Fiji Consumer Council - Prices and Practices ^ Pharmaceutical Survey 2010 - 2010

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Prices and Practices

Pharmaceutical Survey 2010

Supported byReport by

CONSUMER COUNCIL OF FIJI

Funded by

EUROPEAN UNION


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About Consumer Council o Fiji (CCOF)Consumer Council o Fiji (CCOF) is a statutory organization dedicated to protect the rights and interests o consumers in Fiji and pro-

mote consumers interests nationwide through education, research, campaign and lobbying. It was established in 1976 and currently

has 3 ofces in Fiji.

For more inormation, visitwww.consumersfji.org

Prices and Practices : Pharmaceutical Survey 2010

2010. This work is copyright. Apart rom any air dealing or the purpose o private study, research, criticism or review as

permitted under the Copyright Act, no part may be reproduced by any process without written permission.

Layout and Concept : Consumer Council o Fiji.

Printed in Fiji.

USP Library Cataloguing-in-Publication DataPrices and practices : pharmaceutical survey 2010 / [Consumer Council o Fiji]. Suva, Fiji : Consumer Council, 2011.

44 p. :col. ill. ; 28 cm.

ISBN: 978-982-98044-2-6

Drugs - Prices - Fiji 2.Prescription pricing - Fiji I. Consumer Council o Fiji.

HD9674.F5P74 2011

338.436151

Published by Consumer Council o Fiji (CCOF)

Suva Ofce (HQ)

Ming Building, 4 Carnavon Street

P Private Mail Bag

T (679) 330 0792 | (679) 331 0183 | (679) 330 5864

F (679) 330 0115

E [email protected]

Lautoka Ofce

Suite 4, Popular Building, Vidilo Street

P P.O.Box 5396, Lautoka

T (679) 666 4987F (679) 665 2846

M (679) 926 2807

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Labasa Ofce

Level 1, Lot 41 Raza Properties Limited, Nasekula Road

P P.O.Box 64, Lautoka

T (679) 881 2559

F (679) 881 2559

E [email protected]


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CORRIGENDUM

At the time medicines were purchased, Midway Pharmacy Ba did not provide a receipt withitemized prices nor were the prices stated on the individual medicine pack. The Council soughtthe prices of individual medicines over the phone from Midway. This is why the individualmedicine prices for Midway on row number 35 in the appended table (Individual Medicine

Prices & Comments) on page 35 do not tally with the total price paid for the medicinespurchased which is $18. 00. Now that Midway has provided evidence, the Council is satisfiedthat the pharmacy is not overcharging. Hence the claims of Midway overcharging made on pages6, 14, 15, 17, 18, 19 and 20 of this report should be disregarded.


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Prices and Practices

Pharmaceutical Survey 2010

A Consumer Council of Fiji Report

CONSUMER COUNCIL OF FIJI


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The Consumer Council of Fiji is greatly appreciative of the proactive assistance and support

of the Ministry of Health, in particular the Honourable Minister Dr Neil Sharma. The survey

would have been dicult had it not been for the support and advice of the Minister. We also

would like to thank the Fiji Commerce Commission and the Pharmacy & Poisons Board for the

valuable comments and advice provided towards strengthening the nal report. These three

agencies have also taken the necessary rst steps towards taking necessary action on some of

the recommendations included in this report. Last, but not least, the Council wishes to express

its gratitude to those consumers who have assisted this endeavour by way of complaints and

contributing their voice to the public debate over medicine prices in the country. Needless

to say the responsibility for errors, omissions and content of the report lies entirely with the

Consumer Council of Fiji.


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Glossary And Acronyms 4

List of Tables 4

Executive Summary 5-7

Introduction 8

Objectives of the study 9

Survey Methodology 10

Key Findings 11 - 20

Pharmacy Trade Practices 21 - 24

Pharmacy Ownership 25

Conclusion and Recommendations 26 - 27

References 28

Appendix:

Response from Pharmacy and Poisons Board 29

Response from Fiji Pharmaceutical Society 30 - 31

Individual Medicine Prices & Comments 32 - 42

Price Comparisons - 43 - 47

Same medicine, batch number,

manufacturer/source country

Contents


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Branded medicines - Branded medicines are those medicines that are protected by patents. A medicine brand nameis often the trade or brand name the manufacturer gives to the medicine. Another term used is originator brand andthe patent gives the manufacturer the exclusive right to market the medicine under its brand name for a dened period,often many years depending on the patent conditions. Other companies can have the right to manufacture and market

the medicine under a dierent name or under its generic name once the patent expires. Branded medicines are oftenmore expensive because the manufacturer has spent considerable money and other resources in research and clinicaltrials, and also packaging and marketing the medicines.

Commerce Commission - The competition and commerce regulator in Fiji responsible for administering and enforc-ing the Commerce Commission Decree which contains laws and regulations pertaining to fair trade, consumer pro-tection and competition. The Commission is also the price regulator responsible for issuing price control orders andenforcing such orders.

DHA - Drug Houses of Australia

Drug In the pharmaceutical industry a drug is a chemical substance used in the treatment, cure, prevention, or diag-nosis of disease or used to otherwise enhance physical or mental well-being. The term drug is often used interchange-ably with the term medicine. Both mean the same thing in the pharmaceutical industry or in pharmacology.

Generic medicines (or generics) - Medicines produced and marketed under their chemical or generic name, e.g.paracetamol as opposed to Panadol, a brand or trade name of a paracetamol produced, patented and marketed bypharmaceutical company GlaxoSmithKline. Generics are normally no longer protected by patents. A generic drug canonly be sold after the patent runs out. While generic drugs are cheaper for consumers, they still must meet the requiredstandards set by regulatory authorities. For example, the US Food & Drug Administration (FDA) requires that genericsmust contain the active ingredients as the original formulation. Generics should have the same route of administration,safety, ecacy and intended use as branded medicines.

GOF - Government of Fiji

GSK - Glaxo Smith Kline

FIRCA - Fiji Islands Revenue and Customs Authority

FPS - Fiji Pharmaceutical Society

NCDs - Non Communicable Diseases

NGOs -Non Government Organizations

Patent - A patent normally is an exclusive right granted by a government or regulatory agency to an individual inventoror business to manufacture, market and sell a product or invention for a certain number of years.

Price Control Order A regulation or legal decision to control or prescribe the allowable maximum price of a product.

PIB- Prices and Incomes Board (now merged with Fiji Commerce Commission)

TIN- Tax Identication Number

VAT- Value Added Tax

Glossary and Acronyms

Glossary and Acronyms

Table 1 No: of Pharmacies Surveyed in each Division

Table 2 Prices for Prescription Pack

Table 3 Highest and Lowest Prices (Full Pack)

Table 4 National Analysis-Pharmacies with 6 Genericsand One Originator Brand (Glipizide-Minidiab)

Table 5 Divisional Analysis- Pharmacies with 6 Genericsand One Originator Brand (Glipizide-Minidiab)

Table 6 Price Analysis-Frusemide Same Dosage/Quantity

Table 7 Aspirin

Table 8 Metformin

Table 9 Simvastatin

Table 10 Enalapril

Table 11 Amoxicillin

Table 12 Glipizide

Table 13 Comparison of Same Drug and Quantity

Table 14 Non Disclosure of Individual Medicine Prices

Table 15 Queries on Prescription

Table 16 Pharmacy Ownership

List of tables


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IntroductionThe pharmaceutical sector plays an important role in providing safe and af-

fordable medicines to the people of any country. Fiji is no exception. Medicineprices are controlled through the Prices and Incomes Board (PIB (now mergedwith Commerce Commission) which sets percentage mark-ups at whole-sale and retail level. The Government of Fiji (GOF) has provided incentivesthrough duty exemptions and consumer protection through percentageprice control. Despite all these measures, consumers are still complaining ofhigh health costs. This is a direct result of anomalies in the pricing of medi-cations in pharmacies.

While not codied, the general practice amongst pharmacies is to sup-ply generic medication, as opposed to originator brands for prescriptionsfrom a public hospital or a health centre unless requested by patients todo otherwise.

The Consumer Council of Fiji conducted surveys in to ascertain pricesof commonly prescribed drugs for diabetes, hypertension, heart diseaseand other non communicable diseases. The Fiji Pharmaceutical Soci-ety (FPS) rejected the ndings of these surveys claiming that they weretechnically awed. The Councils drawback then was the lack of technical adviceand co-operation from the pharmaceutical sector.

Hence, the Council decided to carry out a comprehensive survey with the assistance of the Ministry of Health and a techni-cal expert to investigate prices of prescribed medicines, pharmacy practices and anti-competitive conduct (if any) in thisvery important sector.

In nalising the survey report the Council presented the draft and initial ndings to the FPS for its comments. This endeavour was necessary to get the feedback from FPS and its members on the ndings. The FPS had re-

sponded via the Minister of Health and a copy of their comments has been included in this published report.(refer to Appendix)

Survey MethodologyA patients prescription from a registered medical doctor at apublic hospital was presented to 47 out of 55 pharmacies for dis-pensing. These were purchased by the Council and documentspertaining to this transaction are retained as evidence and forverication. This study looked at the following aspects:

Prices of medications of the same brand, quantity, batchnumber and country of origin from dierent pharmacies;

The kind of brands that were dispensed (generics or originator);

Whether the consumer was informed of the availability of thischoice to buy generic or originator brands;

Pharmacists conduct in dispensing medicines;

Whether prices were fully disclosed to the consumer;

Labelling requirements set by the Ministry of Health which requires the quantity of medication dispensed, directions foruse, brand if possible and prices to be displayed on the 1labels ;

Whether issuing of receipts complied with the Commerce Commission requirements;

Whether registered pharmacists were in attendance during the dispensing of medicines; and

To understand market practices in terms of competition, fair play and corporate social responsibility.

