Concurrent Contributed Paper Session 4: Pharmacoepidemiology at the macro level: Drug utilisation, policy impacts and global pharmacogenetics
Tracks
Track 2
| Sunday, November 23, 2025 |
| 9:00 - 10:30 |
Speaker
Mr Hung-Wei Lin
Senior Consultant
IQVIA Solutions Taiwan
Real-world treatment patterns and outcomes of biologics in severe asthma in Taiwan
Abstract
Introduction:
With the increasing availability of biologic therapies for severe asthma in Taiwan, it is important to assess their real-world utilization patterns and associated outcomes to inform treatment decisions and healthcare policy.
Aims:
To investigate the real-world treatment retention and risk of severe asthma exacerbation (SAE) among patients with severe asthma initiating biologic therapies in Taiwan.
Methods:
This retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database and Cause of Death Registry (2017-2023). Adult patients with asthma who initiated a biologic—benralizumab, mepolizumab, or omalizumab—between January 2018 and November 2022 were included. The index date was defined as the date of the first biologic prescription. Generalized overlap weighting was applied to balance the baseline characteristics across groups. The 12-month treatment retention rate was estimated, and time to treatment discontinuation was analyzed using Kaplan-Meier methods. Risks of SAE within one year after the index date were evaluated using a negative binomial regression model.
Results:
A total of 2,586 eligible patients were identified. After weighting, 112, 111, and 110 patients were included in the benralizumab, mepolizumab, and omalizumab group, respectively. Benralizumab users had a higher 12-month treatment retention rate (65.8%) compared with mepolizumab (61.1%) and omalizumab users (50.8%). Median time to treatment discontinuation was longest for benralizumab (716 days), followed by mepolizumab (570 days), and omalizumab (394 days). The SAE incidence rate per person-year was lowest for benralizumab 0.20 (95% CI: 0.14-0.30), compared to mepolizumab (0.36 [0.30-0.44]) and omalizumab (0.40 [0.33-0.47]). Compared to benralizumab, the incidence rate ratio for SAE was 1.80 (1.16-2.77, p<0.01) for mepolizumab and 1.96 (1.28-3.01, p<0.01) for omalizumab.
Conclusion:
In this real-world cohort, benralizumab was associated with higher treatment persistence and a lower risk of SAEs compared to mepolizumab and omalizumab. Further research is needed to confirm these findings.
Keywords: Asthma, Biologics, Acute exacerbations
With the increasing availability of biologic therapies for severe asthma in Taiwan, it is important to assess their real-world utilization patterns and associated outcomes to inform treatment decisions and healthcare policy.
Aims:
To investigate the real-world treatment retention and risk of severe asthma exacerbation (SAE) among patients with severe asthma initiating biologic therapies in Taiwan.
Methods:
This retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database and Cause of Death Registry (2017-2023). Adult patients with asthma who initiated a biologic—benralizumab, mepolizumab, or omalizumab—between January 2018 and November 2022 were included. The index date was defined as the date of the first biologic prescription. Generalized overlap weighting was applied to balance the baseline characteristics across groups. The 12-month treatment retention rate was estimated, and time to treatment discontinuation was analyzed using Kaplan-Meier methods. Risks of SAE within one year after the index date were evaluated using a negative binomial regression model.
Results:
A total of 2,586 eligible patients were identified. After weighting, 112, 111, and 110 patients were included in the benralizumab, mepolizumab, and omalizumab group, respectively. Benralizumab users had a higher 12-month treatment retention rate (65.8%) compared with mepolizumab (61.1%) and omalizumab users (50.8%). Median time to treatment discontinuation was longest for benralizumab (716 days), followed by mepolizumab (570 days), and omalizumab (394 days). The SAE incidence rate per person-year was lowest for benralizumab 0.20 (95% CI: 0.14-0.30), compared to mepolizumab (0.36 [0.30-0.44]) and omalizumab (0.40 [0.33-0.47]). Compared to benralizumab, the incidence rate ratio for SAE was 1.80 (1.16-2.77, p<0.01) for mepolizumab and 1.96 (1.28-3.01, p<0.01) for omalizumab.
