"Ang presyo ng gamot, hindi maabot"
PRIVILEGE SPEECH OF AKBAYAN SENATOR RISA HONTIVEROS

Mr. President, we are facing the worst threats to public health in over a decade. Ang dengue, lumalala since 2012. As of August 31, an estimated 1,107 people have died of dengue in the Philippines, with almost half being children between five and nine years of age. Sa measles, may 550% increase in 2019 kumpara sa 2018. At matapos ang matagal na panahon na tayo ay polio-free, nanumbalik ang polio at isa sa pinakabulnerableng area ay ang Bangsamoro Autonomous Region. Palala pa din ng palala ang problema ng teenage pregnancy, at tayo pa din ang number 1 sa pagtaas ng HIV-AIDS.

We have made significant inroads, Mr. President, at mahalaga ang pagpasa natin ng Universal Health Care Law para harapin ang mga hamon na ito. Ngunit mayroon isang particular na issue na maaring burahin ang mga ganansya sa universal health. I rise before this body to call on the government to address an issue that, if left unchecked, threatens to undermine all the effort, including our effort in the legislature, to achieve universal health care for all Filipinos. Ano ang problema? ANG PRESYO NG GAMOT, HINDI MAABOT.

Mr. President, the latest Philippine National Health Accounts (PNHA) show that 41% of all health care spending in the Philippines is on pharmaceutical products or drugs and medicines. This is significant Mr. President, because the share of pharmaceutical spending in the total health expenditure in other countries ranges from 19.7% in high income countries to 30.4% to low income countries. Bakit mas malaki ang nakakain sa health care expenditure ng pharmaceutical drugs sa Pilipinas kumpara sa ibang bansa? Hindi kaya dahil the prices of pharmaceutical drugs here are absurdly high compared to other countries?

Isa pang punto: pharmaceutical spending accounts for half of out-of-pocket health expenses of Filipinos. Ibig sabihin, sa 100 pesos na ginagastos ng isang Pilipino, 50 pesos ang napupunta sa gamot lang. Samantalang sa buong mundo, ang average ng gamot as percentage of out of pocket health expenditure ay 32 percent lang.

The data is clear and alarming: the prices of medicines in the Philippines remain high and out of reach for majority of Filipinos. A study commissioned by the DOH say that on average, the prices of in the Philippines is still significantly higher than international references prices (IRP). In the public sector, medicine prices are up to 4 times higher than IRP while in the private sector, it can go up to 22 times higher. Magkahalo na dito Mr. President yung mataas na presyo na pinapataw ng manufacturers sa mga gamot nila at yung napaka-laking mark-up na iniimpose ng pribadong health facilities sa mga gamot na ito. More on the latter point, it was also found that final prices for innovator branded medicines are 486% higher in the private sector compared to the same drugs sold in public hospitals. I think this is too much.

Another aspect of this issue Mr. President, is the emergence of high cost medicines which are breakthrough treatments for chronic diseases, orphan diseases, and cancers. These drugs are introduced to Western countries with high prices averaging from $10,000 to even a $100,000, and when they are launched here in our country, there are no differences in prices and there are no considerations for equity and the economic situation of the Philippines. The DOH reports that some cancer drugs and biologics being proposed for inclusion into our National Formulary have average treatment costs that are way above the average annual income of Filipino households. Some drugs even cost close to Php 2 million pesos per treatment course. Kapag ganito ka mahal ang gamot mo, wala na talagang pag-asa gumaling yung may sakit kasi bihira lang ang may kayang magbayad nito.

Out-of-pocket expenditure is an important barrier to health services. Often people in the far flung areas would still not seek consult for their ailments because they know that a considerable cost of the health consult will be shouldered by their savings, by the money that they have set aside for other equally important needs of the family. And yes, this happens even if they are already part of PhilHealth's sponsored program. A study by the health experts from the University of the Philippines showed that the poor and marginalized Filipinos are being crowded out by those in the higher income segments in accessing health services, even in public hospitals and health facilities.

Even middle class and upper middle class households are affected by out-of-pocket expenditure. We have heard of countless stories of families living in relative comfort suffer impoverishment when a member of family gets ill with catastrophic disease like cancer, heart attack or stroke. All of the family's finances are channeled to finance these health care needs. Sometimes it gets to a point where they have to sell property or dip into their savings just to cover the cost of health care.

