Effect of Government-Mediated Access Pricing on Drug Availability

Table 7. Assessment of effect of interaction of year with In terms of drug availability, differences between chain
location on drug availability of competitor drugs using and independent drug stores are more pronounced than
logistic regression differences across location. With bigger capital investments,
chain stores offer a much wider array of drug products than
Competitor drug
Int Int Int Chi- p- independent stores, thus the availability of drugs especially
(OR)11 (OR)21 (OR)31 square2 value3
the commonly known branded ones is more likely to be
Asomex 5 mg tablet 1.36 1.02 1.67 1.43 0.6982
Lifezar 50 mg tablet 0.29 0.50 0.45 13.23 0.0042 higher in the former type of drug store. Thus, it would also
Combizar 50 mg/12 mg tablet 1.72 0.84 0.85 7.20 0.0659 be interesting to examine whether the effect of government
Pritor 40 mg tablet 1.21 0.70 0.64 4.96 0.1748 mediation in drug pricing on drug availability would differ
Atopitar 10 mg tablet 0.15 0.50 0.52 3.99 0.2667
Clopivaz 75 mg tablet 0.91 0.37 0.79 6.29 0.0984
in chain and independent drug stores.
Clizid 80 mg tablet 1.83 2.99 2.45 1.94 0.5851 This study thus examined whether the changes in drug
Azyth 500 mg tablet 1.03 0.64 1.47 4.55 0.2081 availability of the listed drugs from 2009 to 2011 differed by
Zalvos 500 mg tablet 0.86 0.55 0.45 1.43 0.6977
type of retail store. The trends of availability of innovator
Patryl 500 mg tablet 2.09 1.95 2.00 1.10 0.7780
Patryl 125 mg/5ml drugs from 2009 to 2011 differed significantly between chain
6.93 44.21 2.68 10.39 0.0155
suspension and independent drug stores only for Flagyl 125 mg/5 ml
1 Int (OR) = Interaction odds ratios. Three interaction terms are produced in
suspension (χ2=4.86, p=0.0275) and marginally for Lipitor 10
the logistic regression with 4 levels of location (Metro Manila, Luzon,
mg tablet (χ2=3.48, p=0.0619) and Hyzaar 50 mg/12 tablet
Visayas and Mindanao) and 2 levels of year (2009 and 2011). This
column gives the exponential of the coefficient corresponding to each (χ2=3.16, p=0.0753) (Table 9).
interaction term in the model. The interaction (OR) informs how much
the odds ratio is multiplied when two indicator variables are both Table 9. Assessment of effect of interaction of year with type
present (both coded as 1) as compared to when only one of them is
present (one is coded 0 and the other coded as 1).
of drug store on drug availability of innovator drugs using
2 Based on likelihood ratio test (LRT) comparing model with interaction and logistic regression
model without interaction.
3 p-value corresponding to the LRT.
Innovator drug Int (OR)1 Chi-square2 p-value3
Norvasc 5 mg tablet 1.03 0.00 0.9718
Further details of these interaction effects are shown in Cozaar 50 mg tablet 1.30 0.26 0.6080
Hyzaar 50 mg/12 mg tablet 0.42 3.16 0.0753
Table 8. The availability of Lifezar tablet in drug stores
Micardis 40 mg tablet 0.74 0.11 0.7437
registered significant increases in Metro Manila (59.8% in Lipitor 10 mg tablet 0.36 3.48 0.0619
2009 vs 78.6% in 2011, χ2=9.71, p<0.0020). However, there Plavix 75 mg tablet 0.92 0.02 0.8983
was an apparent decrease in Luzon (72.6% in 2009 vs. 65.4% Diamicron 80 mg tablet 1.35 0.31 0.5769
Zithromax 500 mg tablet 0.45 2.07 0.1499
in 2011, χ2=3.17, p=0.0752), while no significant changes in Ciprobay 500 mg tablet 0.99 0.00 0.9826
Lifezar availability occurred in Visayas and Mindanao. The Flagyl 500 mg tablet 2.57 1.87 0.1718
reduction in the availability of Patryl suspension in drug Flagyl 125 mg/5ml suspension 2.94 4.86 0.0275
outlets was more severely felt in Metro Manila (6.8% in 2009
1
Odds ratio of the interaction term obtained by getting the exponential of the
estimated coefficient corresponding to the interaction term in the logistic
vs. 0.9% in 2011, Fisher’s exact p=0.0180) and Visayas (8.3% regression model. Only 1 interaction term is present in the model.
in 2009 vs. 2.8% in 2011, Fisher’s exact p=0.0670). No 2 Based on likelihood ratio test (LRT) comparing model with interaction and

significant change was seen in Luzon (6.4% in 2009 vs. 5.3% model without interaction.
3 p-value corresponding to the LRT.
in 2011, χ2=0.31, p=0.5790). From only one drug outlet (0.9%)
that had Patryl suspension in Mindanao, this reached five
Table 10 shows the percent availability of Flagyl
stores (4.6%) (Fisher’s exact p=0.0160). A significantly higher
suspension, Lipitor tablet and Hyzaar tablet in 2009 and
percentage of drug stores in Luzon carried Combizar tablet
2011 for chain and independent stores. Among the
in 2011 (75.2%) than in 2009 (56.8%) (χ2=20.11, p<0.0001).
independent stores, the reduction in availability of Flagyl
However, this increase was not seen in other areas (χ2≤1.17,
suspension was from 53.7% in 2009 to 30.8% in 2011 or a
p≥0.2800).
42.6% decrease (χ2=55.00, p<0.001). In chain drug stores, a

Table 8. Percent availability of Lifezar 50 mg tablet, Patryl 125 mg/5 ml suspension and Combizar 50 mg/12 mg tablet in drug
stores in 2009 and 2011, by location

Lifezar 50 mg tablet Patryl 125 mg/5 ml suspension Combizar 50 mg/12 mg tablet

Chi-square / Fisher’s Chi-square / Fisher’s Chi-square / Fisher’s
Location N 2009 2011 2009 2011 2009 2011
exact (p-value) exact (p-value) exact (p-value)
Metro Manila 117 59.8 78.6 9.7099 (0.002) 6.8 0.9 (0.018) 41.0 34.2 1.1656 (0.280)
Luzon 266 72.6 65.4 3.1715 (0.075) 6.4 5.3 0.3083 (0.579) 56.8 75.2 20.1056 (<0.001)
Visayas 108 76.9 78.7 0.1071 (0.743) 8.3 2.8 (0.067) 69.4 72.2 0.2017 (0.653)
Mindanao 109 65.1 69.7 0.5222 (0.470) 0.9 4.6 (0.106) 56.9 59.6 0.1698 (0.680)

VOL. 48 NO. 1 2014 ACTA MEDICA PHILIPPINA 13