Executive Summary

1 Ministry of Health (30 Oct 2009) Press Release on Monitoring of Pharmaceutical Prices in Private Sector

Executive Summary


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1. Thirty (30) or 57% of the pharmacies surveyed chargedhigher prices for the same brand and quantity ofmedication. In some cases overcharging is by 460%despite placing medicines under price control. Thirty(30) tablets of Microlab were sold by Nadi Chemistfor $0.83 where as Midway Pharmacy- Ba & ChovhanPharmacy Ltd-Lautoka sold the same tablet and thesame quantity for $4.65.

2. Forty three (43) pharmacies chose to dispense origi-nator brands for one or more items even though ge-nerics are widely available. Thus, a $15.00 prescriptionwould now cost a consumer up to $44.00, which isthree times more or worth a three months supply ofmedicines. Twelve pharmacies charged more than

$30.00 while Hyperchem Pharmacy, Lautoka; Thakor-lals Pharmacy, Nadi and Western Medicare Pharmacy,Ba charged more than $40.00 for the same prescribedmedicine. These are unreasonable prots being madeat the expense of patients. While not breaching anylaw, these pharmacies have shown gross negligenceand a complete breach of trust placed on them byordinary consumers by dispensing originator brandswithout rst consulting them. The unsuspecting pub-lic, especially the poor, thus need to readjust theirentire months budget which can potentially result inchildren missing school,compromise in living stand-

ards or simply aggravating further their poverty sta-tus. [opinion which would need substantiating]

3. A comparison made for those pharmacies sell-ing 6 generics and 1 originator brand Minidiab(glipizide) revealed that the highest price for all 7medicines was charged by Chovhan PharmacyLautoka at $31.00, while Guardian Angel Phar-macy, Laucala Beach oered the lowest price of$15.35. The percentage price dierence betweenthe lowest and highest for this group was 102%.

This would mean double the price for the same set of

medicine for a consumer in Lautoka than in Suva. Isthis 102% price dierence justed?

4. Only three (3) pharmacies dispensed all 7 genericmedicines as prescribed. Amongst the All GenericsGroup, Health Care Chemist in Tavua charged a higherprice of $30.70 while Nadi Chemist charged $13.45 forall 7 generic medication. A consumer in Tavua wouldpay $17.25 more for the same medicine. This is a clas-sic case of generic medication being sold at a price ofthe originator brand drugs to unsuspecting consum-ers. Interestingly, 36 pharmacies who sold either oneor more originator medicine had a lower total packprice than Health Care Chemist in Tavua.

5. Thakorlals Pharmacy in Lautoka dispensed the in-correct dosage of enalapril. Instead of 10mg (as perprescription), the pharmacist dispensed 5mg withoutinforming the buyer. Similarly, Sugar City Pharmacy,Lautoka issued 15 capsules ofamoxillin instead of 9 or10 for eight hourly courses.

6. Three pharmacies sold generic medication labelledas originator brand and charged the originator brandprice. Thakorlal Pharmacy in Nadi, Wyse Pharmacy inNakasi and Northern Drug Store in Labasa dispensedgeneric Apro frusemide but labelled it as Lasix whichis an originator brand tablet and also charged theprice of Laxis ($4.65) which is much more expensivethan generic Apo ($1.35).

7. Some pharmacies sold the same medicine (brand,dosage & batch number) at dierent prices. For ex-ample, two pharmacies in Ba Hyperchem and Mid-way had a 189% price dierence for the same medi-cine Flaminopril enalapril (Flamingo Pharmaceuticalsbatch #106). Similarly, Arrow (batch# SAWH0019) wassold by Budget Pharmacy in Nadi for $2.95 while MyChemist, Nasea Chemist and Northern Drug Store inLabasa dispensed the same medicine for $9.45. Thesethree pharmacies overcharged consumers by 220%.

8. Nineteen (19) pharmacies violated labelling require-ments in one way or another.

9. None of the 47 pharmacies provided individual medi-cine names on the receipts. However, 32 pharmaciesincluded the price on the labels. Nineteen (19) phar-macies provided both itemised receipts using codesand prices on their labels. Out of the 32 pharmaciesthat included prices on the labels, 15 did not provideitemised receipts.

10. Three pharmacies (Sugar City Pharmacy, Lautoka;

Chovhan Pharmacy, Lautoka and Patel Pharmacy, Si-gatoka issued a receipt without the company name,

TIN number or company address. Madison Pharmacy,Suva gave a chit with company name and total pricewhen a receipt was requested. In the Northern Divi-sion, Northern Drug Store, Labasa issued a receiptfrom My Chemist instead of a receipt specically forNorthern Drug Store. Ownership is the same for MyChemist and Northern Drug Store.

Main Findings

Executive Summary


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11. 51% of total pharmacies under survey made inquirieson the prescription and the patient, while 49% of thepharmaciess dispensed the drugs without any furtherclarication on the prescription.

12. During the survey, none of the pharmacies askedwhether the patient wanted generics or originator

brand medications. The general rule amongst phar-macists is to dispense generic drugs when presentedwith a public hospital prescription.

13. Pharmacy Plus of Suva and Life Pharmacy Nadi hadthe incorrect patients name typed on the medicinepack.

14. Generally, the prices of medicine in the Western Divi-sion are higher than in Central and Northern Divisions.In the Central division, Superdrug Pharmacy, Suva and

Central Pharmacy, Suva sold the 7 medicines undersurvey for $38.80 and $38.50 respectively.

Recommendation

These ndings call for the implementation of some nec-essary actions that would address current problems andalso benet the consumers and the pharmaceuticalsector. The following are recommended:

1. To acknowledge that there have been breachesand unfair trade practices by the pharmaceu-tical sector and that the enforcement agencieshave not been vigilant;

2. Pharmacy and Poisons Board together with PIB(Commerce Commission) to prosecute pharma-cies if breaches have occurred.

3. The Price Control Order (PCO) is now some 18years out of date thus urgently needs to be re-viewed and amended to address Fijis increasingcost of health care.

4. Pharmacy and Poisons Board needs to take amore proactive role in regulating the industryand its practices.

5. The law also establishes the Fiji PharmaceuticalSociety (Section 32B). They need to strengthentheir code of ethics and monitor market practic-es. FPS to ensure its members wear professionalattire (e.g. white coat) so that the public can dif-ferentiate a pharmacist from other pharmacysta. FSP should also require that pharmaciesdisplay the pharmacists name that is on duty atone particular period of time;

6. FPS, the Ministry of Health and the ConsumerCouncil of Fiji should educate consumers onthe dierent categories of medicines generics,branded generics and originator brands, includ-

ing labelling information;

7. A price list of common drugs consumed forcommon illnesses should be prominently dis-played at pharmacies. PIB/Commerce Commis-sion to list these in a revised price order;

8. The Ministry of Health to impose a strict Codeof Conduct that must be practiced by all phar-macies. The Code of Conduct has to be a bind-ing document and any breaches to it shouldlead to nes or cancellation of licenses. FPS andthe Ministry of Health should set up guidelinesfor dispensing of drugs.

9. Fiji Islands Revenue and Customs Authority(FIRCA) can investigate whether companies andtheir shareholders are accurately and truthfullydeclaring their income for tax purposes. Thereare violations, for example, nonpharmacists areshareholders in some cases and in a few casesthe same shareholder(s) own multiple pharma-cies according to the Registrar of Companiesrecords;

10. The Ministry of Health and Commerce Com-

mission should also look at the importers anddistributors of pharmaceuticals in Fiji to ensurecompetition.

11. The Government to implement the recommen-dations of this study so that Fijis citizens are noteasily manipulated and their health interests areprotected at all times.

Executive Summary


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The pharmaceutical sector plays an

important role in providing safe and af-fordable medications to the citizens ofany country. Fiji is no exception. For this,a strong regulatory mechanism is re-

quired to monitor prices and availability ofessential medicines to ensure that 34% in

urban areas and 43% of people in rural areasliving below the poverty line have access to

aordable medications 2.

A consumer depends solely on the doctors andthe pharmacists to be treated fairly while pre-scribing and dispensing medicines. Medications

are perhaps the only product where consumerscannot exercise their preference and therefore

trust that professional guidance is providedby the pharmacist in good faith. Therefore,professional and ethical conduct of pharma-cist is paramount in ensuring that consum-

ers are treated fairly.

Prescribing in the public sector is pri-marily by generic name, however in the

private sector both brand and genericnames are in use based on each individualpharmacists preferences. The existing legis-

lation requires that in the private sector, thepharmacist must supply the brand prescribed by the doc-tor, however in practice, the pharmacist may discuss alter-native generic products and prices with the patient whothen makes the selection 3.

Medicine prices is an important item on the Ministry ofHealths agenda 4. In October 2009, the Ministry intro-duced a monitoring system of Pharmaceutical Prices inthe Private Sector by encouraging the public to report anyprice-related issues. In November 2009, the Minister ofHealth, Dr Neil Sharma had raised issues of overchargingunder the heading of professionalism and ethics in a writ-

ten speech delivered to members of the Fiji Pharmaceuti-cal Society 5. The Ministry of Health in July 2010 convened

a Working Committee on medicine prices comprising

health ocials and representatives from the ConsumerCouncil, Commerce Commission/Prices & Incomes Board(PIB) and the Ministry of Finance.

Price ControlAll medicines in both public and private sectors in Fiji areimported. Medicines are on percentage price control asstipulated in the Price Control Order No.5, 1992 EthicalMedicine. Under the formula outlined in this Order, thewholesale prot margins for medicines are set at: Totalinto-store cost for pricing plus 20%, while the retail phar-

macies are allowed a maximum mark-up of 30% for overthe counter drugs and 35% for prescription drugs plus45c for dispensing doctors prescriptions 6. The PIB (nowmerged with the Commerce Commission) is the agencythat is charged with monitoring medicine prices and en-suring compliance by wholesalers and retailers of phar-maceutical products. There is no value-added tax ( VAT) ondispensed medicines but this tax is payable on medicinespurchased over the counter without prescription 7.

However, since 1992, the PIB has not done any review ofthe PCO on medicines nor has it produced any formalmonitoring report to gauge compliance. The Price Control

Order is now some 18 years out of date and urgently needsa review and amendment to address Fijis increasing costof health care. The fact that there is a trend towards privatehealth care and a user-pay system to relieve pressure onstate-funded services and facilities, price control is a wayto mitigate any negative impacts on poor and low-incomeconsumers.

