.95. When trying to solve a drug-related case study question, about 31.5% of students implemented the idea of human genetic variation. Only 28.8% of students attended a lecture related to the effects of genetic variations on drug therapy. Good practice positively and significantly (p=0.01) affected students' knowledge of PGx tests.Conclusion: The senior pharmacy students had good knowledge and attitudes towards PGx. However, the practice of PGx needs to be improved to facilitate the application of PGx in clinical practice in Pakistan.Keywords: pharmacogenomics, knowledge, attitude, practice

OBJECTIVE: To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability. DESIGN: Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology. SETTING: Four districts of Lahore division, Pakistan. PARTICIPANTS: 16 public sector hospitals and 16 private sector retail pharmacies. MEASURES: The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days' wages required to get a standard treatment by the lowest paid unskilled government worker. RESULTS: The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%–58.3% and 20.3%–32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019. CONCLUSIONS: The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, ...