Conclusion:
In this real-world cohort, benralizumab was associated with higher treatment persistence and a lower risk of SAEs compared to mepolizumab and omalizumab. Further research is needed to confirm these findings.
Keywords: Asthma, Biologics, Acute exacerbations
Biography
Kevin is a Senior Consultant at IQVIA Taiwan with over 10 years of experience in Health Economics and Outcomes Research (HEOR) and real-world studies. For the past 7 years, Kevin has worked in consulting, supporting evidence generation strategies for the healthcare industry, includes health technology assessments (HTA), market access strategies.
Dr. Mohitosh Biswas
Professor
University of Rajshahi
Prevalence of risk phenotypes associated with CYP2D6 genetic polymorphisms in world populations
Abstract
Introduction: The CYP2D6 enzyme encoded by the CYP2D6 gene is highly polymorphic, in which CYP2D6*2,*4,*10 and *41 may affect the safety or effectiveness of many clinically important medications as outlined in the (PGx)-based dosing guidelines.
Aims: It was aimed to determine the predictive prevalence of risk phenotypes associated with the CYP2D6*2,*4,*10 and *41 genetic variants collectively in the world populations. It was also aimed at linking the predictive risk phenotypes with the safety or effectiveness of medications.
Methods: Allele frequency of CYP2D6*2,*4,*10 and *41 were obtained from the 1000 Genomes project. Risk phenotypes were assigned using international standardized consensus terms based on the carrier of characteristics alleles and were linked with the safety or effectiveness of medications using PGx-dosing recommendations.
Results: Overall, ~32% of the total 2504 world populations that participated in the 1000 Genomes projects were identified as risk phenotypes (ultra-rapid, intermediate and poor metabolizers) due to inheriting CYP2D6*2,*4,*10 and *41 genetic variants. The risk phenotypes were highly prevalent in Africans (11.98%, 95% CI 11%-13%) followed by Europeans (9.11%; 95% CI 8%-10%), Southeast Asians (5.23%; 95% CI 4%-6%), Americans (4.79%; 95% CI 4%-6%) and East Asians (0.56%; 95% CI 0%-1%)), respectively. The prevalence of these risk phenotypes in different ethnicities was highly statistically significant (χ2 test, p=4.04×10-64). At least 27 drugs that are routinely used in clinical practice are identified that may need either dose adjustments or alternative drugs of standard therapy in these risk phenotypes due to inheriting CYP2D6 genetic variants.
Conclusions: Approximately one-third of global populations may be at risk of either sub-therapeutic responses or toxicities for at least 27 routinely used very important drugs due to the CYP2D6 genetic variability. Clinical studies are warranted that could be able to assess the safety or effectiveness of these medications considering the PGx effects in real-world clinical settings.
Aims: It was aimed to determine the predictive prevalence of risk phenotypes associated with the CYP2D6*2,*4,*10 and *41 genetic variants collectively in the world populations. It was also aimed at linking the predictive risk phenotypes with the safety or effectiveness of medications.
Methods: Allele frequency of CYP2D6*2,*4,*10 and *41 were obtained from the 1000 Genomes project. Risk phenotypes were assigned using international standardized consensus terms based on the carrier of characteristics alleles and were linked with the safety or effectiveness of medications using PGx-dosing recommendations.
Results: Overall, ~32% of the total 2504 world populations that participated in the 1000 Genomes projects were identified as risk phenotypes (ultra-rapid, intermediate and poor metabolizers) due to inheriting CYP2D6*2,*4,*10 and *41 genetic variants. The risk phenotypes were highly prevalent in Africans (11.98%, 95% CI 11%-13%) followed by Europeans (9.11%; 95% CI 8%-10%), Southeast Asians (5.23%; 95% CI 4%-6%), Americans (4.79%; 95% CI 4%-6%) and East Asians (0.56%; 95% CI 0%-1%)), respectively. The prevalence of these risk phenotypes in different ethnicities was highly statistically significant (χ2 test, p=4.04×10-64). At least 27 drugs that are routinely used in clinical practice are identified that may need either dose adjustments or alternative drugs of standard therapy in these risk phenotypes due to inheriting CYP2D6 genetic variants.
