Prices and Practices Pharmaceutical Survey 2010

Report by

Supported by

Funded by

CONSUMER COUNCIL OF FIJI

EUROPEAN UNION

About Consumer Council of Fiji (CCOF)

Consumer Council of Fiji (CCOF) is a statutory organization dedicated to protect the rights and interests of consumers in Fiji and promote consumers interests nationwide through education, research, campaign and lobbying. It was established in 1976 and currently has 3 offices in Fiji.

For more information, visit www.consumersfiji.org

Prices and Practices : Pharmaceutical Survey 2010

2010. This work is copyright. Apart from any fair dealing for the purpose of private study, research, criticism or review as permitted under the Copyright Act, no part may be reproduced by any process without written permission.

Layout and Concept : Consumer Council of Fiji. Printed in Fiji.

USP Library Cataloguing-in-Publication Data

Prices and practices : pharmaceutical survey 2010 / [Consumer Council of Fiji]. Suva, Fiji : Consumer Council, 2011. 44 p. :col. ill. ; 28 cm.

ISBN: 978-982-98044-2-6
Drugs - Prices - Fiji 2.Prescription pricing - Fiji I. Consumer Council of Fiji. HD9674.F5P74 2011 338.436151

Published by Consumer Council of Fiji (CCOF) Suva Office (HQ) Ming Building, 4 Carnavon Street P Private Mail Bag T (679) 330 0792 | (679) 331 0183 | (679) 330 5864 F (679) 330 0115 E complaints@consumersfiji.org Lautoka Office Suite 4, Popular Building, Vidilo Street P P.O.Box 5396, Lautoka T (679) 666 4987 F (679) 665 2846 M (679) 926 2807 E consumerltk@connect.com.fj Labasa Office Level 1, Lot 41 Raza Properties Limited, Nasekula Road P P.O.Box 64, Lautoka T (679) 881 2559 F (679) 881 2559 E colbs@connect.com.fj

CORRIGENDUM At the time medicines were purchased, Midway Pharmacy Ba did not provide a receipt with itemized prices nor were the prices stated on the individual medicine pack. The Council sought the prices of individual medicines over the phone from Midway. This is why the individual medicine prices for Midway on row number 35 in the appended table (Individual Medicine Prices & Comments) on page 35 do not tally with the total price paid for the medicines purchased which is $18. 00. Now that Midway has provided evidence, the Council is satisfied that the pharmacy is not overcharging. Hence the claims of Midway overcharging made on pages 6, 14, 15, 17, 18, 19 and 20 of this report should be disregarded.

CONSUMER COUNCIL OF FIJI

Prices and Practices Pharmaceutical Survey 2010

A Consumer Council of Fiji Report

The Consumer Council of Fiji is greatly appreciative of the proactive assistance and support of the Ministry of Health, in particular the Honourable Minister Dr Neil Sharma. The survey would have been difficult had it not been for the support and advice of the Minister. We also would like to thank the Fiji Commerce Commission and the Pharmacy & Poisons Board for the valuable comments and advice provided towards strengthening the final report. These three agencies have also taken the necessary first steps towards taking necessary action on some of the recommendations included in this report. Last, but not least, the Council wishes to express its gratitude to those consumers who have assisted this endeavour by way of complaints and contributing their voice to the public debate over medicine prices in the country. Needless to say the responsibility for errors, omissions and content of the report lies entirely with the Consumer Council of Fiji.

Contents
Glossary And Acronyms List of Tables Executive Summary Introduction Objectives of the study Survey Methodology Key Findings Pharmacy Trade Practices Pharmacy Ownership Conclusion and Recommendations References Appendix: Response from Pharmacy and Poisons Board 29 Response from Fiji Pharmaceutical Society Individual Medicine Prices & Comments Price Comparisons Same medicine, batch number, manufacturer/source country 30 - 31 32 - 42 43 - 47 4 4 5-7 8 9 10 11 - 20 21 - 24 25 26 - 27 28

