Comparison of pharmacy prices versus NHIF reference prices for antipyretic, antihypertensive and antidiabetic medicines across four regions in Tanzania

Abstract

Background: Availability of essential medicines in the public health facilities is a major problem in developing countries, including Tanzania. As a result ,private sector pharmacies and drug shops play an important role as sources of essential medicines for patients. Beneficiaries of the National Health Insurance Fund (NHIF) also utilize these premises as their sources of medicines. However, it is not known how pharmacy prices differ from NHIF reference prices across different regions. Objective: This study aims to compare pharmacy prices and NHIF reference prices for antipyretic, antihypertensive and antidiabetic medicines across four regions in Tanzania. Methodology: This was a cross-sectional study and employed both qualitative and quantitative methods of data collection. It was conducted in four regions of Tanzania, namely; Dar es Salaam, Dodoma, Morogoro and Kilimanjaro. A total of thirty three (33) pharmacies were surveyed. Qualitative data were collected using an interview guide while quantitative data were collected by using structured questionnaire, which was designed to capture the prices of 53 tracer medicines. Interviews were conducted with two NHIF officers who are responsible to set reference prices and other 33 personnel from the pharmacies performing similar roles. Quantitative data were analysed by using Statistical Package for Social Sciences (SPSS) software version 20. Results: The study findings showed that 29 tracer medicines were available in more than 10 pharmacies and hence qualified for price comparisons. NHIF reference prices for 13 of them (4 antipyretics, 6 antihypertensives and 3 antidiabetics), which represents 45%, was lower than mean price at the pharmacies. A Price difference varies across regions; in some NHIF prices were higher than pharmacy prices and vice versa for the similar medicines. Majority of pharmacies (72.7%) set their retail prices by adding a profit margin ranging from 20% to 50% of the purchase prices. As for NHIF, the market retail price and inflation rates are used to determine the reference price for reimbursements. There was some consensus among the dispensers that when NHIF reference prices are lower than the pharmacy prices, then patients are requested to pay for the price difference, otherwise they will not get the prescribed medicines. Conclusion: Pharmacy prices were higher than NHIF reference prices for about half of the antipyretic, antihypertensive and antidiabetic of the essential medicines which were readily available in the accredited premises in the study regions. Therefore, patients have high chances of incurring out-of-pocket expenses as copayments in order to access essential medicines even when they are fully covered with health insurance. Recommendation: Tanzania needs to establish a regulatory body to control prices of medicines in retail premises. NHIF should also review their price annually, involving all stakeholders for the purpose of capturing fluctuation of medicine prices in the market. By considering that NHIF prices are lower than the retail pharmacy prices, patients are more likely to incur co-payments, and this needs further research to establish its implication on medicine accessibility.