Previous Surveys Conducted in 2007

and 2009This investigation is a continuation of the Councils moni-

toring of retail prices of medicines in the local pharmaceu-tical market. Surveys were conducted in 2007 and 2009to ascertain prices of essential prescription drugs for most

Introduction

Medications are perhaps the only product where

consumers cannot exercise their preference and

therefore trust that professional guidance is provided

by the pharmacist in good faith. Therefore, professional

and ethical conduct of pharmacist is paramount in

ensuring that consumers are treated fairly.

Introduction

2 Preliminary Report on Poverty and Household Incomes in Fiji in 2008-09,

Bureau of Statistics. 2010

3 http://www.haiweb.org/medicineprices/surveys/200409FJ/survey_report.pdf4 Ministry of Health (30 October, 2009) Naturopathic Medicine Retailing in Fiji

5 Speech of the Ministry for Health, Dr Neil Sharma delivered to members of

the Fiji Pharmaceutical Society, Natadola, Nadi, 29th Nov 2009. ww w. www.

health.gov./speeches/29/11/2009--Fiji-pharmaceutical-society natadola. html

(Accessed 15 June 2010)

6 Fiji Republic Gazette Supplement, No.26, Friday 5th June, 1992; Legal NoticeNo.69, Counter-Ination Act (Chapter 73), Counter-Ination (Price Control),

Ethical Medicine, No.5, Order, 1992.

7 http://www.haiweb.org/medicineprices/surveys/200409FJ/survey_report.pdf


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The government has played its part by making prescribedmedicines both duty and VAT exempt as well as placingthese under price control. Despite all these measures,consumers are still complaining of high price variancebetween pharmacies and continued rising prices of phar-maceutical products. To this end, the Council carried outsurveys in 2007 and 2009 to ascertain prices of commonly

used prescription drugs which included medications usedfor diabetes, hypertension, heart disease and other noncommunicable diseases. The ndings of these surveyswere rejected by the Fiji Pharmaceutical Society (FPS) onthe basis that they were technically awed. The Councilsdrawback while conducting the survey then was lack of

It should be noted that while the objective of the surveywas to investigate prices of prescription medicines, scru-tinise pharmacy practices and ascertain anti-competitivebehaviour (if any), the ultimate goals have been to correctthe anomalies in the pharmaceutical sector and provid-ing relief to consumers. The rst steps towards these goalshave been taken as the Council has received very positiveresponses from the principal enforcement agency namelythe Pharmacy & Poisons Board of the Ministry of Health.

The Board was prompted to investigate the issues raisedin the draft report and this had commenced in late 2010.

During the nal stages of the publishing of this report, theBoard informed the Council that a general warning letterhad been issued to all retail pharmacies and specic casesare being addressed through its disciplinary procedures.Further, the Councils recommendation to make publicthe action taken against specic pharmacies would be dis-cussed at its rst meeting of 2011. It can be asserted herethat the ultimate goals of the report are being graduallyachieved and the Council is very optimistic that the full

impact will soon be realised.

professional advice and non cooperation by the retail sec-tor.

The Council thus decided to carry out a comprehensivesurvey with the help and approval of the Ministry of Healthand a technical expert.

The objective of the survey was to to investigate prices

of prescription medicines, pharmacy practices in dispens-ing drugs and anti-competitive behaviour (if any) in thepharmaceutical sector. However, it was equally importantfor the Council to establish whether the current Price Con-trol on medicines under the Commerce Commission isactually beneting the consumers. More specically, theCouncil investigated the following aspects:

Aspects Research questions

1. Price of Medicine a) Comparison of prices of prescription medicines of the same brand, same batchnumber, same country of origin and same quantity in dierent pharmacies aroundFiji;

b) Whether generics or originator brands were dispensed;c) Did the pharmacist oer choice between originator and generic medicines?e) Whether generic medicines were sold at an originator price; andf) Comparison of prices of medication in those pharmacies with the same owner(s)

2. Pharmacy Trade Practices a) Were pharmacists present at the outlets during dispensing of medications?b) Was there any interaction between the pharmacist and the consumer?c) Was the labelling of medications correct and whether directions on the labels were

clearly written?d) Did the pharmacist disclose the prices of medications before dispensing the

medicines? ande) Did the consumer receive an itemised receipt and whether price information on

each medicine was clearly stated?

3. Pharmacy Ownership a) Who are the owners of these pharmacies? Is there multiple ownerships?

b) Is there price xing if pharmacies are owned by the same person(s) or cartel likeoperation if ownership is dierent?

Objectives of The Study

common ailments and diseases suered by a growingnumber of people in Fiji such as diabetes, hypertension,heart diseases and other non-communicable diseases(NCDs). According to the Ministry of Health, NCDs are theleading causes of deaths in Fiji and hypertension preva-lence is 19.1% 8. In the 2009 price survey the Council ana-lysed the prices of essential drugs voluntarily provided by

selected pharmacies. These prices were then comparedwith a similar survey held in 2007 to determine the extent

of price increases. There were limitations to this method.The pharmacies would have rightly assumed that a pricesurvey was underway and thus would have supplied pric-es that did not reect what was actually charged to con-sumers. Also, out of 20 leading pharmacies approached in2009, only 14 provided their prices. It was necessary thento acquire realistic prices by actually purchasing a number

of prescribed medicines.

Objectives of The Study

8 Panapasa G., 2010, Symposium on NCDs, Fiji Times, 6 July.


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Pharmacy Trade Practices- Observation

The Council also prepared a checklist for observations re-garding pharmacy practices while dispensing medicines.Some of these were:

Presence of pharmacists on the premises and duringdispensing;

Labelling requirements as set by the Ministry of Health

which require that the quantity of medication dis-pensed, directions for use, brand (if possible) and pricesto be displayed on the labels;

Was the patient given a choice to purchase a generic oran originator brand?;

If information such as phone contact, age, etc of thepatient was sought by the pharmacy;

Was itemised receipt given with price information oneach medicine and whether these were clearly stated?

Pharmacist interaction with the patient;

Disclosure of prices; and

Issuance of receipts.

Pharmacy Ownership This was done by retrieving pharmacy ownership docu-ments from the Registrar of Companies. The idea is toascertain ownership and investigate possibility of pricexing if more than one pharmacy is owned by the sameperson(s) or cartel like operation if ownership is dier-

ent. The intention was to understand market practicesin terms of competition, fair play and corporate socialresponsibility.

In order to understand theproblems pertaining to pricevariations, pharmacy practicesand pharmacy ownership,three separate investigations/observations were conduct-ed as outlined below:

Prescription To obtain the actual pricesof medications that patientspay for required the Coun-cil to acquire a prescriptionfrom a medical doctor to purchase medicines from phar-

macies around Fiji. The Council with the assistance of theMinistry of Health was able to obtain a prescription froma doctor at a public Hospital. (See Appendix 1 for a copyof the prescription). The prescription was prepared for anelderly male patient suering from diabetes, cardiovascu-lar ailments, high blood pressure and high cholesterol. Itmust be noted that the age of the patient is not stated onthe prescription; instead Adult/m is used.

Multiple copies of the same prescription were taken topharmacies around Fiji. The sta posed as a relative, anemployee, a neighbour or a friend of the patient whenpresenting the prescription for dispensing. The Council

bought the medicines under the patients name. The sur-vey was held from 26th April to 12th May 2010, covering

Nausori, Suva-Nasinu, Sigatoka, Nadi, Lautoka, Ba, Rakiraki,Tavua and Labasa.

A total of 47 pharmacies were surveyed around Fiji. Thetotal cost of the medicines from the 47 pharmacies was$1169.63. A total of 23 pharmacies were surveyed in theCentral/Eastern Division along the Suva-Nausori corri-dor, while 21 were surveyed in the Western Division fromSigatoka to Rakiraki and 3 in the Northern Division (Labasahas only 3 pharmacies).

MedicinesA total of seven (7) medicines (amoxicillin, enalapril, sim-vastatin, metformin, frusemide, glipizide and aspirin) wereprescribed with a maximum of 2 repeats for all except foramoxicillin which the prescription did not allow for a re-peat (see Appendix 1 for details). Since the ailments ad-dressed in the prescription are common in Fiji, it is expect-ed that these medicines are readily available in aroundthe country pharmacies.

Table 1: No. of Pharmacies Surveyed in each Division

DIVISIONS No. of Pharmacies

Central/Eastern 23

Western 21

Northern 3TOTAL 47

Survey Methodology

Survey Methodology


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PRICE ANALYSISOut of the 47 pharmacies,7 did not oer the fullpack of medicines as pre-scribed. Six pharmaciesdid not dispense amoxi-

cillin since theprescription

was writtena whilea g o ,

w h i l eone did

not have glipiz-ide. Most pharmacies dis-

pensed Minidiab brand ofglipizideas generics are not readily available and

with little price dierence. However there

is no excuse for dispensing Lasix instead of frusemide asthis is readily available.

In the analysis (see Appendix 2), all 47 pharmacies wereconsidered depending on the type of information thatwas sought. For example, all 47 pharmacies were consid-ered while investigating pharmacy practices and the costof individual medicine while 40 pharmacies were consid-ered for determining the cost of all 7 medicines.

Prescription Pack: Price Differences,

Lowest and HighestThe comparison is made for all (7) prescribed medicinespurchased by the Council sta irrespective of genericsand originator brand as choice was not oered by any ofthe pharmacy. Table 2 below provides what a consumer ismost likely to pay for the 7 medicines from 47 pharmacies.

