DOH Administrative Order No 2020 0043
DOH Administrative Order No 2020 0043
DOH Administrative Order No 2020 0043
ADMINISTRATIVE ORDER
No. 2020 — (043
The Philippines is one of the countries where less than thirty percent (30%) of the
population has regular access to essential medicines. Affordability is considered to be
one of the significant obstacles especially among the marginalized sector who spend
around fifty nine percent (59%) of
their out-of-pocket (OOP) expenditures for health
on medicines, according to WHO. In 2019, a survey conducted by the Pulse Asia
revealed that ninety nine percent (99%) of Filipinos do not buy all
their medicine
prescriptions because they are expensive. When asked how much they
are willing to
pay for a month’s supply of medication, seventy one percent (71%) responded that
they can only spend One thousand Pesos (Php1000) or less in a month, while only
twenty four percent (24%) are willing to spend up to Five Thousand Pesos
(Php5000.) This often leads to non-compliance to the full treatment course, which
could result to more serious health implications. In terms of price, medicines are
relatively more expensive in the Philippines compared to other Asian countries with
similar economic status. For the past years, various initiatives from the government
were done to make medicines more accessible and affordable to all Filipinos. The
presence of generic market players is also one of the factors why the prices of
medicines has improved over time. However, access to medicines remains a serious
challenge in the country. The financial burden of medicine costs is
still heavy among
households across all
socioeconomic class.
In 2008, the Republic Act No. 9502 or the “Universally Accessible Cheaper and
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das. Quality Medicines Act’”’ was implemented, which warrants the Department of Health
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(DOH) to monitor and regulate the prices of drugs and medicines to protect the
patients and the public procuring entities from excessive mark-ups resulting from
oS ST ML information asymmetry and lack of effective competition. To address these issues,
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guide the public health facilities
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“oS Price Monitoring System (EDPMS) was likewise put in place. However, despite
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Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http://www.doh.gov.ph; e-mail: officeofsoha doh.gov.ph
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these initiatives, excessive mark-ups on some essential medicines were observed and
were not being addressed.
Currently,. the Administrative Order (AO) No. 2005-0010 allows all DOH
hospitals a thirty percent (30%) mark-up for all medicines procurement regardless of
acquisition cost. This policy may not adequately address the increasing challenge of
high-priced innovative single-sourced medicines. The passage of the Republic Act
No. 11223, otherwise known as “Zhe Universal Health Care Act”, provides the
government the mandate to ensure equitable access to quality and affordable
healthcare goods and services in the country. In line with its implementation, there is
a need to review and update existing policies on medicines prices. Section 28 of the
UHC
Actand its Implementing Rules and Regulations (IRR) provides for medicine
affordability using price reference indices and determination of price mark-ups of
medicines among DOH-owned health facilities to protect the patients from excessive
and unnecessary charges.
In order to achieve such mandate, the DOH is hereby creating these guidelines to
provide a mark-up structure on essential medicines across all DOH hospitals. This
likewise aims to lessen the wide range of prices of the same medicine at different
DOH facilities.
II. OBJECTIVES
being dispensed and/or charged the patients and to PhilHealth in all DOH hospitals.
. To align this policy in the implementation of the UHC Act and its IRR which
mandates the prescribing of a uniform rules and strucures in setting mark-ups for
drugs and medical devices and supplies to protect patients from excessive and
unnecessary charges.
This Order shall apply to all essential medicines being dispensed and/or sold to
patients in all DOH-owned health facilities (ie. Hospitals, Specialty Hospitals and
Treatment and Rehabilitation Centers) nationwide.
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IV. DEFINITION OF TERMS
4, Essential medicines- refers to medicines that satisfy the priority health care needs
of the population, which are selected based on the evidence of their efficacy,
safety, and comparative cost-effectiveness.
5. Highly specialised drugs- refers to drugs for the treatment of complex medical
conditions that require ongoing specialised medical supervision.
6. Mark-up- refers to the amount added to the cost price in calculating a selling
price, especially the amount that takes into account the overhead cost and profit.
