Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to <i>Farmácia Popular</i> Program

Silva, Rondineli Mendes da; Caetano, Rosângela

doi:10.1590/S1518-8787.2016050006605

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Sumário

Original Articles • Rev. Saúde Pública 50 • 2016 • https://doi.org/10.1590/S1518-8787.2016050006605 copy

Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to Farmácia Popular Program

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the costs of public pharmaceutical services compared to Farmácia Popular Program (Popular Pharmacy Program).

METHODS

Comparison between prices paid by Aqui Tem Farmácia Popular Program (Farmácia Popular is available here) with the full costs of medicine provision by the Municipal Health Department of Rio de Janeiro. The comparison comprised 25 medicines supplied by both the municipal pharmaceutical service and Aqui Tem Farmácia Popular Program. Calculating the cost per pharmaceutical unit of each medicine included expenditure by Municipal Health Department of Rio de Janeiro with procurement (price), logistics, and local dispensation. The reference price of medicines paid by Aqui Tem Farmácia Popular was taken from the Brazilian Ministry of Health standard in force in 2012. Comparisons included full reference price; reference price minus 10.0% copayment by users; and maximum reference paid by the Ministry of Health (minus copayment and taxes). Simulations were carried out of the differences between the costs of Municipal Health Department of Rio de Janeiro with the common medicines and those potentially incurred based on the reference price of Aqui Tem Farmácia Popular.

RESULTS

The Municipal Health Department of Rio de Janeiro spent R$28,526,526.57 with 25 medicines of the common list in 2012; 58.7% accounted for direct procurement costs. The estimated costs of the Health Department were generally lower than the reference prices of the Aqui Tem Farmácia Popular Program for 20 medicines, regardless of reference prices. The potential costs incurred by Health Department if expenditure of its consumption pattern were based on the reference prices of Aqui Tem Farmácia Popular would be R$124,170,777.76, considering the best scenario of payment by the Brazilian Ministry of Health (90.0% of the reference price, minus taxes).

CONCLUSIONS

The difference in costs between public provision by Municipal Health Department of Rio de Janeiro and Farmácia Popular Program indicates that some reference prices could be reviewed aiming at their reduction.

Pharmaceutical Services, economics; Drug Costs; Drugs, Essential, supply & distribution; Costs and Cost Analysis; Health Economics; National Policy of Pharmaceutical Assistance

Common list medicines	PU Consumption 2012	PU Procurement price	Procurement costs 2012	PU logistics cost	Logistics costs 2012	PU dispensation costs	Dispensation costs 2012	Total PU cost	Total SMS-RJ cost 2012
Alendronate sodium 70 mg pill	290,040	0.2698	78,252.79	0.1620	46,986.48	0.1045	30,309.18	0.5363	155,548.45
Atenolol 25 mg pill	40,146,204	0.0117	469,710.59	0.0087	349,271.97	0.0108	433,579.00	0.0312	1,252,561.56
Ipratropium Bromide 0.02 mg/dose	1,219,200	0.0776	94,609.92	0.0175	21,336.00	0.1173	143,012.16	0.2124	258,958.08
Ipratropium Bromide 0.25 mg/ml	1,789,440	0.0272	48,672.77	0.0105	18,789.12	0.0111	19,862.78	0.0488	87,324.67
Budesonide 50 mcg/nasal spray dose	18,000,000	0.0820	1,476,000.00	0.0047	84,600.00	0.0230	414,000.00	0.1097	1,974,600.00
Captopril 25 mg pill	78,002,640	0.0102	795,626.93	0.0050	390,013.20	0.0036	280,809.50	0.0188	1,466,449.63
Carbidopa 25 mg+Levodopa 250 mg pill	253,440	0.1598	40,499.71	0.0300	7,603.20	0.2485	62,979.84	0.4383	111,082.75
Benserazide hydrochloride 25 mg +Levodopa 100 mg pill	240,000	1.0500	252,000.00	0.0600	14,400.00	0.3761	90,264.00	1.4861	356,664.00
Metformin hydrochloride 500 mg pill	7,440,000	0.0429	319,176.00	0.0300	223,200.00	0.0482	358,608.00	0.1211	900,984.00
Metformin hydrochloride 850 mg pill	52,466,280	0.0349	1,831,073.17	0.0200	1,049,325.60	0.0200	1,049,325.60	0.0749	3,929,724.37
Propranolol hydrochloride 40 mg pill	3,870,480	0.0097	37,543.66	0.0200	77,409.60	0.0068	26,319.26	0.0365	141,272.52
Beclomethasone dipropionate 250 mcg/spray dose	12,720,000	0.1200	1,526,400.00	0.0080	101,760.00	0.0343	436,296.00	0.1623	2,064,456.00
Beclomethasone dipropionate 50 mcg/spray dose	4,800,000	0.1400	672,000.00	0.0163	78,240.00	0.0658	315,840,00	0.2221	1,066,080.00
Ethinyl Estradiol 0.15 mg + Levonorgestrel 0.03 mg pill	131,604	0.4500	59,221.80	1.2900	169,769.16	0.0429	5,645.81	1.7829	234,636.77
Glibenclamide 5 mg pill	43,710,216	0.0070	305,971.51	0.0100	437,102.16	0.0022	96,162.48	0.0192	839,236.15
Hydrochlorothiazide 25 mg pill	68,826,204	0.0094	646,966.32	0.0040	275,304.82	0.0039	268,422.20	0.0173	1,190,693.33
NPH Human Insulin 100 UI/ml vial 10 ml	324,000	8.7800	2,844,720.00	0.3600	116,640.00	2.4004	777,729.60	11.5404	3,739,089.60
Regular Human Insulin 100 UI/ml vial 10 ml	86,400	9.3500	807,840.00	0.9900	85,536.00	2.0247	174,934.08	12.3647	1,068,310.08
Losartan potassium 50 mg pill	42,000,000	0.0330	1,386,000.00	0.0100	420,000.00	0.0082	344,400.00	0.0512	2,150,400.00
Enalapril Maleate 10 mg pill	104,937,840	0.0145	1,521,598.68	0.0014	146,912.98	0.0107	1,122,83.89	0.0266	2,791,346.54
Timolol Maleate 5 mg/ml (0.5%)	92,760	0.1940	17,995.44	0.2020	18,737.52	0.0851	7,893.88	0.4811	44,626.84
Norethisterone 0.35 mg pill	72,348	4.5150	326,651.22	0.0300	2,170.44	0.3074	22,239.78	4.8524	351,061.44
Simvastatin 20 mg pill	10,800,000	0.0389	420,120.00	0.0600	648,000.00	0.0276	298,080.00	0.1265	1,366,200.00
Sulfate Salbutamol 100 mcg/spray dose	9,636,000	0.0149	143,576.40	0.0058	55,888.80	0.0090	86,724.00	0.0297	286,189.20
Estradiol 50 mg/ml + Norethisterone 5 mg/ml amp	113,196	5.1500	582,959.40	0.4900	55,466.04	0.5354	60,605.14	6.1754	699,030.58