Conclusions: Approximately one-third of global populations may be at risk of either sub-therapeutic responses or toxicities for at least 27 routinely used very important drugs due to the CYP2D6 genetic variability. Clinical studies are warranted that could be able to assess the safety or effectiveness of these medications considering the PGx effects in real-world clinical settings.
Biography
Dr. Mohitosh Biswas is currently serving as a Professor at the Department of Pharmacy of Rajshahi University, Bangladesh. Dr. Biswas completed his PhD degree from the School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Australia in 2018. He has completed 02 years of Research Consultancy at the Pharmacogenetics and Personalized Medicine (PPM) Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. To date, Dr. Biswas has published more than 50 peer-reviewed journal articles, many of which have been published in high-quality international scholarly journals including Nature Portfolios, with over 100 cumulative impact factors. Dr. Biswas has substantial research experience in the field of molecular epidemiology and pharmacogenomics.
Dr Takehiro Ishida
Visiting doctorial researcher
Teikyo University Graduate School of Public Health
Nationwide serial cross-sectional study for outpatient cancer chemotherapy after new policy implementation
Abstract
Introduction
Outpatient chemotherapy enables cancer patients to maintain quality of life and to reduce the financial burden of hospitalization. In April 2022, the Ministry of Health, Labour and Welfare in Japan newly introduced incentives for outpatient chemotherapy and its side effect management (1,000 JPY for patients ≥ 15 years old).
Aims
This study analyzed the effectiveness of the newly introduced policy for enhancing the management system for outpatient chemotherapy in Japan.
Method
A nationwide serial cross-sectional study was conducted using Japan’s annual reimbursement claims from fiscal years 2021 to 2022.
The primary outcome was the outpatient ratio of anticancer medications, a percentage of the prescription number of anticancer medications for outpatients in the total anticancer medication prescriptions. Another outcome was the claim counts for outpatient oncology chemotherapy Type 1 and 2. There are two types of outpatient chemotherapy, and Type 1 requires a more experienced pharmacist and dedicated treatment equipment.
The means (95% CI) of prefecture-based outpatient ratio, and claim counts of Type1 and Type2 were analyzed (n=47), and a paired t-test was performed for the outpatient ratio in FY2021–FY2022. P-value (two-sided) < 0.05 was considered statistically significant.
Result
The means (95% CI) of the outpatient ratios in 47 prefectures were 69.21% (67.26%–71.16%) in FY2021, and 71.28% (69.64%–72.91%) in FY2022. The differences of outpatient ratio were 2.06% (p<0.001) for FY2021–FY2022.
The mean (95% CI) prefecture-level increase in outpatient chemotherapy for FY2021–FY2022 was 14.31% (12.54%–16.08%) for Type 1, and -6.56% (-20.87%–7.75%) for Type 2.
Conclusion
The statistically significant increase of the outpatient ratio for oncology chemotherapy was observed in Japan after the newly introduced policy in 2022. The increase in Type 1 outpatient chemotherapy suggests improved access to specialized care, while the stagnation in Type 2 highlights potential disparities in healthcare infrastructure.
Keywords
outpatient oncology chemotherapy, policy assessment, serial cross-sectional study
Outpatient chemotherapy enables cancer patients to maintain quality of life and to reduce the financial burden of hospitalization. In April 2022, the Ministry of Health, Labour and Welfare in Japan newly introduced incentives for outpatient chemotherapy and its side effect management (1,000 JPY for patients ≥ 15 years old).
Aims
This study analyzed the effectiveness of the newly introduced policy for enhancing the management system for outpatient chemotherapy in Japan.