Key Findings

No Pharmacy Location Total Price

CENTRAL/EASTERN DIVISION

1 A.J. Swann Co Ltd, Suva 21 Thomson St, Suva $19.40

2 Amy Street Pharmacy, Toorak 120 Amy St, Toorak $18.85

3 Central Pharmacy, Suva Lot 1, Cumming St, Mid city, Suva $38.50

4 City Centre Pharmacy, Suva MHCC, Suva $28.26

5 Flagsta Pharmacy, Suva 7 Rewa St, Flagsta $28.75

6 Good Health Care Pharmacy, Suva Nasese Medical Centre,62 Ratu Sukuna Rd $18.35

7 Guardian Angel Pharmacy, L/Beach Vivras Plaza, Laucala Bch $15.35

8 Holistic Pharmacy, Suva 1 Nina Street, Suva $15.15*

9 Laucala Bay Pharmacy, Suva Sport City,1 Grantham Rd, Laucala Bay $18.60

10 Life Pharmacy, Nausori Lot 1, NG Patel Rd, Nausori $14.50*

11 Madison Pharmacy, Suva 83 Cumming St,Suva $19.90

12 Mega Care Pharmacy, Makoi, Nasinu Matanikorovatu Road, Makoi $23.25*

13 Metro Pharmacy, Suva Renwick Road, Suva $25.20*

14 Nasese Pharmacy , Suva 36 Ratu Sukuna Rd, Nasese,Suva $29.85

15 Nausori Pharmacy Ltd, Nausori Kings Rd, Nausori $25.26

16 Pharmacy Plus, Suva 190 Renwick Rd, Suva $20.30

17 Rewa Pharmacy, Nausori Wing Zoing Wah Bldg, Main Street, Nausori $13.60*

18 Samabula Drug Store,Samabula 77 Ratu Mara Rd, Samabula $15.90

19 Superdrug Pharmacy, Nabua 550 Rt Mara Rd, Nabua $23.30*

20 Superdrug Pharmacy, Suva Suva Central Bldg, Suva $38.80

21 Suva City Pharmacy, Suva 10 Thomson St, Suva $21.40*

22 Wyse Pharmacy, Nakasi Tebara Shopping Mall, Nakasi $29.65

23 Wyse Pharmacy, Valelevu Shop 4,Daniva Rd, Valelevu $24.50

Key Findings


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12

Pharmacies in the Western Division had both the mostexpensive and lowest priced pack. The most expensivepack was $44.25 purchased at Hyperchem Pharmacy inLautoka, while the lowest priced pack was $13.45 at NadiChemist. The highest price in the Central/Eastern area was$38.80 recorded at Superdrug Pharmacy (Suva CentralBldg), while the lowest priced pack was sold by GuardianAngel Pharmacy (Vivraz Plaza, Laucala Beach) for $15.35.

There were not much price dierences between the threepharmacies in the Northern Division. The Northern Drug

Store had the highest price of $25.50, while Nasea Chemisthad the lowest at $21.80.

Table 3 below shows percentage dierence in each divi-sion and at the national level.

WESTERN DIVISION

24 Budget Pharmacy, Nadi Shop 3, Namaka Lane, Nadi $18.00

25 Care Chemist, Sigatoka Suewing Bldg,Sigatoka $20.31

26 Chandulals Pharmacy, Lautoka 23 Yasawa St, Lautoka $19.80

27 Chovhan Pharmacy Ltd, Lautoka 5 Yasawa St, Lautoka $31.00

28 Health Care Chemist, Tavua Market St, Tavua $30.70

29 Health First Pharmacy, Nadi 40 Lodia St, Nadi Town $32.08

30 Hyperchem Pharmacy, Ba Main St, Ba $21.55

31 Hyperchem Pharmacy, Lautoka 101 Vitogo Parade, Lautoka $44.25

32 Island Pharmacy Complex, Nadi Main St, Nadi $24.55

33 Island Pharmacy, Ba 62 Bank St, Ba $28.50

34 Life Pharmacy Ltd, Nadi 41 Lodhia St, Nadi $22.00

35 Midway Pharmacy, Ba Kings Rd, Ba $18.00

36 MS Pharmacy, Nadi 9 Caly St, Nadi Town $25.35

37 Nadi Chemist, Nadi Clay St, Nadi Town $13.45

38 Naidus Medical Centre Vaileka Street, Rakiraki $30.50

39 Namaka Medisure Pharmacy, Nadi Namaka Lane, Nadi $31.00

40 Patel Pharmacy Ltd, Sigatoka Box 12,Sigatoka $30.50

41 Sugar City Pharmacy Ltd, Lautoka 23 Naviti St, Lautoka $21.55

42 Thakorlals Pharmacy, Lautoka 1003 Vitogo Parade, Lautoka $30.17

43 Thakorlals Pharmacy, Nadi 347 Main St, Nadi $40.10

44 Western Medicare Pharmacy, Ba Main Street, Ba $40.50

NORTHERN DIVISION

45 My Chemist, Labasa Shop 5 Nasekula Rd, Labasa $23.40

46 Nasea Chemist, Labasa Shop1,168 Nasekula Rd,Labasa $21.80

47 Northern Drug Store, Labasa R.B.Patel Building, Labasa $25.50

*pharmacies that did not dispense all 7 medicine

Table 3: Highest & Lowest Prices (Full Pack)

DIVISION LOWEST PRICE HIGHEST PRICE % Dierence

All/National $13.45 $44.25 229%

Central/Eastern $15.35 $38.80 153%

Western $13.45 $44.25 229%

Northern $21.80 $25.50 17%

The percentage dierence between the highest and low-est prices for the full complement of prescribed medi-cines was 229%. This means that a consumer who paysthe highest price of $44.25 for the prescribed medicinepack was paying 229% more or three times more than theone who pays the lowest price of $13.45. The Northern Di-vision had the lowest price dierence which reects thelimited choice consumers have in this division. In essencewe can deduce that huge price gaps exists between thepharmacies (irrespective of originator brand or generics)

and many consumers may be unaware of this and are buy-ing medicines at exorbitant prices.

Key Findings


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13

CENTRAL/EASTERN WESTERN NORTHERN

Lowest price $15.35 $20.80 $21.80

Highest price $29.85 $31.00 $25.50

Price dierence between lowest and highest price $14.50 $10.20 $3.70

Percentage price dierence between lowest and highest price 94% 49% 17%

Table 5: Divisional Analysis- Pharmacies with 6 generics and one originator brand (Glipizide Minidiab)

Number of pharmacies compared 16

Highest Price (Chovhan Pharmacy Lautoka) $31.00

Lowest Price (Guardian Angel Pharmacy, LaucalaBeach, Nasinu)

$15.35

Price dierence between lowest and highestprice

$15.65

Percentage price dierence between lowest andhighest price

102%

Table 4: National Analysis Pharmacies with 6

generics and one originator brand

(Glipizide Minidiab)

Pharmacies that sold 6 generics and one originator medicineA comparison was also made for 16 pharmacies that sold 6 generics and 1 originator brand from the prescribed 7 medi-cines. From these 16 pharmacies, nine (9) are in the Central/Eastern, 4 in the Western and 3 in the Northern division.

The highest price was charged by Chovhan Pharmacy Lautoka at $31.00, while Guardian Angel Pharmacy, Laucala BeachNasinu had the lowest price of $15.35. The percentage price dierence between the lowest and highest priced pharmacyin this group was 102%. Below are the price dierences per division.

The price dierence for the same packs (6 generics and 1 originator brand) in 3 division show the same medicines are soldat a higher price in the Western and Northern divisions compared to the Central division. Consumers have limited choicein costs in the Western and Northern divisions. The percentage dierences between the lowest and highest prices were:Central/Eastern 94%; Western 49%; and Northern 17%. In Labasa, consumer choice is restricted because there areonly three pharmacies where two have common ownership.

All GenericsOnly three (3) pharmacies dispensed all 7 generic medicines listed as per prescription. These were Midway Pharmacy, Ba;Health Care Chemist, Tavua and Nadi Chemist.

Amongst the All Generics Group, the Health Care Chemist in Tavua charged a higher price of $30.70 while Nadi Chemistcharged $13.45 for all 7 generic medication. A consumer in Tavua paid $17.25 more for the same medicine. This is a caseof generics being sold at a price of originator drugs to unsuspecting consumers. Interestingly, 36 pharmacies who soldeither one or more originator medicine had a lower total pack price than Health Care Chemist in Tavua.

Comparison of Prices per MedicineFor price comparison of individual medicines sold in all 47 pharmacies seeAppendix 2. However, listed below are examples of medicines on which pricecomparisons were made for the same brand with identical quantity and thesame manufacturer oered by the pharmacies (see Appendix 3).

Key Findings


17/52

14

Table 7: Aspirin

Medicine

Name

No of

pharmacy

Quantity Lowest Price Highest Price % price

Dierence

Aspirin India

26 15/300mg $0.60Mega Care Pharmacy, HolisticPharmacy, Rewa Pharmacy, WysePharmacy Valelevu

$2.70Midway Pharmacy, Ba

350%

Aspirin -

India

15 30/300mg $0.73

Health First Pharmacy, Life PharmacyLtd -Nadi, Nadi Chemist

$2.00

Western MedicarePharmacy, Lautoka

174%

Aspirin -India

2 20/300mg $2.25Wyse Pharmacy, Nakasi

$2.70Chovhan PharmacyLtd

20%

Aspirin

Aspirin is a common drug available in Fiji. The Care Chemist in Sigatoka sold Cardiprinan originator brand for $4.61instead of generic aspirin which is sold for $0.60. A consumer could have saved $4.01 if the pharmacist had giventhe consumer the option to choose.

From the above table it can be deduced that it was cheaper to obtain 30 tablets at $0.73 or 2 months supply thanto get 15 tablets for $0.60 which was enough for a month. Midway Pharmacy, Ba sold 15 tablets at $2.70, i.e. 350%more for the same quantity and same brand of medicine available at Mega Care Pharmacy, Holistic Pharmacy, RewaPharmacy, and Wyse Pharmacy Valelevu that sold aspirin for $0.60. Health First Pharmacy- Nadi, Life PharmacyLtd -Nadi, Nadi Chemist sold 30 tablets at $0.73 compared to Western Medicare Pharmacy, Lautoka which sold thesame tablets in the same quantity at $2.00, which is a price dierence of 174%. These are examples of unfair tradepractices. The pharmacies have engaged in proteering thus defeating the whole purpose of placing medicines

under Price Control.

