A systematic review of policies regulating or removing mark-ups in the pharmaceutical supply and distribution chain

Iris R. Joosse, David Tordrup, Julie Glanville, Aukje K. Mantel-Teeuwisse, Hendrika A. van den Ham*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The regulation of mark-ups throughout the pharmaceutical supply and distribution chain may be a valuable approach to control prices of medicines and to achieve broader access to medicines. As part of a wider review, we aimed to systematically determine whether policies regulating mark-ups are effective in managing the prices of pharmaceutical products. We searched for studies published between January 1, 2004 and October 10, 2019, comparing policies on regulating mark-ups against other interventions or a counterfactual. Eligible study designs included randomized trials, and non-randomized or quasi-experimental studies such as interrupted time-series (ITS), repeated measures (RM), and controlled before-after studies. Studies were eligible if they included at least one of the following outcomes: price (or expenditure as a proxy for price and volume), volume, availability or affordability of pharmaceutical products. The quality of the evidence was assessed using the GRADE methodology. A total of 32,011 records were retrieved, seven of which were eligible for inclusion for this review. The limited body of evidence cautiously suggests that policies regulating mark-ups may be effective in reducing medicine prices and pharmaceutical expenditures. However, the design of mark-up regulations is a critical factor for their potential success. Additional research is required to confirm the effects of these policies on the availability, affordability or usage patterns of medicines and in low- and middle-income countries.

Original languageEnglish
Article number104919
Pages (from-to)1-9
Number of pages9
JournalHealth Policy
Volume138
DOIs
Publication statusPublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)

Funding

This systematic review was commissioned and funded by the World Health Organization [ HQ/EMP/2019/002 , 2019] under a grant from the United Kingdom Department for International Development (DFID). The review was part of the process for developing the 2020 WHO Guideline on Country Pharmaceutical Pricing Policies. The WHO secretariat and its advisors provided technical support for formulating the review protocol, performing specific searches on government websites, and translating several non-English publications. WHO, its advisors and DFID had no role in data analysis or interpretation. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the WHO or DFID.

FundersFunder number
United Kingdom Department for International Development
World Health OrganizationHQ/EMP/2019/002
Department for International Development, UK Government

    Keywords

    • Mark-ups
    • Medicine prices
    • Pricing policy
    • Supply chain
    • Systematic review

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