This brief presents a summary of the main findings of the study presented in the Technical Note, "Failures in the generic medicines market in Chile and recommendations to improve competition"Failures in the generic medicines market in Chile and recommendations to improve competition competition". This study analyzes the generic medicines market and its level of competition in Chile. Despite the benefits generated by the existence and availability of generics in the market once the patent expires, in practice, the functioning of the generic medicines market medicines present flaws that limit the levels of competition. This publication investigates the causes that limit competition and their effect on the final price faced by consumers. To propose concrete public policy recommendations for the Chilean context. The study presents three analyzes quantitative measures of market concentration: at the household level, at the level of public purchases and at the level of pharmacies. Based on the results obtained and a qualitative analysis of interviews with key actors, recommendations emerge that are classified around a macro or systemic level and according to actor: distributors, prescribers and patients. Beyond the fact that each one presents its own particularities, to achieve efficiency in public and private spending on medicines requires collective efforts and complementary policies between the different levels of the market.

This policy brief is based on a webinar presented by Luis Alejandro Rivera, Chief of the Pricing Unit at the Dirección Nacional de Medicamentos (National Directorate of Medicines DNM) in El Salvador. The presentation was given on July 2019. Rising prices of medications are a global concern as healthcare expenditures soar and more patients are unable to access the medicines they need. El Salvador has managed to control and lower the price of prescription medicines for both innovator and generic medicines, while maintaining a well-functioning and cost-saving pharmaceutical market. This publication presents takeaways, such as price setting methods, the identification of appropriate market segments, and the introduction of online monitoring platforms, so that other policymakers may use them when introducing price regulation in their own pharmaceutical markets.

Health spending has been growing at a much higher rate than the income of countries practically all over the world. This increase is due to many factors such as the demographic and epidemiological transition, the increase in the expectations of the middle class and, mainly, the presence of more and better health technologies, such as medicines and medical devices. The case of Brazil does not escape the general rule. Expenditure on medicines increased by 40% from 2010 to 2015. Currently, this expenditure represents 16% of the public health budget. To face this challenge, the country has implemented pharmaceutical pricing policies among its strategies. This document presents the main strategies that the country has adopted, and the results achieved to date; highlighting the importance of regulatory designs aligned with the policy objectives and the local contexts.

This technical note discusses the application of economic evidence in health technology assessments for decision-making on the allocation of health resources. There is already recognition in Latin America that the economic dimensions of health interventions, such as cost-effectiveness and budgetary impact, are critical dimensions that should always be considered when making decisions about the coverage or inclusion of technologies in benefits packages. However, there are still barriers and constraints that prevent the evaluation of economic evidence in the region from being an integral part of all decision- making processes, with serious implications for the equity and efficiency with which health resources are allocated. The purpose of this technical note is to provide elements and tools that contribute, in a practical way, to overcoming these barriers, answering the questions asked by health systems that are beginning to apply economic evidence in their evaluation and decision-making processes. How do we know if a technology or intervention is cost- effective in our context? What cost-effectiveness threshold should be applied? How might non-economic criteria and dimensions influence our cost-effectiveness threshold? What limit should be considered when a technology implies a high budgetary impact in a particular health system? Given the existing difficulties in generating local economic evidence, what can the economic evidence generated in other jurisdictions tell us? How can economic evidence be taken into account in a fragmented health system? Consideration of these aspects is key to ensuring fairer, more transparent allocation of health resources and thus achieving more efficient and equitable health systems in Latin America.

Access to safe and quality medicines is an essential axis to guarantee the population's right to health. Health is not only an objective in itself, but it is one of the fundamental pillars to reduce poverty and achieve sustainable economic development (Andean Committee on Access to Medicines, 2017, United Nations 2020).

LESSONS LEARNED FROM A NATIONAL CATASTROPHIC FUND: THE ENGLAND CANCER DRUG FUND Presentation by DR. KALIPSO CHALKIDOU. NOVEMBER 2019

HEALTH BENEFIT PLANS AND RESULTS-BASED FINANCING: TWO ALLIES FOR UNIVERSAL AND EFFECTIVE HEALTH COVERAGE Presentation by DR. MARTIN SABIGNOSO. MARCH 2017

THE ROLE OF HEALTH REGULATORY AGENCIES IN EXPENDITURE PRIORITIZATION SYSTEMS: THE CASE OF INVIMA IN COLOMBIA. Presentation of DR. JAVIER HUMBERTO GUZMÁN CRUZ.AUGUST 2017

This Breve first highlights the importance of pharmaceutical procurement policies. It then focuses on the goals of National Drug Policies. Based on these goals, it looks into the reasons for intervening in pharmaceutical markets and different forms of intervention. The subsequent sections analyze in further detail the procurement of in-patent and off-patent medicines, since there are fundamental differences in the procurement of these two medicine types. Finally, the Breve concludes by summarizing the most important issues for policymakers to keep in mind when defining procurement policies.

COVERAGE OF HIGH COST INTERVENTIONS IN CHILE: A CRITICAL VIEW ON THE RICARTE SOTO LAW. Presentation of DR. MANUEL ESPINOZA. NOVEMBER2016