MANILA, Philippines?Filipinos suffering from high-blood pressure have reason to cheer because the antihypertensive drug amlodipine will be sold at half its current price starting Aug. 15.

Thanks to an executive order that President Gloria Macapagal-Arroyo has signed, a 2.5-mg tablet of amlodipine will sell for a maximum of P9.60.

A 5-mg tablet will cost no more than P22.85 and a 10-mg tablet, P38.50.

Executive Order No. 821 also imposes a 50-percent price reduction or a maximum retail price (MRP) on four other essential medicines whose prices their manufacturers have refused to voluntarily bring down.

These are the anti-cholesterol drug atorvastatin, the antibiotic/antibacterial drug azith-romycin, the anti-neoplastics/anticancer drugs cytarabine, and doxorubicin.

The prices of the other pharmaceutical products?many of which were essential medicines?were voluntarily lowered by their respective producers following an appeal from Ms Arroyo.

Last week, pharmaceutical companies acceded to government pressure to cut in half the prices of the 16 other essential medicines which the health department found to be exorbitant.

These are medicines for hypertension, diabetes, common bacterial infections, amoebiasis (a leading cause of diarrhea) and cancers (such as leukemia, the top killer pediatric cancer).

But the drug companies refused to give in to the appeal of the Department of Health (DoH) for a 50-percent price cut for the five other medicines on the list.

Full implementation

?The reduction of the prices of these drugs and medicines shall commence on Aug. 15, 2009 and shall be fully implemented by Sept. 15, 2009,? said the order which Ms Arroyo signed on July 27 but released only Tuesday.

The order said the list of the medicines and their corresponding prices would be reviewed by the DoH three to six months after the effectivity of the order or ?as often as necessary? as determined by the health secretary.

?The period from the issuance of this order up to Aug. 15, 2009 shall constitute the transition period in which appropriate packaging, labeling and disposition of existing inventory should be accomplished,? Ms Arroyo said.

?Thereafter, regardless of extent of existing inventory and compliance with packaging and labeling requirements, strict implementation of the MRP and this order shall be enforced,? she said.

The President said the price differentials shall be shouldered by the manufacturer, trader or importer of the drug.

Drug companies also offered to voluntarily reduce by 10 percent to 50 percent the prices of 22 other drugs not on the list of 21 essential medicines the DoH had recommended for price ceiling.

When competition fails

Republic Act No. 9502, the so-called cheaper medicines law that was signed in June last year, allows the President, upon the recommendation of the DoH, to impose a price ceiling on medicines in case market competition fails to curb exorbitant drug prices.
EO 821 said the DoH and the Department of Trade and Industry (DTI) included in the MRP list the following medicines:

? Those that are sold at much higher prices in the country compared with their international prices.

? Those that do not have healthy competition from viable generic counterparts.

? Medicines whose innovator product is the most expensive yet most prescribed or bought in the market.

? Those that account for the leading causes of morbidity and mortality in the country.

All retail outlets

The MRP shall be imposed in all retail outlets whether public or private, including drugstores, hospitals and hospital pharmacies, health maintenance organizations, convenience stores and supermarkets.

The new prices will also serve as the ceiling for the procurement of such drugs by all government hospitals and agencies, including the Philippine Charity Sweepstakes Office and Philippine Amusement and Gaming Corp.

The new prices shall also serve as the ceiling for reimbursement by Philippine Health Insurance Corp. (PhilHealth), Social Security System (SSS) and Government Service Insurance System (GSIS).

Industry regrets control

The Pharmaceutical and Healthcare Association of the Philippines (PHAP), composed of drug companies, said it would abide by EO 821.

?However, PHAP regrets that price control for certain (drug) molecules has been imposed since it believes that the same result could be achieved through free-market competition,? the group said in a statement.

It said that ?price control may deliver some short-term benefits but the long-term negative consequences not only on the pharmaceutical industry but on other industries must be considered. If price adjustments do not result in market expansion, then affected companies will have to study options to remain viable.?

The group insisted that the MRP ?is not the best approach since even at drastically reduced prices, most of these medicines will remain inaccessible to the poor who live on an income of less than P100 a day.?

It suggested that a longer-term solution be implemented that considers adequate healthcare financing through PhilHealth, infrastructure building and training of healthcare providers in rural areas.

The pharmaceutical industry is estimated to lose about P7 billion to P10 billion ($146 million to $208 million) a year in sales, making it hard for smaller drug firms that produce and market three or four products to survive, the PHAP spokesperson earlier said.

MRP as last resort

Dr. Robert So, program manager of the DoH?s National Drug Policy, said the executive order reflected ?initial efforts to bring down the prices of medicines? under the cheaper medicines law regime.

?If the pharmaceutical companies won?t work with us and won?t impose fair prices where we would not be on the losing end, we can always use the MRP when needed,? So said.

?The MRP is a reserve instrument. We?re not going to abuse our discretion. We?ll only use it as a last resort,? he added.

MRP for medicines

Under the executive order, the maximum price for the following medicines are as follows:

? Atorvastatin 10 mg film-coated tablet P34.45; 20 mg film-coated tablet P39.13; 40 mg film-coated tablet P50.50; 80 mg film-coated tablet P50.63.

? Amlodipine besilate 5 mg + Atorvastatin calcium 10 mg tablet P45.75

? Amlodipine besilate 5 mg + Atorvastatin calcium 20 mg tablet P66.25

? Amlodipine besilate 5 mg + Atorvastatin calcium 40 mg tablet P84.42

? Amlodipine besilate 5 mg + Atorvastatin calcium 80 mg tablet P89.99

? Amlodipine besilate 10 mg + Atorvastatin calcium 10 mg tablet P51.13

? Amlodipine besilate 10 mg + Atorvastatin calcium 20 mg tablet P73.25

? Amlodipine besilate 10 mg + Atorvastatin calcium 40 mg tablet P91.79

? Amlodipine besilate 10 mg + Atorvastatin calcium 80 mg tablet P91.79

? Azithromycine 250 mg tablet P108.50; 200 mg/5 ml powder for suspension (15 ml) P427.50; 200 mg/5 ml powder for suspension (22.50 ml) P638.00; 500 mg tablet P151.43; 500 mg vial for injection P992.50; and 2 g granules P468.

? Cytarabine 100 mg/ml ampul/vial (IV/SC) P240; 100 mg/ml ampul/vial (IV/SC) 5 ml or 500 mg vial P900; 100 mg/ml ampul/vial (IV/SC) 10ml or 1 g vial P1,800; 20 mg/ml 5 ml ampul/vial for injection P1,980.

? Doxorubicin 10 mg powder vial for injection P1,465.75; 50 mg powder vial for injection P2,265.74. With reports from Abigail Ho and Reuters