Method
A nationwide serial cross-sectional study was conducted using Japan’s annual reimbursement claims from fiscal years 2021 to 2022.
The primary outcome was the outpatient ratio of anticancer medications, a percentage of the prescription number of anticancer medications for outpatients in the total anticancer medication prescriptions. Another outcome was the claim counts for outpatient oncology chemotherapy Type 1 and 2. There are two types of outpatient chemotherapy, and Type 1 requires a more experienced pharmacist and dedicated treatment equipment.
The means (95% CI) of prefecture-based outpatient ratio, and claim counts of Type1 and Type2 were analyzed (n=47), and a paired t-test was performed for the outpatient ratio in FY2021–FY2022. P-value (two-sided) < 0.05 was considered statistically significant.
Result
The means (95% CI) of the outpatient ratios in 47 prefectures were 69.21% (67.26%–71.16%) in FY2021, and 71.28% (69.64%–72.91%) in FY2022. The differences of outpatient ratio were 2.06% (p<0.001) for FY2021–FY2022.
The mean (95% CI) prefecture-level increase in outpatient chemotherapy for FY2021–FY2022 was 14.31% (12.54%–16.08%) for Type 1, and -6.56% (-20.87%–7.75%) for Type 2.
Conclusion
The statistically significant increase of the outpatient ratio for oncology chemotherapy was observed in Japan after the newly introduced policy in 2022. The increase in Type 1 outpatient chemotherapy suggests improved access to specialized care, while the stagnation in Type 2 highlights potential disparities in healthcare infrastructure.
Keywords
outpatient oncology chemotherapy, policy assessment, serial cross-sectional study
Biography
Doctor of Public Health from Teikyo University (March 2024)
MBA from University of Massachusetts (May 2020)
Registered pharmacist in Japan (June 2009)
Mr Sam Wade
PhD Student
Monash University
Impact of gender-affirming hormonal therapy on medication use: interrupted time series analysis
Abstract
Introduction: Trans and gender diverse people have a gender identity that differs to the one assigned to them at birth. Gender affirming hormone therapy (GAHT) is used to align physical characteristics with gender identity and improve psychosocial outcomes. Changes in medication use may serve as proxies for the health impacts of GAHT.
Aims: To perform an interrupted time series (ITS) to identify the impact of GAHT initiation on antidepressant, anxiolytic/hypnotic, antiepileptic, and cardiovascular medication use.
Methods: A 10% sample of subsidised prescriptions from the Australian Pharmaceutical Benefits Scheme was used from 2012-2024 to identify GAHT users aged ≥12. GAHT initiation was defined as: 1. Incongruent use of sex hormone (oestradiol or testosterone) with recorded sex; or 2. A change in recorded sex, and congruent sex hormone use. GAHT users were grouped into ‘assigned female at birth’ (AFAB) and ‘assigned male at birth’ (AMAB). To quantify physical and mental health impacts, a quasi-experimental ITS was performed using a Prais-Winsten regression on monthly medication use rates for 12-months pre- and post-GAHT initiation.
Results: 2519 GAHT users were identified (1032 AFAB; 1487 AMAB). Prior to GAHT initiation, an increasing trend in antidepressant use was observed for AFABs (+0.20%, 95% CI[0.08%,0.31%]) and AMABs (+0.39%, 95% CI[0.27%, 0.51%]), anxiolytic/hypnotic use for AMABs (+0.06%,95% CI[0.02%,0.10%]), and cardiovascular medication use for AFABs (+0.09%, 95% CI[0.04%,0.13%]). Following GAHT initiation, there was an immediate increase in antidepressant use in AMABs (1.60%, 95% CI[0.44%,2.76%]). There was a decline in the rates of antidepressant use after GAHT for AFABs (-0.19%, 95% CI[-0.38%,-0.01%]) and AMABs (-0.24%, 95% CI[-0.41%,-0.06%]).
Conclusions: GAHT initiation significantly impacted antidepressant use in both subgroups, suggesting positive psychological effects by nearly negating the increasing pre-intervention trend. In contrast, GAHT initiation had no significant impact for anxiolytic/hypnotics, antiepileptics, or cardiovascular medications.