Manufactures

Name

Medicine

Name

No. of

pharmacies


Dierence

Not stated Frusemide-Microlab

20 30/40mg $0.83Nadi Chemist

$4.65Midway Pharmacy- Ba &Chovhan Pharmacy Ltd-Lautoka charged originatorbrand price for generic

medicine.

460%

Not stated Frusemide-Apo

6 30/40mg $1.35NaseaChemist,Labasa

$4.65Northern Drug Store, WysePharmacy, Nakasi & ThakorlalPharmacy-Nadi chargedoriginator brand price forgeneric medicine.

244%

Table 6: Price Analysis Frusemide Same Dosage/Quantity

FrusemideTwenty (20) pharmacies dispensed Microlab frusemide, 19 sold Lasix, while 6 dispensed Apo. One pharmacy dis-pensed Durin, while another gave Flamingo frusemide.

Midway Pharmacy- Ba and Chovhan pharmacy- Lautoka dispensed the same drug as Nadi Chemist (Microlab) butcharged 460% more i.e. $4.65 compared to Nadi Chemist which sold the same drug for 0.83cents. This is a case of

unethical practice where consumers were duped into buying generic medicine but at an originator drug price. Asimilar case is with Apo where Nasea Chemist in Labasa sold Apo for $1.35 while Northern Drug Store, ThakorlalPharmacy, Nadi and Wyse Pharmacy, Nakasi charged $4.65 for the same drug, a price dierence of 244%!

Key Findings


18/52

15

MetforminThere are pharmacies that sell originator drugs rather than generic drugs for maximum prots. For example LifePharmacy Ltd, Nadi and Namaka Medisure Pharmacy, Nadi sold Glucophage while MS Pharmacy in Nadi and West-ern Medicare Pharmacy, Lautoka and Super Drug Pharmacy, Suva sold Diaformin - both are originator brands al-though generic metformin is readily available for diabetic patients as diabetes is a common ailment in Fiji.

Comparing the same batch numbers and source of medicines, Midway Pharmacy, Ba sold the most expensiveFlamingo metformin at $2.70, while Health First Pharmacy Nadi and Nadi Chemist sold the tablets at $1.48. Price dif-ference was 82%. The most common price was $1.95 charged by Nausori Pharmacy, Suva City Pharmacy, ChadulalsPharmacy, Lautoka and Hyperchem Pharmacy, Ba.

Ten (10) pharmacies in the Central/Eastern Divison sold the same batch ofmetformin (Pure Pharma, batch number80002). AJ Swann Suva sold at $2.00 while Mega Care Pharmacy Makoi sold the same quantity at $1.05, a price dif-ference of 94%.

ManufacturerName

Name No of pharmacy

Quantity Lowest Price Highest Price % priceDierence

Pure Pharma Ltd,India

PurePharma

10 30/500mg $1.05Wyse Pharmacy Valelevu,Mega Care Pharmacy-Makoi, Holistic Pharmacy Suva

$2.00AJ SwannPharmacy, Suva

94%

FlamingoPharmaceuticalsLtd, India

Flamingo 11 30/500mg $1.48Health First Pharmacy,Nadi and Nadi Chemist

$2.70MidwayPharmacy, Ba

82%

Flamingo

PharmaceuticalsLtd, India

Flamingo 3 15/300mg $1.35

Nasea Chemist andNorthern Drug Store inLabasa.

$1.95

MyChemist,Labasa

44%

Windlas BiotechLtd, India

Metofen 2 30/500mg $1.38Amy St. Pharmacy - Suva.

$1.95Rewa Pharmacy -Nausori

41%

Key Findings

Table 8: Metformin


19/52

16 SimvastatinSix (6) pharmacies dispensed Arrow simvastatin (SAWH0019). The highest price was recorded in the three Laba-sa pharmacies at $9.45. Budget Pharmacy Nadi had the cheapest price of $2.95. The three northern pharmaciescharged 220% more than the cheapest Arrow simvastatin purchased.

Winstatin was sold by Amy Street Pharmacy; Good Health Care, Suva; Guardian Angel, L/Beach for $3.15 while

Western Medicare Ltd charged $10.00. This is a price dierence of 217%, which is three times more than what aconsumer would pay for in Suva.

Five (5) pharmacies dispensed Arrow simvastatin (SAWH0023). Chovhan Pharmacy Lautoka charged $7.50, whichwas 143% more expensive than the lowest price oered by Nadi Chemist which was $3.08.

Arrow (Batch No: SAWH0021) was sold by Patel Pharmacy in Sigatoka for $15.00 while Hyperchem Pharmacy, Basold the same tablets for $5.10, a price dierence of 194%

Manufacturer

Name

Name No of

pharmacy


Dierence

Not Stated ArrowBatch No:

SAWH0019

6 30/20mg $2.95Budget Pharmacy,

Nadi

$9.45My Chemist,

Nasea Chemistand NorthernDrug Store inLabasa

220%

Windlas BiotechLtd, India

Winstatin 4 30/20mg $3.15Amy Street Pharmacy;Good Health Care,Suva; Guardian Angel,L/Beach;

$10.00WesternMedicare Ltd

217%

Not Stated ArrowBatch No:SAWH0021

3 30/20mg $5.10Hyperchem Pharmacy,Ba

$15.00PatelPharmacy,Sigatoka

194%

Not Stated ArrowBatch#SAWH0023

5 30/20mg $3.08Nadi Chemist, Nadi

$11.55CentralPharmacy,Suva

275%

Cipla Ltd, Ltd Simcard 11 30/20mg $9.75Flagsta Pharmacyin Suva, Mega CarePharmacy in Makoiand ThakorlalsPharmacy in Nadi.

$11.59Health FirstPharmacy,Nadi

19%

Crescent PharmaLtd

Crescsent 2 28/20mg $5.85Thakor lal Pharmacy,Lautoka

$18.00Health CareChemist, Tavua

207%

Table 9: Simvastatin

Key Findings


20/52

17

Manufacturer

Name

Name No of

pharmacy


Dierence


Flaminopril

Batch No:1868

14 30/10mg $1.50Life Pharmacy Ltd,Nausori

$5.00Chovhan Pharmacy,Lautoka

233%


FlaminoprilBatch No:106

2 30/10mg $1.73Hyperchem Pharmacy,Ba

$5.00Midway Pharmacy,Ba

189%

RanbaxyLaboratories Ltd,India

Invoril 9 30/10mg $2.25Guardian Angel, L/Beach;Wyse Pharmacy, Valelevu

$4.50Wyse Pharmacy,Nakasi

100%

Suvik Hitek PvtLt, India

Sunapril 3 30/10mg $1.95Super Drug, Nabua andMetro Pharmacy, Suva

$3.25AJ SwannPharmacy, Suva

66%

Merck SharpDohme(Australia)Pty Ltd

Renitec 2 30/10mg $9.00Western MedicareLautoka

$13.01HyperchemPharmacy, Lautoka

45%

Global PharmaHealth Care PvtLtd, India

Priloten 4 30/10mg $3.69Amy Street Pharmacy,Suva

$3.75City CentrePharmacy &Good Health CarePharmacy, Suva andRewa Pharmacy,

Nausori

1.6%

Table 10: Enalapril

EnalaprilThe most popularly dispensed enalaprilwas Flaminopril (17 pharmacies). The most expensive, Flaminopril (samebatch #1868) was recorded in the Western Division, at Chovhan Pharmacy in Lautoka. It was selling it for $5.00, whilethe lowest price of $1.50 was recorded in the Centra/Eastern Divison at Life Pharmacy in Nausori, a dierence ofabout 233%. This drug was commonly priced at $1.95 by three pharmacies - Pharmacy Plus, Samabula Drug Storeand Suva City Pharmacy.

Nine (9) pharmacies sold Invoril enalaprilfrom Ranbaxy Laboratories Ltd, India. The medicine had the same batchnumber 1952512 and expiry date of 08/2010. The highest price was recorded by Wyse Pharmacy Nakasi at $4.50 andinterestingly Wyse Valelevu oered the lowest price of $2.25. The price dierence between the two Wyse branchesfor the same medicine is 100%.

There was a price dierence of 189% between two pharmacies selling Flaminopril (Batch No: 106). HyperchemPharmacy, Ba sold this drug for $1.73 while Midway Pharmacy, Ba sold the same drug for $5.00.

AJ Swann Suva sold Sunapril enalaprilat 66% more than two pharmacies selling the same batch Metro PharmacySuva and Superdrug Nabua.

Key Findings


21/52

18 AmoxicillinApo, a most popular generic was dispensed in three dierent quantities 9/500mg; 10/500mg and 15/500mg. Forthe 9/500mg quantity the highest price was $4.00 by Chovhan Pharmacy Ltd, Lautoka and lowest of $1.67 by LifePharmacy, Nadi (percentage price dierence of 89%).

Stalmox amoxicillin, manufactured by Stallion Laboratories Pvt Ltd, India was dispensed by Guardian Angel Phar-macy, L/Beach for $1.85 while Island Pharmacy, Ba dispensed the same drug for $7.00, a price dierence of 278%.

GSK was sold for $3.60 by MS Pharmacy, Nadi and the same medicine was sold for $7.24 by Thakorlals Pharmacy,Lautoka, a price dierence of 101%. See table below for more details.

Manufacturer

Name

Name No of

pharmacy


Dierence

StallionLaboratories PvtLtd, India

Stalmox 2 10/500mg $1.85Guardian AngelPharmacy, L/Beach

$7.00Island Pharmacy, Ba

278%

(PrawilLaboratories Ltd)

Amoxywil 9/500mg $1.61Amy Pharmacy, Suva


148%

Glaxo Smith

Kline AustraliaPty Ltd

GSK 2 9/500mg $3.60

MS Pharmacy, Nadi

$7.24

Thakorlals Pharmacy,Lautoka

101%

Not stated Apo 10 9/500mg $1.67Life Pharmacy, Nadi

$4.00Chovhan PharmacyLtd, Lautoka

89%

Pure Pharma Ltd,India

Peemox 2 10/500mg $1.85Wyse Pharmacy,Nakasi

$2.65Flagsta Pharmacy,Suva

43%

Table 11: Amoxicillin

GlipizideWith the same source and batch number, six pharmacies dispensed the same Minidiab glipizide (batch L927B). The

highest price was recorded at Island Pharmacy Ba ($3.50) while the cheapest was sold by Madison Suva ($3.00).

