Access to essential medicines in Peru 

by Eduardo Rodríuez Zárate and Jessica Valeria Tang Herrera

According to the WHO Policy Perspectives on Medicines released in March 2004, “Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford”. 

Obviously, essential medicines save lives and improve health when they are available, affordable and of assured quality. Still, lack of access to essential medicines remains one of the most serious global public health issues. In fact, one-third of the world’s population lacks access to essential medicines and in the poorest parts of Africa and Asia this figure rises to one-half. But what is the situation in Peru?

Peru is one of the richest countries in the world in terms of natural resources and biodiversity. With an area of 1,285,215 square km, Peru is the third-largest country in South America after Brazil and Argentina, ranking it amongst the world's 20 largest nations. However, Peru is also one of the poorest countries of South America, economically speaking, with an estimated 27 million population (according to the last population study in 2005) and a gross domestic product (GDP) of USD 2180 per capita. Although the health situation has improved greatly over the last years with government’s new policies and health models, Peru still has a high infant and maternal mortality rate, one of the highest incidence rate of tuberculosis in Latin America and an HIV prevalence among adults ranging between 0.35% and 0.5%, which means that about 76,000 persons are living with HIV/AIDS.

Peru, like other countries of the Andean Community (CAN), is a member of the World Trade Organization (WTO) and therefore, bound by the obligations of the Agreement on Trade-Related Aspects of Intellectual Property rights (TRIPS). On the other hand, due to previous legislation that did not allow pharmaceutical patents, most of essential medicines currently on the market in Peru are not protected by one. The few Peruvian patents that exist only protect secondary inventions related to existing medicines such as combinations, compositions of formulations which means that these medicines are not subject to a monopoly for their primary form and use. Also, in Peru there are patent laws available known as “safeguards” to counterbalance the negative effect of patent protection of pharmaceuticals.

To further regulate the patents, now there are compulsory licenses which are an authorization given by the State for the use of a patented invention and any interested person can request a license to the “Office of Inventions and New Technologies” of INDECOPI, the patent office in Peru.

Another option for a greater access to essential medicines in Peru, are the parallel imports in which medicines could be imported without the authorization of the patent owner. However, the importer needs to get an authorization from the Ministry of Health to ensure the safety, efficacy and quality of the product to import it in Peru. This is a very important issue as people will buy what is cheaper for them as drug expenditures in the Peruvian Health System are out of pocket and only 23,5% of the population benefit from national or private social security (although this is changing nowadays with the government introducing new insurances for the babies, kids, teenagers, pregnant women and old people).

Still a number of generic manufacturers are present on the Peruvian market and they also compete with other manufacturers of original brand-name products. An example of the market competition is antiretrovirals. Competition has forced the price of first-line AIDS medicines down to as little as $408 per person per year, compared to $4,300 per person per year for brand-name drugs. However, despite competition, prices of some essential medicines in Peru remain very high compared to prices in the international market and with regard to the buying power of the population.

This is an issue that concerns us all, not just us, as future physicians but healthcare providers in general, governments, and organizations such as the WHO, UNAIDS, UNICEF, etc. We, have the responsibility to demand the best possible level of care for our patients.