Total	501,968,292	-	16,705,186.30	-	4,894,463.09	-	6,926,877.18	-	28,526,526.57

Common list medicines	RP	Max. RP paid MH	RP minus taxes	% dif. between full RP and SMS Cost	% dif. between max. RP paid by MH and SMS Cost	% dif. between max. RP paid by MH minus taxes and SMS Cost
Alendronate sodium 70 mg pill	3.7400	3.3700	3.2261	597.4	528.4	501.5
Atenolol 25 mg pill	0.1900	0.1900	0.1819	509.0	509.0	483.0
Ipratropium Bromide 0.02 mg/dose	0.0600	0.0600	0.0574	-71.8	-71.8	-73.0
Ipratropium Bromide 0.25 mg/ml	0.2700	0.2700	0.2585	453.3	453.3	429.7
Budesonide 50 mcg/nasal spray dose	0.1300	0.1200	0.1149	18.5	9.4	4.7
Captopril 25 mg pill	0.2800	0.2800	0.2680	1,389.4	1,389.4	1.325.8
Carbidopa 25 mg+Levodopa 250 mg pill	0.6400	0.5800	0.5552	46.0	32.3	26.7
Benserazide hydrochloride 25 mg +Levodopa 100 mg pill	1.1700	1.0500	1.0052	-21.3	-29.3	-32.4
Metformin hydrochloride 500 mg pill	0.1300	0.1300	0.1244	7.3	7.3	2.8
Metformin hydrochloride 850 mg pill	0.1600	0.1600	0.1532	113.6	113.6	104.5
Propranolol hydrochloride 40 mg pill	0.0800	0.0800	0.0766	119.2	119.2	109.8
Beclomethasone dipropionate 250 mcg/spray dose	0.1500	0.1500	0.1436	-7.6	-7.6	-11.5
Beclomethasone dipropionate 50 mcg/spray dose	0.1300	0.1300	0.1244	-41.5	-41.5	-44.0
Ethinyl Estradiol 0.15 mg + Levonorgestrel 0.03 mg pill	4.1900	3.7700	3.6090	135.0	111.5	102.4
Glibenclamide 5 mg pill	0.1200	0.1200	0.1149	525.0	525.0	498.3
Hydrochlorothiazide 25 mg pill	0.0800	0.0800	0.0766	362.4	362.4	342.7
NPH Human Insulin 100 UI/ml 10 ml vial	26.5500	26.5500	25.4163	130.1	130.1	120.2
Regular Human Insulin 100 UI/ml 10 ml vial	26.5500	26.5500	25.4163	114.7	114.7	105.6
Losartan potassium 50 mg pill	0.3200	0.3200	0.3063	525.0	525.0	498.3
Enalapril Maleate 10 mg pill	0.3900	0.3900	0.3733	1,366.2	1,366.2	1,303.6
Timolol Maleate 5 mg/ml (0.5%)	0.9600	0.8600	0.8233	99.5	78.8	71.1
Norethisterone 0.35 mg pill	4.9600	3.7700	3.6090	2.2	-22.3	-25.6
Simvastatin 20 mg pill	0.5100	0.4600	0.4404	303.2	263.6	248.1
Sulfate Salbutamol 100 mcg/spray dose	0.1000	0.1000	0.0957	236.7	236.7	222.3
Estradiol 50 mg/ml + Norethisterone 5 mg/ml amp	11.3100	10.1700	9.7357	83.1	64.7	57.7
Average difference				279.8	270.7	254.9

