Pharmaceutical policies used in LMIC countries to enhance pharmaceutical spending efficiency: a review

Pharmaceutical spending makes up for a major share of healthcare costs in Low- and-MiddleIncome Countries (LMICs), where access to essential medicines is hindered by high prices, inefficient procurement, and restricted budget. In order to achieve Universal Health Coverage (UHC), there must be policies that ensure affordability and sustainability while addressing gaps involving access to medicine. This review aims to examine pharmaceutical policies implemented in selected LMICs to enhance spending efficiency, focusing on cost-containment strategies, value-based pricing, and Health Technology Assessment (HTA). A systematic literature review was conducted using databases including PudMed, Scopus, Google Scholar, ScienceDirect, SpringerLink, and Cochrane Library, covering studies published between 2010 and 2023. The inclusion criteria used was peer-reviewed articles on pharmaceutical policies in LMICs and the exclusion criteria used were studies unrelated to cosefficiency or outside the LMIC context. The data was synthesised thematically to identify policy trends and gaps. Three major themes emerged: (1) Cost-containment policies such as External Reference Pricing (ERP), which are widely adopted in countries like Vietnam and Turkey, though implementation challenges persist due to regulatory and resource constraints; (2) Cost-sharing mechanisms, including co-payment, often reduce access for vulnerable populations despite intended savings; (3) Value-based pricing and HTA are gaining traction, with South Africa and Thailand showing progress, but institutionalisation remains limited. Generic medicine policies significantly reduce costs, as seen in South Africa where generics account for over 65% of market volume. Tailored pharmaceutical policies can improve spending efficiency and equitable access in LMICs. Measures such as strengthening HTA systems, promoting generics, and adopting transparent pricing strategies are critical for sustainable UHC. This study recommends that future research should focus on evaluating policy impact and developing context-specific frameworks to guide implementation.

Grantor dc:publisher.institution

University of the Western Cape

Year dc:date.issued

2025

Author dc:creator

• Diphalane, Morake Justice

• Affordability of care
• Impact of drug prices
• Low and middle-income countries (lmics)
• Pharmaceutical expenditures
• Public health policy

Licence

• https://uwcscholar.uwc.ac.za/bitstreams/dd1d3ac6-ccec-4d9d-9c9e-c1b171e59227/download