Keywords: Interrupted time series, quasi-experimental, trans & gender diverse
Aims: To perform an interrupted time series (ITS) to identify the impact of GAHT initiation on antidepressant, anxiolytic/hypnotic, antiepileptic, and cardiovascular medication use.
Methods: A 10% sample of subsidised prescriptions from the Australian Pharmaceutical Benefits Scheme was used from 2012-2024 to identify GAHT users aged ≥12. GAHT initiation was defined as: 1. Incongruent use of sex hormone (oestradiol or testosterone) with recorded sex; or 2. A change in recorded sex, and congruent sex hormone use. GAHT users were grouped into ‘assigned female at birth’ (AFAB) and ‘assigned male at birth’ (AMAB). To quantify physical and mental health impacts, a quasi-experimental ITS was performed using a Prais-Winsten regression on monthly medication use rates for 12-months pre- and post-GAHT initiation.
Results: 2519 GAHT users were identified (1032 AFAB; 1487 AMAB). Prior to GAHT initiation, an increasing trend in antidepressant use was observed for AFABs (+0.20%, 95% CI[0.08%,0.31%]) and AMABs (+0.39%, 95% CI[0.27%, 0.51%]), anxiolytic/hypnotic use for AMABs (+0.06%,95% CI[0.02%,0.10%]), and cardiovascular medication use for AFABs (+0.09%, 95% CI[0.04%,0.13%]). Following GAHT initiation, there was an immediate increase in antidepressant use in AMABs (1.60%, 95% CI[0.44%,2.76%]). There was a decline in the rates of antidepressant use after GAHT for AFABs (-0.19%, 95% CI[-0.38%,-0.01%]) and AMABs (-0.24%, 95% CI[-0.41%,-0.06%]).
Conclusions: GAHT initiation significantly impacted antidepressant use in both subgroups, suggesting positive psychological effects by nearly negating the increasing pre-intervention trend. In contrast, GAHT initiation had no significant impact for anxiolytic/hypnotics, antiepileptics, or cardiovascular medications.
Keywords: Interrupted time series, quasi-experimental, trans & gender diverse
Biography
Sam Wade is a PhD candidate at the Centre for Medicine Use and Safety at Monash University. Sam holds a Bachelor of Science, and a Master of Pharmaceutical Science from Monash University. Sam’s research focuses on the identification and validation of computable phenotypes in pharmacoepidemiologic research, to enable reproducible research on the safety and efficacy of medications in novel populations.
Dr Grace Hui-Min Wu
Global Epidemiology, Johnson & Johnson
Impacts of dedicated budget policy on long-acting injectable antipsychotic usage in Taiwan
Abstract
Introduction: Long-acting injectable antipsychotics (LAIs) are covered by Taiwan's National Health Insurance (NHI), but their utilization remains low due to budget constraints, especially for second-generation LAIs (SGA-LAI). To promote LAI use, the NHI introduced the LAI-dedicated budget policy (LAI-DBP) in January 2022, allocating annual NT$2.7 billion. The real-world impact of this policy has yet to be investigated.
Aims: To assess the impact of the LAI-DBP on prescription rates for first- and second-generation (FGA/SGA) LAIs in patients with schizophrenia (SCZ), schizoaffective disorder (SCA) or bipolar I disorder (BPI).
Methods: Prescription data for patients aged 18 and older with SCZ, SCA, or BPI were collected from Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (KSPH) electronic medical records between October 2005 and September 2024. An interrupted time-series design with Prais-Winsten regression was utilized to estimate changes in the proportion of LAI, FGA-LAI, and SGA-LAI prescriptions among antipsychotic (AP) prescriptions (LAI/AP, FGA-LAI/AP, and SGA-LAI/AP proportions) before and after the LAI-DBP implementation.