7. Overhead cost- refers to the ongoing expense of operating a business. Overheads
are the expenditure which cannot be conveninetly traced to or identified with any
particular cost unit, unlike operating expnses such as raw materials and labor.
8. Prevailing price- refers to the average price at which a basic necessity has been
sold within a month from the occurrence of any of the conditions enumerated
under Section 6 of Republic Act No. 7581 (The Price Act).
9. Price freeze- refers to the situation in which the prices/s specific products are
fixed at the prevailing level and no increase is allowed.
10. Regressive mark-up- a mark-up whereby the size or value of the mark-up
decreases
applied in
asthe price of the product increases. This may be on
differential (discrete) steps according to threshold a
prices.
sliding scale or
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Table 1. Mark-up structure for regular essential medicines
Acquisition Cost (Php) Mark-up
P0.01-P50.00 40%
P500.00
P35 2070 04the excess of P115.00 P615.00
P6,500.00
P215 +
e000 excessof 765.00 P7,265.00
PLAID + excess Of
P50,000.00 210000 3 115.00 P53,115.00
‘2. For highly specialised drugs (HSD), medicines for oncology, total parenteral
nutrition (TPN) and medicines which needs to be compounded, the retail price
shall be computed similar in Table 1. However, compounding fee shall be added
as indicated in Table 2.
3. The rate of compounding fee may vary depending on the cost of supplies and
other utilities used in the preparation. This will be added on top of the mark-up for
each preparation regardless of the number of
medicines being compounded.
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Table 2.1 Sample computation for HSD and TPN
Acquisition Cost Mark-up Compounding fee Retail Price
4, The list of HSDs in Annex A shall be identified based on the data submitted by
the DOH Specialty Hospitals. The list can be updated accordingly upon
submission of request of medicines not included in
the list.
5. For HSDs availed by outpatients, no compounding fee shall be added to the retail
price. Hence, it will be treated similar to the regular essential medicines as shown
in Table 2.2 above.
6. For regular essential medicines, the retail price should be the same for outpatients
and inpatients and regardless of the room type (e.g. ward, semi-private, private).
Charges for additional amenities should be applied to room rates/charges.
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{ 7. As stipulated in the Administrative Order (AO) No. 2012-0007, medicines being
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-- Program (MAJIP), Philippine Health Insurance Corporation (PHIC)), SC/PWD
SaHO ST discounts will no longer be applied.
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VI. SPECIFIC GUIDELINES
1. The level of mark-up should remain the same regardless of the quantity supplied
by the hospital pharmacies.
For medicines identified under Executive Order (EO) NO. 104, s. 2020 entitled,
“Improving Access to Healthcare through the Regulation of Prices in the Retail
Drugs and Medicines”, the mark-up structure under this Order shall be applied.
Except for instances wherein the calculated retail price using the mark-up
structure under this Order yields a higher final retail, then the Maximum Retail
Price under EO No. 104 shall prevail.
Apart from random physical monitoring, compliance to this Order shall likewise
be monitored through checking and analysis of the existing price databases such
as the Drug Price Reference Index (DPRI) and the Electronic Drug Price
Monitoring System (EDPMS).
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The CHD through the National Drug Policy Compliance Officer (NDPCO) shall
act accordingly on the complaint received against the erring hospitals or facilities.
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A written report shall be submitted to the PD-.on the actions taken by the said
Office. F
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VI. ROLES AND RESPONSIBILITIES
A. PHARMACEUTICAL DIVISION
1. Set policies and procedures relative to the regulation of mark-up of essential
medicines in all DOH hospitals.
2. Monitor the compliance of DOH facilities in accordance with the set
guidelines and recommend appropriate sanctions for overpricing.
Notify the erring hospitals and issue an initial warning for their non-
compliance.
Address all issues and concerns relative to the implementation of this Order
and improve and/or revise the guidelines when necessary.
Conduct regular review and analysis of the price information in coordination
with the Drug Price Advisory Committee (DPAC) and use the gathered data in
pharmaceutical pricing policy review.