Glossary and Acronyms

Glossary and Acronyms

Branded medicines - Branded medicines are those medicines that are protected by patents. A medicine brand name is often the trade or brand name the manufacturer gives to the medicine. Another term used is originator brand and the patent gives the manufacturer the exclusive right to market the medicine under its brand name for a defined period, often many years depending on the patent conditions. Other companies can have the right to manufacture and market the medicine under a different name or under its generic name once the patent expires. Branded medicines are often more expensive because the manufacturer has spent considerable money and other resources in research and clinical trials, and also packaging and marketing the medicines. Commerce Commission - The competition and commerce regulator in Fiji responsible for administering and enforcing the Commerce Commission Decree which contains laws and regulations pertaining to fair trade, consumer protection and competition. The Commission is also the price regulator responsible for issuing price control orders and enforcing such orders. DHA - Drug Houses of Australia Drug In the pharmaceutical industry a drug is a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being. The term drug is often used interchangeably with the term medicine. Both mean the same thing in the pharmaceutical industry or in pharmacology. Generic medicines (or generics) - Medicines produced and marketed under their chemical or generic name, e.g. paracetamol as opposed to Panadol, a brand or trade name of a paracetamol produced, patented and marketed by pharmaceutical company GlaxoSmithKline. Generics are normally no longer protected by patents. A generic drug can only be sold after the patent runs out. While generic drugs are cheaper for consumers, they still must meet the required standards set by regulatory authorities. For example, the US Food & Drug Administration (FDA) requires that generics must contain the active ingredients as the original formulation. Generics should have the same route of administration, safety, efficacy and intended use as branded medicines. GOF - Government of Fiji GSK - Glaxo Smith Kline FIRCA - Fiji Islands Revenue and Customs Authority FPS - Fiji Pharmaceutical Society NCDs - Non Communicable Diseases NGOs -Non Government Organizations Patent - A patent normally is an exclusive right granted by a government or regulatory agency to an individual inventor or business to manufacture, market and sell a product or invention for a certain number of years. Price Control Order A regulation or legal decision to control or prescribe the allowable maximum price of a product. PIB- Prices and Incomes Board (now merged with Fiji Commerce Commission) TIN- Tax Identification Number VAT- Value Added Tax

List of tables
Table 1 No: of Pharmacies Surveyed in each Division Table 2 Prices for Prescription Pack Table 3 Highest and Lowest Prices (Full Pack) Table 4 National Analysis-Pharmacies with 6 Generics and One Originator Brand (Glipizide-Minidiab) Table 5 Divisional Analysis- Pharmacies with 6 Generics and One Originator Brand (Glipizide-Minidiab) Table 6 Price Analysis-Frusemide Same Dosage/ Quantity Table 7 Aspirin Table 8 Metformin Table 9 Simvastatin Table 10 Enalapril Table 11 Amoxicillin Table 12 Glipizide Table 13 Comparison of Same Drug and Quantity Table 14 Non Disclosure of Individual Medicine Prices Table 15 Queries on Prescription Table 16 Pharmacy Ownership

Executive Summary

Executive Summary
Introduction
The pharmaceutical sector plays an important role in providing safe and affordable medicines to the people of any country. Fiji is no exception. Medicine prices are controlled through the Prices and Incomes Board (PIB (now merged with Commerce Commission) which sets percentage mark-ups at wholesale and retail level. The Government of Fiji (GOF) has provided incentives through duty exemptions and consumer protection through percentage price control. Despite all these measures, consumers are still complaining of high health costs. This is a direct result of anomalies in the pricing of medications in pharmacies. While not codified, the general practice amongst pharmacies is to supply generic medication, as opposed to originator brands for prescriptions from a public hospital or a health centre unless requested by patients to do otherwise. The Consumer Council of Fiji conducted surveys in to ascertain prices of commonly prescribed drugs for diabetes, hypertension, heart disease and other non communicable diseases. The Fiji Pharmaceutical Society (FPS) rejected the findings of these surveys claiming that they were technically flawed. The Councils drawback then was the lack of technical advice and co-operation from the pharmaceutical sector. Hence, the Council decided to carry out a comprehensive survey with the assistance of the Ministry of Health and a technical expert to investigate prices of prescribed medicines, pharmacy practices and anti-competitive conduct (if any) in this very important sector. In finalising the survey report the Council presented the draft and initial findings to the FPS for its comments. This endeavour was necessary to get the feedback from FPS and its members on the findings. The FPS had responded via the Minister of Health and a copy of their comments has been included in this published report. (refer to Appendix)

Survey Methodology
A patients prescription from a registered medical doctor at a public hospital was presented to 47 out of 55 pharmacies for dispensing. These were purchased by the Council and documents pertaining to this transaction are retained as evidence and for verification. This study looked at the following aspects: Prices of medications of the same brand, quantity, batch number and country of origin from different pharmacies; The kind of brands that were dispensed (generics or originator); Whether the consumer was informed of the availability of this choice to buy generic or originator brands; Pharmacists conduct in dispensing medicines; Whether prices were fully disclosed to the consumer; Labelling requirements set by the Ministry of Health which requires the quantity of medication dispensed, directions for use, brand if possible and prices to be displayed on the 1labels ; Whether issuing of receipts complied with the Commerce Commission requirements; Whether registered pharmacists were in attendance during the dispensing of medicines; and To understand market practices in terms of competition, fair play and corporate social responsibility.