Results: Before the LAI-DBP launch, the LAI/AP proportion was 23.2%, 32.4%, and 15.1% for SCZ, SCA, and BPI, respectively. After the LAI-DBP, LAI/AP proportions increased significantly, with SGA-LAI/AP proportion rising by 74.5%, 40.7%, and 61.1%, while decreasing FGA-LAI/AP proportion by 44.0%, 27.4%, and 37.6%, for SCZ, SCA, and BPI patients, respectively. The policy had a greater impact on increasing SGA-LAI/AP proportion and decreasing FGA-LAI/AP proportion among male patients compared to females. The LAI/AP proportion among SCZ patients aged 18-35 and SCA patients aged 36-50 reaching 45% post-implementation. The policy launch shows little influence on SCA and BPI patients over 66.
Conclusions: The LAI-DBP notably boosted LAI usage, particularly SGA-LAIs, among patients with SCZ, SCA, or BPI in Taiwan. Further research is recommended to evaluate the policy's long-term impact on medication adherence and treatment effectiveness.
Keywords: schizophrenia; schizoaffective disorder; bipolar I disorder;
Aims: To assess the impact of the LAI-DBP on prescription rates for first- and second-generation (FGA/SGA) LAIs in patients with schizophrenia (SCZ), schizoaffective disorder (SCA) or bipolar I disorder (BPI).
Methods: Prescription data for patients aged 18 and older with SCZ, SCA, or BPI were collected from Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (KSPH) electronic medical records between October 2005 and September 2024. An interrupted time-series design with Prais-Winsten regression was utilized to estimate changes in the proportion of LAI, FGA-LAI, and SGA-LAI prescriptions among antipsychotic (AP) prescriptions (LAI/AP, FGA-LAI/AP, and SGA-LAI/AP proportions) before and after the LAI-DBP implementation.
Results: Before the LAI-DBP launch, the LAI/AP proportion was 23.2%, 32.4%, and 15.1% for SCZ, SCA, and BPI, respectively. After the LAI-DBP, LAI/AP proportions increased significantly, with SGA-LAI/AP proportion rising by 74.5%, 40.7%, and 61.1%, while decreasing FGA-LAI/AP proportion by 44.0%, 27.4%, and 37.6%, for SCZ, SCA, and BPI patients, respectively. The policy had a greater impact on increasing SGA-LAI/AP proportion and decreasing FGA-LAI/AP proportion among male patients compared to females. The LAI/AP proportion among SCZ patients aged 18-35 and SCA patients aged 36-50 reaching 45% post-implementation. The policy launch shows little influence on SCA and BPI patients over 66.
Conclusions: The LAI-DBP notably boosted LAI usage, particularly SGA-LAIs, among patients with SCZ, SCA, or BPI in Taiwan. Further research is recommended to evaluate the policy's long-term impact on medication adherence and treatment effectiveness.
Keywords: schizophrenia; schizoaffective disorder; bipolar I disorder;
Biography
Dr. Wu is the Associate Director of the Asia-Pacific Team at the Global Epidemiology, Johnson & Johnson. She leads Real-World Studies supporting scientific evidence gap in the APAC region. Grace is dedicated to fostering strategic partnerships with stakeholders while driving advancements in the methodology employed for generating Real-World Evidence (RWE).
As an epidemiologist and health economist, Dr. Wu has 18 years experiences in health authority and academia in Taiwan. She conducted several studies using Real-World Data (RWD) to support decision-making in multiple disease areas while she worked as senior economic evaluation researcher in Health Technology Assessment Division for Center for Drug Evaluation, and as Deputy Director of Hepatitis B & C Prevention and Control Office, Health Promotion Administration, MOHW in Taiwan. She has involved with a wide range of epidemiological studies from community to hospital. She is an author of more than 40 peer-reviewed scientific articles.