Ten pharmacies dispensed the same Minidiab glipizide (batch L942A). The highest price recorded was $3.75 by CityCentre Pharmacy Suva and Nasea Chemist Labasa, while the lowest was sold by Central Pharmacy Suva for $3.00.

The price dierence was $0.75 or 25%. An interesting observation was that Life Pharmacy Nausori sold this samebatch medicine but at a higher dosage of 40/5mg for $2.50. Most of the 30/5mg dosage sold cost more than $2.50.

The generic DHA glipizide was sold for $4.45 (Midway Pharmacy-Ba) and lowest at $3.00 (Health Care Chemist,Tavua), a percentage price dierence of 48%.

Manufacturer

Name

Name No of

pharmacy


Dierence

Pzer AustraliaPty Ltd

MinidiabBatch No:L942A

10 30/5mg $3.00Central Pharmacy, Suva

$3.75City Centre Pharmacy,Suva and NaseaChemist in Labasa.

25%


MinidiabBatch No:M111A

15 30/5mg $3.08Care Chemist, Sigatoka

$4.45Chovhan Pharmacy,Lautoka

44.5%


MinidiabBatch No:M111A

6 40/5mg $4.05Superdrug Pharmacy,Suva and ThakorlalsPharmacy, Nadi

$4.85Superdrug Pharmacy,Nabua and FlagstaPharmacy, Suva

20%

Drug Houseof Australia

(Asia) Pte LtdSingapore

DHA 2 30/5mg $3.00Health Care

Chemist,Tavua


48%

Table 12: Glipizide

Key Findings


22/52

19Price Variance- Same Medicine and Same QuantityPharmacists are charging higher prices for the same drug and quantity which has no credible explanation other than over-pricing. The following table would illustrate this point:

Table 13: Comparison of same drug and quantity

Manuacturers Name Drug Name Quantity Weight Lowest Price Highest Price % diference

Microlab Frusemide 30 40mg $0.83 - Nadi Chemist $4.65

Midway Pharmacy- Ba & Chovhan PharmacyLtd-Lautoka charged originator brand price

or generic medicine.

460%

Apo Frusemide 30 40mg $1.35 - Nasea Chemist,Labasa $4.65

Northern Drug Store, Wyse Pharmacy,

Nakasi & Thakorlal Pharmacy-Nadi charged

originator brand price or generic medicine.

244%

Aspirin India 15 300mg $0.60 - Mega Care Pharmacy, Holistic

Pharmacy, Rewa Pharmacy, Wyse

Pharmacy Valelevu

$2.70

Midway Pharmacy, Ba

350%

Aspirin - India 30 300mg $0.73 - Health First Pharmacy, Lie

Pharmacy Ltd -Nadi, Nadi Chemist

$2.00

Western Medicare Pharmacy, Lautoka

174%

Pure Pharma Ltd Pure Pharma Metormin

30 500mg $1.05 - Wyse Pharmacy Valelevu,Mega Care Pharmacy-Makoi, Holistic

Pharmacy Suva

$2.00A.J. Swan Pharmacy, Suva

94%

Flamingo

Pharmaceuticals Ltd

Flamingo-

Metormin

30 500mg $1.48 - Health First Pharmacy, Nadi

Chemist

$2.70

Midway Pharmacy, Ba

82%

Arrow-

Simvastatin

Batch #

SAWH0019

30 20mg $2.95 - Budget Pharmacy Nadi $9.45

My Chemist, Nasea Chemist and Northern

Drug Store, Labasa

220%

Arrow-

Simvastatin

Batch #

SAWH0023

30 20mg $3.08 - Nadi Chemist, Nadi $11.55

Central Pharmacy Suva

275%

Crescent Pharma Ltd Crescent

Batch# 08016

28 20mg $5.85 - Thakor lal Pharmacy, Lautoka $18.00

Health Care Chemist, Tavua

207%

Windlas Biotech Ltd Winstatin-

Simvastatin

30 20mg $3.15 - Amy Street Pharmacy; Good

Health Care, Suva; Guardian Angel,

L/Beach;

$10.00

Western Medicare Ltd

217%

Flamingo

Pharmaceuticals Ltd

Flaminopril-

Enalapril

30 10mg $1.50 - Holistic Pharmacy, Suva $5.00

Nadi Chemist, Patel Pharmacy, Sigatoka

233%

Flamingo

Pharmaceuticals Ltd,

India

Flaminopril

Batch No: 106

2 30/10mg $1.73 - Hyperchem Pharmacy, Ba $5.00Midway Pharmacy, Ba

189%

Ranbaxy Laboratories

Ltd

Invoril-

Enalapril

30 10mg $2.25 - Guardian Angel, L/Beach;

Wyse Pharmacy, Valelevu

$4.50

Wyse Pharmacy, Nakasi

100%

Suvik Hitek Pvt Ltd Sunapril-

Enalapril

30 10mg $1.95 - Super Drug, Nabua $3.25

A.J.Swan Pharmacy, Suva

66%

Merck Sharp Dohme

Pty Ltd

Renitec-

Enalapril

30 10mg $9.00 - Western Medicare Lautoka $13.01

Hyperchem, Lautoka

45%

Apo-

Amoxicillin

9 500mg $1.67 - Lie Pharmacy, Nadi $4.00

Chovhan Pharmacy Ltd,Lautoka

89%

Stallion Laboratories

Pty Ltd

Stalmox-

Amoxicillin

10 500mg $1.85 - Guardian Angel Pharmacy,

L/Beach

$7.00

Island Pharmacy, Ba

278%

Prawil Laboratories

Ltd

Amoxywil 9 500mg $1.61 - Amy Street Pharmacy, Suva $4.00

Midway Pharmacy, Nadi

148%

Glaxo Smith Kline GSK-

Amoxicillin

9 500mg $3.60 - MS Pharmacy, Nadi $7.24

Thakorlals Pharmacy, Lautoka

101%

Pzer Australia Pty

Ltd

Minidiab-

Glipizide

30 5mg $3.00 - Madison Pharmacy, Suva;

Central Pharmacy, Suva

$4.45

Chovhan Pharmacy, Lautoka

48%

Key Findings


23/52

20

This survey clearly demonstrates anomalies in pricing de-spite placing medicines under Price Control. A few exam-ples of meaningless pricing are outlined below:

Midway Pharmacy, Ba sold 15 aspirin for $2.70, WysePharmacy, Nakasi sold 20 aspirin for $2.25 whereas

Health First Pharmacy, Life Pharmacy, Nadi, and NadiChemist sold 30 aspirin for $0.73. Why sell 15 aspirin for$2.70 but 30 aspirin for $0.73?

Sugar City Pharmacy, Lautoka sold 15 amoxicillin (Apo)for $3.45 while Chovhan Pharmacy Ltd, Lautoka sold 9tablets ofamoxicillin (Apo) for $4.00.

10 Amoxywil was sold for $2.00 by Hyperchem, Bawhere as Midway Pharmacy Ltd sold 9 tablets of Amox-

ywil for $4.00. Island Pharmacy, Ba dispensed 30 Crescent, aimvastitin

for $9.00 while Thakorlal Pharmacy, Lautoka dispensed28 tablets for $5.85. Why does it cost $3.15 for only twoextra tablets?

The above analysis clearly shows that the majority of phar-macies in Fiji are unnecessarily charging higher pricesthus indulging in proteering. The trade margins in phar-maceuticals are astronomical. The dierence in price isover 400%! The pharmaceutical sector owes an explana-tion to the Government (provider of incentives) and thepublic (consumers) for these absurd anomalies in prices.Although prescribed medicines are placed under PriceControl with a percentage mark up of 35%, the Councils

survey still reveals very high trade margins. For example,drugs such as Microlab frusemide (with 460% price dier-ence); aspirin (India) (with 350% price dierence); Stalmoxamoxicillin (with 278% price dierence) are only a tip ofthe iceberg. It was also noted that several pharmaciessold originator brand for maximum prots. Consumers areforced to pay for a very inated cost, which could havebeen easily reduced by retailers and still make reasonableprots.

Meaningless Pricing

Protability VS. Proteering

My wife returned home to Australia recently afterspending time with sick Mum in Suva and related arather disquieting story. After a visit to their family doc-tor, her Mum was given a prescription for 30 tabletswhich they took to a pharmacy in the Nabua area. Thesales assistant was very helpful and polite. While shewas browsing, the sales assistant told her that the pre-scription would cost $30.75.

She was surprised at the high cost, but as the needwas urgent she gave approval for the prescription tobe lled. When the medication was brought to her ina plastic zip lock bag, she decided to check the con-tents and noticed only 20 tablets instead of the 30 pre-

scribed. The sales assistant was embarrassed, but rec-tied the problem through the pharmacist. While anapology was given, no further explanation was forth-

coming so my wife thought it was a genuine mistakeand left.

However she decided to share the experience with hersister who uses a pharmacy in Laucala Bay area. Whatshe found was that her sister had paid only $6.75 forthe same prescription the previous month at the Lau-cala Bay pharmacy. They rang the Laucala Bay phar-macist who was very helpful and explained that themedication from Nabua pharmacy was most likely theoriginal, hence the exorbitant price.

It came to light after my wife checked with the phar-macy in Nabua that the medication was indeed theoriginal, hence the excessive cost. It was ironic that a

few days later, the local newspapers featured an arti-cle on generic brands versus original brands and howsome pharmacies were not giving the public the op-tion to choose.