Monitor and evaluate the implementation of mark-up regulation based on the
submitted medicines price data from DOH facilities.
Endorse to the Commission on Audit (COA) any report of non-compliance
observed by the Internal Audit Service (IAS).
B. DOH HOSPITALS
1. The DOH hospital chief shall ensure strict compliance and adherence with the
ceiling mark-up rates and other provisions stated in this guidelines.
2. Provide data to the PD relevant to the operational expenses of the pharmacy
when necessary.
3, Report to the PD any issues and concerns encountered in the implementation
of this Order.
1. The Regional Drug Price Monitoring Officer (RDPMO shall provide technical
assistance to the PD in relation to the implementation of this policy which
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shall include bt not limited to: dissemination of all related issuances to all
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DOH faclities, collection of related data from DOH facilites when necessary
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and submit a written report to the PD on the actions taken thereon.
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Vill. SANCTIONS
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Provisions on mark-ups specified under Administrative Order_No. 2005-0010 and
other existing issuances, which are inconsistent with or contrary to this Order are
hereby repealed, amended or modified accordingly. All other provisions of existing
issuances whichare not affected by this Order shall remain valid and in
effect.
TRANSITION PERIOD
1. To give the DOH-owned facilities an ample time to sell the remaining stocks of
medicines, this Order shall be implemented three (3) months after it has been
signed.
2. The Point of Sale (POS) system shall likewise be updated within the grace period
of three (3) moths and include the new mark-up mechanisms for medicines upon
implementation of this Order.
XI. EFFECTIVITY
This Order shall take effect three (3) months after being signed.
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Annex A
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EPOETIN BETA
2000 IU/0.3 mL, pre-filled syringe with needle (IV,
SC)5000 IU/0.3 mL, pre-filled syringe with needle (IV,
SC) 10,000 IU/0.6 mL, pre-filled syringe (IV, SC)
P. RIVE
KMITS -R DS SECTIO
Department_ of -Health
g
20 mg/mL, 5 mL ampul/vial (IV) 20 mg/mL, 10 mL vial
22 ETOPOSIDE (IV) powder 100 mg vial (IV)
23 EVEROLIMUS 250 mcg and 500 mcg tablet
150 micrograms/0.6 mL, vial (IV, SC) 300 mcg/0.5 mL
solution for injection in pre-filled syringe (IV, SC) 300
micrograms/mL, vial (IV, SC) 300 micrograms/1.2 mL,
24 FILGRASTIM vial (IV, SC)
25 FLUOROURACIL 50 mg/mL, 10 mL ampul/vial (IV, IV infusion)
26 GANCICLOVIR 500 mg vial (IV infusion) (as sodium) (1, 2)
27 GEMCITABINE 200 mg and 1 vial (IV infusion)
28 IDARUBICIN powder, 5 mg vial (IV)
29 IFOSFAMIDE powder, 1 g and 2 g vial (IV infusion)
40 mg/2 mL concentrate, vial (IV infusion) 100 mg/5 mL
30 IRINOTECAN concentrate, vial (IV infusion)
100 mg and 150 mg tablet/film coated tablet
LAMIVUDINE
31 10mg/mL suspension, 240mL bottle
32
LAMIVUDINE
ZIDOVUDINE
+ 150 mg + 300 mg tablet
100 mg levodopa + 25 mg carbidopa per tablet
LEVODOPA + 250 mg levodopa + 25 mg carbidopa per tablet
CARBIDOPA 200 mg levodopa + 50 mg carbidopa extended
33 release tablet
LOPINAVIR +
34 RITONAVIR 200 mg + 50 mg tablet/capsule
35 MANNITOL Inj.: 20%, 250 mL and 500 mL bottle (IV)
SEP 15 2020.
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PACLITAXEL
Inj.: 6 mg/mL, 5 mL, 17 mL, 25 mL and 43.4 mL vial
41 (IV, IV Infusion)
42 RIBAVIRIN Oral: 200 mg, 500 mg and 600 mg tablet
150 mg capsule (for HIV/AIDS patient on
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