Undergraduate Kalpani Aleththuge
Student
University of Moratuwa
A Multi-tier Regressive Markup Pricing Model for imported Medicines in Sri Lanka
Abstract
Introduction:
The heavy import based pharmaceutical market in Sri Lanka follows a cost-plus pricing mechanism with a fixed supply chain markup of 65% on the Cost, Insurance, and Freight (CIF) value. This has led to affordability issues, especially for high-priced drugs. Given economic and healthcare constraints in Sri Lanka, evaluating a multi-tier regressive markup pricing structure appears practically appealing.
Aim:
To develop a regressive markup pricing model to improve the affordability to patients while supporting sustainability of the pharmaceutical sector.
Method:
Secondary data on 7,192 imported medicines in 2024 were obtained from the IQVIA database. A six-tier regressive pricing model was then developed by applying decreasing markup percentages to increasing CIF ranges. Annual community spending on medicines under the existing and proposed pricing regimes were then compared.
Results:
The total community spending under the proposed method records a 11.68% increase compared to the current method. However, there are affordability gains for pharmaceutical products in some ranges. In particular, CIF above LKR 10,000 shows a cost reduction of 27%. Similarly, for the ranges of LKR 5,000 - 10,000 and LKR 1,000 - 5,000, the cost reduced by 18% and 9% respectively. On the other hand, LKR 1-100 and LKR 100-500 showed a cost increase of 12% and 3% respectively. Since around 59% of the total medicines fall into these low-cost categories, the increased cost supports profitability across the supply chain.
Conclusions:
The proposed regressive markup eases financial pressures on high-cost medicines, supporting better affordability, despite a modest increase in overall community spendings. Future regulatory reforms may consider adopting multi-tier pricing models referenced by internal and external pricing.
Keywords:
pharmaceutical pricing, maximum retail price, regressive markup
The heavy import based pharmaceutical market in Sri Lanka follows a cost-plus pricing mechanism with a fixed supply chain markup of 65% on the Cost, Insurance, and Freight (CIF) value. This has led to affordability issues, especially for high-priced drugs. Given economic and healthcare constraints in Sri Lanka, evaluating a multi-tier regressive markup pricing structure appears practically appealing.
Aim:
To develop a regressive markup pricing model to improve the affordability to patients while supporting sustainability of the pharmaceutical sector.
Method:
Secondary data on 7,192 imported medicines in 2024 were obtained from the IQVIA database. A six-tier regressive pricing model was then developed by applying decreasing markup percentages to increasing CIF ranges. Annual community spending on medicines under the existing and proposed pricing regimes were then compared.
Results:
The total community spending under the proposed method records a 11.68% increase compared to the current method. However, there are affordability gains for pharmaceutical products in some ranges. In particular, CIF above LKR 10,000 shows a cost reduction of 27%. Similarly, for the ranges of LKR 5,000 - 10,000 and LKR 1,000 - 5,000, the cost reduced by 18% and 9% respectively. On the other hand, LKR 1-100 and LKR 100-500 showed a cost increase of 12% and 3% respectively. Since around 59% of the total medicines fall into these low-cost categories, the increased cost supports profitability across the supply chain.
Conclusions:
The proposed regressive markup eases financial pressures on high-cost medicines, supporting better affordability, despite a modest increase in overall community spendings. Future regulatory reforms may consider adopting multi-tier pricing models referenced by internal and external pricing.
Keywords:
pharmaceutical pricing, maximum retail price, regressive markup
Biography
Alethuge Kalpani Kavindya is a final-year undergraduate student in the Department of Decision Sciences at the University of Moratuwa, Sri Lanka. She is currently pursuing a Bachelor of Business Science and is on track to graduate with a First Class Honours degree. Her academic journey has been marked by strong analytical skills and a deep interest in applying quantitative methods to real-world policy challenges. Kalpani is the author of a research study that focused on developing a retroactive marking mechanism for imported medicines in Sri Lanka, aimed at improving affordability and accessibility in the pharmaceutical sector. Reflecting her commitment to data-driven decision-making for social impact, her work connects economic theory and public health policy. Kalpani hopes to further develop her expertise in health economics and regulatory analysis, with aspirations to contribute meaningfully to national and global development through evidence-based policy research.