The other disconcerting thing is that, the Nabua andnearby areas are serviced by possibly one pharmacy.

This leaves members of the public little or no choiceand at the mercy of a monopolistic trader.

COLIN DEOKI

Australia

Medicine

price

Letter to Editor

Published in Fiji Times - 19/12/2010

Key Findings


24/52

21Pharmacy Trade PracticesThis part of the report deals with non-price issues in particular pharmacy practices in dispensing medicines to

consumers.

Issues with ReceiptsThis research has also highlighted many problems with the receipting procedures of these pharmacies. Noneof the 47 pharmacies provided individual medicine names on their receipts however, nineteen (19) provideditemised receipts using codes. Thirty two (32) pharmacies provided medicine price on their labels. Out of the 32pharmacies that provided prices on their labels, 15 did not provide itemised receipts.

Three (3) pharmacies did not supply the basic information required by Fiji laws such as the company name, taxnumber, and company address and so on. These were Sugar City Pharmacy- Lautoka and Chovhan Pharmacy alsoin Lautoka and Patel Pharmacy in Sigatoka. Madison Pharmacy, Suva provided a chit with total price when re-quested for a receipt by our sta. In the Northern Division, Northern Drug Store, Labasa issued a receipt from MyChemist instead of a receipt specically for Northern Drug Store. The owners are the same for both Drug Stores.

There were some pharmacies with receipts that had one code such as 005785 Prescription instead of the namesof each medicine. There was no way a consumer could have known how much he/she paid for each medication.An interesting nding here was that Wyse Pharmacies in Nakasi and Valelevu have the same owner but Valelevubranch had prices clearly marked on each medication pack whereas the one in Nakasi did not do this. WyseNakasi instead provided a receipt with the total amount. One would assume that the same business would have

similar practices however in this case the practice of pricing was dierent. Some of the practices used by thepharmacies in issuing receipts are a breach of Counter Ination Act (Cap 73)

2

1

Pharmacy Trade Practices

Table 14: Non-disclosure of individualmedicine prices

PHARMACY Location/Division

1 A.J.Swann Co Ltd Suva/Central Eastern

2 Life PharmacyNausori/ CentralEastern

3 Wyse PharmacyNakasi/ CentralEastern

4 Chovahan Pharmacy Ltd Lautoka/Western

5 Midway Pharmacy Ba/ Western

6Western Medicare

Pharmacy

Lautoka/ Western

7 Island Pharmacy Ba/ Western

8 Patel Pharmacy Ltd Sigatoka/ Western

9 Naidus Medical Centre Rakiraki/Western

10 Health Care Chemist Tavua/ Western

Non-disclosure of individual medicine prices

It should be noted that 10 pharmacies (see Table 14) did notprovide price information on individual receipts or on the pack-age. Instead the total cost of medicine purchased was provided.Seven (7) of these pharmacies are in the Western Division while3 are in the Central/Eastern Divisions. All 3 pharmacies in Labasaprovided itemised receipts. However, Northern Drug Store, La-basa issued a My Chemist receipt. To obtain individual pricesof medicines, 11 pharmacies were contacted via telephone byCouncil sta. The team was unable to obtain pricing informa-tion from Naidus Medical Centre in Rakiraki. Furthermore, somepharmacies which issued receipts with total cost of medicine didhave prices on individual medication packs but only on some ofthem. Other packets did not have prices on them. For exampleLife Pharmacy in Nadi did not provide prices on the packets ofsimvastatin, metformin and frusemide. Some of these pharma-cies, for example, Chovhan Pharmacy Ltd, Midway Pharmacy, Badid not provide itemised receipts but sold generics at originatorbrand price.


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22 Presence of PharmacistA pharmacist is required to check the prescrip-tions before dispensing medicines. 35 out of 47pharmacies surveyed did not have a pharmacistvisible within the premises. The Council sta, whowere posing as consumers were either servedby the Pharmacy Assistant or the Sales Assist-ant. However, a more rm conclusion about thepresence of the pharmacist would have beenpossible, if there was a whole days surveillancein each pharmacy. The Council wishes to statethat the onus is on the regulatory authorities tolook into this and to be more vigilant on this is-sue. FPS should encourage pharmacists to weara coat so that the public can identify a pharma-cist from other sta. The name of the pharmaciston duty should be made visible at all times.

Queries on prescription51% of pharmacies under survey made inquirieson the prescription and the patient, while 49%dispensed drugs without any further clarica-tion. The two questions posed by the pharma-cies were age and the patients phone number.One pharmacy Hyperchem Pharmacy, Ba re-quested the address of the patient, while Tha-korlals Pharmacy Nadi commented that the pa-tient must be very sick and dying

It should be noted that the higher number ofqueries on the prescription were made by thepharmacies in the Western Division. This wasprobably due to two factors; the prescriptionwas from a Suva-based doctor and the purchas-er was non-Indian when the prescription was foran elderly Indian man.

DIVISIONSNo. of

Pharmacies

Queries

made%

No

queries

made

%

Central/Eastern

23 3 13 20 87

Western 21 11 52.4 10 47.6

Northern 3 0 0 3 100

TOTAL 47 24 51 23 49

Wrong Name on Medicine Packets

Pharmacy Plus of Suva incorrectly entered the patients name on the medicine packs. The purchasers name(Alisi) appeared on the packs instead of the patients name (Hari Ram) as per prescription (Case 1). Similarly,Life Pharmacy in Nadi incorrectly entered the patients second name (Ram) and had Prasad instead (Case 2).

3 4

5

6

Choice over generic or originator brand medicinesDuring our survey, none of the pharmacies asked the buyer whether he/she wanted generics or originator brandof medicines. The general rule amongst pharmacists is to dispense generic drugs when presented with a hospitalprescription 9. Some pharmacies dispensed originator brand even though generic versions are commonly avail-able. For example, 500mg of generic metformin was available at Budget Pharmacy for at $0.85 while an originatorbrand was sold for $7.95 at Namaka Medisure Pharmacy, Nadi which is ten times more.


9 Information provided by our industry expert.


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23Wrong strength dispensedOne common practice among pharmacies is to dispense the correct medicine but with an incorrect dosage. Thereis a general assumption that a pharmacist as a professional would dispense the correct dosage of medication as andwhen required. Too little or too much of any medication could have adverse eect on ones health. There are severalexamples of this. Thakorlals Pharmacy in Lautoka dispensed 5 mg enalaprilas seen on the packet but the label

stated 10mg as per prescription. A consumer unknowingly would have consumed a lower dose which is contraryto the doctors recommendation. Such mistakes can be fatal. This pharmacy also incorrectly stated that the doctorwas from Lautoka Hospital instead of CWM hospital.

Sugar City Pharmacy in Lautoka dispensed 15 amoxicillin capsules when the prescription required a dosage of 9capsules. The prescription clearly stated no repeats for this particular anti-biotic. In another case Wyse Pharmacy inValelevu dispensed 30 tablets of 100mg

Aspirin tablets with instructions on the label to take one tablet daily after food. The prescription stated a dosage150mg aspirin per day for a month.

In other cases, Thakorlals Pharmacy, Nadi dispensed 28 tablets of 20mg of simvastatin - Crescent rather than 30tablets of 20mg. Life Pharmacy, Nausori dispensed 40 tablets of 5g ofglipizide Minidiab instead of 30 and NaidusMedical Centre issued 20 tablets of 5mg ofglipizide Minidiab. Rewa Pharmacy Nausori changed the dose anddispensed 20/40mg ofsimvastatin Arrow instead of 30/20mg.

Fraudulent SaleThree pharmacies were found selling generic medication labelled as originator brand and also charging origi-nator brand price. Thakorlal Pharmacy in Nadi, and Wyse Pharmacy in Nakasi dispensed generic frusemidetablets Apo but labelled it as Laxis which is an originator brand tablet and also charged the price of Laxis ($4.65) which is much more expensive than generic Apo ($1.35

7

8



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24

Problems with labelsNineteen (19) pharmacies violated labelling re-quirements in one way or another. An apparentissue with labelling was the directions for useof the medicine. For example, Life Pharmacy-

Nausori had hand written directions on all thelabels of its medication. The problem here wasthat these instructions could easily fade throughhandling or if it gets wet. A number of pharma-cies did not have any directions for the use ofmedication on their labels while there weresome which not only had clear directions foruse but also had auxiliary labels with additionalcautionary advice such as avoid taking alcoholor grape fruit juice while taking the medication.

There needs to be a standardisation of practicein the labelling of labelling medication.

Pharmacy located in same building as medical practitioners or near

each otherIn Nadi, two pharmacies situated on Lodhia Street are each housed in the same building as medical practi-tioners. Life Pharmacy is located next door in the same building as Faizals Medical Centre. The next buildingis Health First Pharmacy housed under the same building as Zens Medical Centre. The survey found a $10.08

prescription pack price dierence between Life Pharmacy ($22.00) and Health Pharmacy ($32.08). In Suva, thesame goes for Amy Street Pharmacy located within the Suva Private Hospital pharmacy. The issue here is therestriction of consumer choice as doctors are more likely to recommend these pharmacies to their patients.Moreover, inpatient and outpatients choice on pharmacies can be very limited in this case.

9

10



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25

Pharmacy ownership laws are totally exploited by select-ed individuals through false information. In some casesnames are lent to operate limited liability companies butthe people whose names are used had migrated as farback as 1987 or are working for some other organisationor are non pharmacists. Non pharmacists who appear asowners must have been given token shares for use of theirnames.

Under the Pharmacy and Poisons Act (Cap 115), Section18 (d) all the share capital of the body corporate is ownedby registered pharmacists. Our company search has foundthat there are 9 non-pharmacists who have shares in phar-macies. This does not include others who had migrated.