Something must be done about this, Mr. President. Masasayang lang ang UHC law if this is not addressed. All the funds that will be channeled for the implementation of this law will not make a dent in providing financial risk protection for our countrymen because of the high cost of medicines. Lahat ng dagdag pondo will just be eaten up by these companies as they try to maximize profits by keeping their prices high. Republic Act 9502 or the Cheaper Medicines Law, a landmark piece of legislation which I am proud to have co-authored as a Representative of the partylist Akbayan in 2008, provided the framework and mechanisms to ensure universal access to quality and affordable medicines. It built on the Generics Act in 1988 through the promotion effective market competition and strengthening of the local pharmaceutical industry as means to pursue this noble objective.

Over the past decade, we have seen how the law worked as reports from the DOH show the increasing in market share in terms of volume and value of generic drugs in our country. Competition has improved but it is not a vibrant as we would want considering that only 11 companies, 10 of which are multinational companies, account for more than 50% of the total pharmaceutical market. This is explained by the domination of "branded generics" or generic products marketed with unique/trade names which affords them some differentiation with the other generics drugs and allows them to secure premium pricing. The market share of true low-cost generics account for only 2% of values and 4% of volume sales indicating their low availability and penetration in hospitals and drug retail outlets.

Pero may solusyon, Mr. President. Ang mga sakit gaya ng kanser na mabilis at malawakan ang pagkalat, kailangan din ng mabilis at malawakang tugon at solusyon.

Fortunately, Mr. President, RA 9502 provided the government other instruments to address of the issue of high drug prices in the country. I'm specifically referring to the power to directly regulate prices of drugs and medicines in the country. Two years after we passed the Cheaper Medicines Law, the government used this power and set Maximum Drug Retail Prices (MDRP) of 5 drugs, immediately slashing their prices by 50%. This was done after several discussions with different stakeholders and after dialogue with the pharmaceutical industry. The list of drugs under price control would have been longer if not for the DOH's acceptance of the industry's offer to voluntary reduce prices, albeit at a lower rate.

Isang dekada na ang nakakalipas mula nang huli natin nagamit ang mandatong ito. Panahon na para muling ipatupad ito. Sa tindi ng krisis sa pambansang kalusugan na ating dinadanas, kailangan mabilis, malawakan at mapagkalinga ating tugon at solusyon.

For the past 2 years, I have been asking the DOH about the imposition of the MDRP during budget hearings and oversight committee meetings. Time pa ni Sec. Paulyn Ubial, Mr. President, when I first asked this. Now, I believe that we have an answer. After months of policy and evidence review and after several consultations and deliberations with experts and stakeholders, the DOH is ready to push the button on price control. I understand that they have already a list of 120 drugs and medicines which they have submitted to the Office of the President (for verification). These are drugs for a variety of conditions asthma, hypertension, heart diseases, diabetes, different type of cancers which are among the top causes of mortality or morbidity in the country. I fully support this effort of the Department of Health as this is long overdue.

I also call on the President, who is given the authority under the law to impose the MDRP to act on these recommendations immediately. Wag na po tayong magpatumpik tumpik pa. Magandang pamasko ito, Mr. President sa mga Pilipino nahihirapan na sa mataas na presyo ng lahat ng bilihin. This is a welcome reprieve for them.

Pero alam natin na mayroon din pumipigil. I understand also that big pharma is moving heaven and earth to prevent these set of price cuts from happening. They are again offering voluntary price reduction, ngunit hindi ito sapat at ito ay kulang na kulang pa din, kung kaya naman pala magbaba ng presyo ng industry, bakit kailangan humatong pa sa sitwasyon na sinisita sila ng gobyerno bago sila umaksyon. They had several years to do it so why are voluntary price reductions only coming out now?

Incidentally, the Philippines is not alone in the world in looking at price control as a cost containment measure. Multinational pharmaceutical companies around the globe are coming under increasing scrutiny from their governments to explain and account for the exorbitantly high prices they set for their medicines. The United States, Canada, the Netherlands, and Malaysia have all conducted hearings on this issue and are planning to institute new policies to address high drug prices. It's high time that we do too.

Ilan pa ba ang mga Pilipinong dapat magkasakit at mamatay bago ibaba ang presyo ng gamot sa mga sakit na may lunas naman? Kailangan bang mabaon sa hirap ang pamilyang Pilipino sa tuwing may sakunang dumadating? Mura, agaran, epektibong lunas at gamot ang kailangan. Mas mahalaga ang kalusugan ng mamamayan kaysa sa tubo o kita ng iilan.

Thank you very much, Mr. President.