Common list medicines	SMS-RJ annual consumption	SMS-RJ total estimated cost	SMS-RJ total expenses simulated by ATFP full RP^a	SMS-RJ total expenses simulated by ATFP^b max RP paid by MH^b	SMS-RJ total expenses simulated by max. RP minus taxes^c
Alendronate sodium 70 mg pill	290,040	155,548.45	1,084,749.60	977,434.80	935.698.33
Atenolol 25 mg pill	40,146,204	1,252,561.56	7,627,778.76	7,627,778.76	7.302.072.61
Ipratropium Bromide 0.02 mg/dose	1,219,200	258,958.08	73,152.00	73,152,00	70.028.41
Ipratropium Bromide 0.25 mg/ml	1,789,440	87,324.67	483,14.,80	483,148.80	462.518.35
Budesonide 50 mcg/nasal spray dose	18,000,000	1,974,600.00	2,340,000.00	2,160,000.00	2.067.768.00
Captopril 25 mg pill	78,002,640	1,466,449.63	21,840,739.20	21,840,739.20	20.908.139.64
Carbidopa 25 mg+Levodopa 250 mg pill	253,440	111,082.75	162,201.60	146,995.20	140.718.50
Benserazide hydrochloride 25 mg + Levodopa 100 mg pill	240,000	356,664.00	280,800.00	252,000,00	241.239.60
Metformin hydrochloride 500 mg pill	7,440,000	900,984.00	967,200.00	967,200.00	925.900.56
Metformin hydrochloride 850 mg pill	52,466,280	3,929,724.37	8,394,60.,80	8,394,604.80	8.036.155.18
Propranolol hydrochloride 40 mg pill	3,870,480	141,272.52	309,638.40	309,638.40	296.416,84
Beclomethasone dipropionate 250 mcg/spray dose	12,720,000	2,064,456.00	1,908,000.00	1,908,000.00	1.826.528.40
Beclomethasone dipropionate 50 mcg/spray dose	4,800,000	1,066,080.00	624,000.00	624,000.00	597.355.20
Ethinyl Estradiol 0.15 mg + Levonorgestrel 0.03 mg pill	131,604	234,636,77	551,420.76	496,147.08	474.961.60
Glibenclamide 5 mg pill	43,710,216	839,236.15	5,245,225.92	5,245,225.92	5.021.254.77
Hydrochlorothiazide 25 mg pill	68,826,204	1,190,693.33	5,506,096.32	5,506,096.32	5.270.986.01
NPH Human Insulin 100 UI/ml 10 ml vial	324,000	3,739,089.60	8,602,200.00	8,602,200.00	8.234.886.06
Regular Human Insulin 100 UI/ml 10 ml vial	86,400	1,068,310,08	2,293,920.00	2,293,920.00	2.195.969,62
Losartan potassium 50 mg pill	42,000,000	2,150,400.00	13,440,000.00	13,440,000,00	12.866.112.00
Enalapril Maleate 10 mg pill	104,937,840	2,791,346.54	40,925,757.60	40,925,757.60	39.178.227.75
Timolol Maleate 5 mg/ml (0.5%)	92,760	44,626,84	89,049.60	79,773.60	76.367.27
Norethisterone 0.35 mg pill	72,348	351,061.44	358,846.08	272,751.96	261.105.45
Simvastatin 20 mg pill	10,800,000	1,366,200.00	5,508,000.00	4,968,000.00	4.755.866.40
Sulfate Salbutamol 100 mcg/spray dose	9,636,000	286,189.20	963,600.00	963,600.00	922.454.28
Estradiol 50 mg/ml + Norethisterone 5 mg/ml amp	113,196	699,030.58	1,280,246.76	1,151,203.32	1.102.046.94

Total		28,526,526.57	130,860,376.20	129,709,367.76	124,170,777.76

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence
: Rondineli Mendes da Silva. Rua Leopoldo Bulhões, 1480 Sala 632 Manguinhos 21041-210 Rio de Janeiro, RJ, Brasil. E-mail: rondineli.mendes@gmail.com