The Council expects the reasons for including of non-

pharmacists are for nancial assistance to start the compa-ny. However, nancial help also amounts to direct interfer-ence in the independence of pharmacies and the abilityof a pharmacist to make decisions based on ethics ratherthan purely on nancial gains. This was evident in the sur-vey where originator brand medicine was dispensed in-stead of generics which are widely available and the samebrand and quantity sold at exorbitant price. Over charg-ing was evident which is a direct result of interference. Itmust be noted that when a few individuals are involvedin a web of cross ownership of pharmacies and subsidiar-ies, we cannot discount the high probability of cartel-like

behaviour or price xing.In one case the company documents of Flagsta Phar-macy, Metro Pharmacy and Nasese Pharmacy were faxed

from the same source where information for SuperdrugPharmacy, Nabua; Central Pharmacy, Suva; SuperdrugPharmacy, Suva; and City Centre Pharmacy was faxed.

The ownership of pharmacies by medical practitionerswhile illegal under the current laws is also a very worryingtrend as both diagnosis and dispensing can be compro-mised for maximum prots.

Fiji Islands Revenue and Customs Authority (FIRCA) shoulddetermine through its own investigation s whether com-panies and their shareholders are accurately declaringtheir income for tax purposes. There are violations, for ex-ample nonpharmacists are shareholders in some casesand in a few cases the same shareholder(s) own multi-ple pharmacies according to the Registrar of Companies

records.

Non-pharmacist Pharmacy having ownership in

Swadesh Prabha Ram Sugar City Pharmacy

Virendra Shantilal PatelBarti Ben

Patel Pharmacy

Hamida Khan Namaka Medisure

Jone Finiasi Metro Pharmacy Suva

Jone Finiasi Nasese Pharmacy Suva

Dr Bijend Ram Rewa Pharmacy

Kalyan Sunil Kumar Laucala Bay Pharmacy

Ajay Ram Khelawan Nausori Pharmacy

Table16: Pharmacy Ownership

Pharmacy Ownership

There are certain pharmacyowners who own more

than two pharmacies, theywould have to either sell or

close down the additionalpharmacies they operate.

Dr. Neil Sharma - Minister of Health, Fiji.

Pharmacy Ownership


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26

The Consumer Council found a majority of those pharma-cies surveyed were engaging in proteering. A consumersimply trusts the pharmacist, and believes that the pre-scription issued by the medical doctor will be dispensedin good faith by the pharmacist. Unfortunately, consumerstrust in pharmacists for their health care had been violatedby not allowing them the freedom to choose a genericor an originator brand of medication, not issuing proper

receipts and engaging in fraudulent practices.

The study has indicated that information is not readilyavailable to patients/consumers (even to the educated cit-izens) on medicines and prices which they should know.Due to the lack of such information, consumers are solelydependent on the local pharmacies/chemists for the in-formation on types, prices, alternatives and other param-eters for the selection of medicines. It was also observedthat whatever little communication that exists betweenthe pharmacists and consumers it often not easily under-stood.

The survey was done realistically and objectively keepingin view the importance of the health sector. It should bereiterated that the role of the pharmaceutical sector is toconduct business within the laws of the country as well askeeping the citizens health and well being in mind. Protsare important for any business but it must not be at theexpense of the innocent patients or consumers. The medi-cal eld has advanced so much that this day and age themain focus globally is access to aordable drugs.

The pharmaceutical sector needs to work with relevantGovernment agencies in making the accessibility and af-fordability of medicines a genuine concern for the well be-

ing and health of our citizens.

RECOMMENDATIONSBased on these ndings, the Council recommends thefollowing measures be adopted by the Ministry of Healthand other concerned organizations dealing with health-care issues and ensuring a better dispensing services ofmedicines at aordable prices:

1. To acknowledge that there have been breaches and

unfair trade practices by the pharmaceutical sectorand that the enforcement agencies have not been

vigilant;

2. Pharmacy and Poisons Board together with PIB

(Commerce Commission) to prosecute pharmacies

if breaches have occurred. The Council will supply

the dispensed medications as evidence, if required.

This must be done by thoroughly scrutinising all in-

voices which are less than 3 months of supply date

as purchases would have been made within that time

frame. This must be done urgently because the Coun-cil wishes to recover money spent on the purchase of

these medications;

3. The Price Control Order is now some 18 years out of

date thus urgently needs to be reviewed and amend-

ed to address Fijis increasing cost of health care. PIB

has neither carried out any review of the Price Control

Order on medicines nor has it produced any formal

monitoring report to gauge compliance. PIB/Com-

merce Commission should play a more active role in

monitoring and enforcing Price Control Orders and

where possible prosecute oending pharmacists;

Conclusion and

Recommendations

The Consumer Council of Fiji survey adds credibility to the notion

that some pharmacies are overcharging consumers either by

pricing more expensive brands rst or deliberately not informing

consumers of the availability of cheaper generic medicine.

It will be interesting to see what action is taken to ensure

consumers are made aware of their right to proper medication

at a price that is justied and fair.

Editorial comment Fiji Times (19/11/2010)

Conclusion and Recommendations


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274. Pharmacy and Poisons Board needs to take a more

proactive role in regulating the industry and its

practices. The governing legislation, Pharmacy and

Poisons Act appears to regulate registration and de-

registration of pharmacists under Section 5 and 33

respectively. This law needs to be better enforced. The

Council calls for an urgent review of the Pharmacy

and Poisons Board to make this body eective and ef-

cient in enforcing the laws and in attending to com-

plaints. Membership should include representatives

from enforcement agencies, consumer groups and

NGOs for transparency and eectiveness of the board;

5. The law also establishes the Fiji Pharmaceutical Soci-

ety (Section 32B). They need to strengthen their code

of ethics and monitor market practices. The society

also needs to undertake regular training and edu-

cation to up-skill its members and ensure that they

are up to date with the changing role of pharmacistsin the health sector. They should have merit system

whereby certain points are acquired to qualify for an-

nual registration. Registration requirements should

be made clearer in the legislation and should include

what is considered bad marketing practices;

6. A price list of common drugs consumed for common

illnesses should be prominently displayed at pharma-

cies. PIB/Commerce Commission to list these in a re-

vised price order;

7. The Ministry of Health to impose a strict Code of Con-

duct that must be practised by all pharmacies. The

Code of Conduct has to be a binding document and

any breaches to it should lead to nes or cancellation

of licenses;

8. Fiji Islands Revenue and Customs Authority (FIRCA)

can investigate whether companies and their share-

holders are accurately and truthfully declaring their

income for tax purposes. There are violations, for ex-

ample nonpharmacists are shareholders in somecases and in a few cases the same shareholder(s) own

multiple pharmacies according to the Registrar of

Companies records;

9. FPS to ensure its members wear professional attire

(e.g white coat) so that the public can dierentiate

a pharmacist from other pharmacy sta. FSP should

also require that pharmacies display the pharmacists

name that is on duty at one particular period of time;

10. FPS, the Ministry of Health and the Consumer Coun-cil of Fiji should educate consumers on the dierent

categories of medicines generics, branded generics

and originator brands, including labelling informa-

tion;

11. Pharmacies should display information on the prices

of essential, commonly used drugs. Such information

will assist consumers to compare prices before pur-

chasing medicines;

12. FPS and the Ministry of Health should set up guide-

lines for dispensing of drugs. Providing consumer

drug information for all parties involved will empower

consumers to make informed decisions thus safe-

guarding their rights to health and information;

13. The Ministry of Health/Commerce Commission

should also look at the importers and distributors of

pharmaceuticals in Fiji to ensure competition. The

Councils coverage of this survey did not include this

aspect but this is an important feature which should

be looked at separately by relevant agencies; and

14. The Government to implement the recommenda-

tions of the study so as to empower the citizens of Fiji

and rid of any room for manipulation by pharmacies

to protect their health interests.

Conclusion and Recommendations


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28

Bailey, M. 2004. Aordability of Medicines in Fiji. http://www.haiweb.org/medicineprices/surveys/200409FJ/survey_report.pdf

Fiji Bureau of Statistics (2010), Preliminary Report : Poverty and Household Incomes in Fiji in 2008-09.

Fiji Republic Gazette Supplement, No.26, Friday 5th June, 1992; Legal Notice No.69, Counter-Ination Act (Chapter 73),Counter-Ination (Price Control), Ethical Medicine, No.5, Order, 1992.

MedilinePlus online service of the United States National Library of Medicine, From the National Institutes of Health, www.nlm.nih.gov/medlineplus/druginfo (Accessed 12 June 2010) Medicine description and use (Table 1).

Ministry of Health, October 2009. Monitoring of Pharmaceutical Prices in Private Sector.

Ministry of Health, October 2009. Naturopathic Medicine- Retailing in Fiji.

Panapasa G., 2010, Symposium on NCDs, Fiji Times, 6 July.

Speech of the Ministry for Health, Dr Neil Sharma delivered to members of the Fiji Pharmaceutical Society, Natadola, Nadi,29th Nov 2009. Www. www.health.gov./speeches/29/11/2009--ji-pharmaceutical-societynatadola.html (Accessed 15

June 2010)

References

References


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29Appendix

Response From Pharmacy and Poisons Board

Response From Pharmacy and Poisons Board


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30Response From Fiji Pharmaceutical Society

Response From Fiji Pharmaceutical Society


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31

Response From Fiji Pharmaceutical Society


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32

CENT

RAL/EASTERNDIVISION

No

Pharmacy

Medication

TotalPrice

Comments/Notes

Frusemide

30/40mg

Aspirin

30/150

mg

Metormin

30/500mg

Simvastatin

30/20mg

Enalapril

30/10m

g

Amoxicilllin

9/500mg

Glipizide

30/5mg

*1

A.J.

SwannCo

Ltd,

Suva

Microlab

$2.0

0

(India)

$1.2

5

PurePharma

$2.0

0

(PurePharma

Ltd)

Batch#80002

ExpiryDate:

06/2011

Arrow

$5.0

0

Batch#

SAWH0022

ExpiryDate:

10/2011

Sunapril

$3.2

5

(SuvikHitekPvtLtd)

Batch#

0002

ExpiryD

ate:

12/2012

Stalmox

$2.4

5

(Stallion

LaboratoriesPvt

Fiji Consumer Council - Prices and Practices ^ Pharmaceutical Survey 2010 - 2010

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