Ministry of Health (30 Oct 2009) Press Release on Monitoring of Pharmaceutical Prices in Private Sector

Executive Summary

Main Findings
1. Thirty (30) or 57% of the pharmacies surveyed charged higher prices for the same brand and quantity of medication. In some cases overcharging is by 460% despite placing medicines under price control. Thirty (30) tablets of Microlab were sold by Nadi Chemist for $0.83 where as Midway Pharmacy- Ba & Chovhan Pharmacy Ltd-Lautoka sold the same tablet and the same quantity for $4.65. Forty three (43) pharmacies chose to dispense originator brands for one or more items even though generics are widely available. Thus, a $15.00 prescription would now cost a consumer up to $44.00, which is three times more or worth a three months supply of medicines. Twelve pharmacies charged more than $30.00 while Hyperchem Pharmacy, Lautoka; Thakorlals Pharmacy, Nadi and Western Medicare Pharmacy, Ba charged more than $40.00 for the same prescribed medicine. These are unreasonable profits being made at the expense of patients. While not breaching any law, these pharmacies have shown gross negligence and a complete breach of trust placed on them by ordinary consumers by dispensing originator brands without first consulting them. The unsuspecting public, especially the poor, thus need to readjust their entire months budget which can potentially result in children missing school,compromise in living standards or simply aggravating further their poverty status. [opinion which would need substantiating] A comparison made for those pharmacies selling 6 generics and 1 originator brand Minidiab (glipizide) revealed that the highest price for all 7 medicines was charged by Chovhan Pharmacy Lautoka at $31.00, while Guardian Angel Pharmacy, Laucala Beach offered the lowest price of $15.35. The percentage price difference between the lowest and highest for this group was 102%. This would mean double the price for the same set of medicine for a consumer in Lautoka than in Suva. Is this 102% price difference justfied? Only three (3) pharmacies dispensed all 7 generic medicines as prescribed. Amongst the All Generics Group, Health Care Chemist in Tavua charged a higher price of $30.70 while Nadi Chemist charged $13.45 for all 7 generic medication. A consumer in Tavua would pay $17.25 more for the same medicine. This is a classic case of generic medication being sold at a price of the originator brand drugs to unsuspecting consumers. Interestingly, 36 pharmacies who sold either one or more originator medicine had a lower total pack price than Health Care Chemist in Tavua. 5. Thakorlals Pharmacy in Lautoka dispensed the incorrect dosage of enalapril. Instead of 10mg (as per prescription), the pharmacist dispensed 5mg without informing the buyer. Similarly, Sugar City Pharmacy, Lautoka issued 15 capsules of amoxillin instead of 9 or 10 for eight hourly courses. Three pharmacies sold generic medication labelled as originator brand and charged the originator brand price. Thakorlal Pharmacy in Nadi, Wyse Pharmacy in Nakasi and Northern Drug Store in Labasa dispensed generic Apro frusemide but labelled it as Lasix which is an originator brand tablet and also charged the price of Laxis ($4.65) which is much more expensive than generic Apo ($1.35). Some pharmacies sold the same medicine (brand, dosage & batch number) at different prices. For example, two pharmacies in Ba Hyperchem and Midway had a 189% price difference for the same medicine Flaminopril enalapril (Flamingo Pharmaceuticals batch #106). Similarly, Arrow (batch# SAWH0019) was sold by Budget Pharmacy in Nadi for $2.95 while My Chemist, Nasea Chemist and Northern Drug Store in Labasa dispensed the same medicine for $9.45. These three pharmacies overcharged consumers by 220%. Nineteen (19) pharmacies violated labelling requirements in one way or another. None of the 47 pharmacies provided individual medicine names on the receipts. However, 32 pharmacies included the price on the labels. Nineteen (19) pharmacies provided both itemised receipts using codes and prices on their labels. Out of the 32 pharmacies that included prices on the labels, 15 did not provide itemised receipts.

6.

2.

7.

8.

3.

9.

4.

10. Three pharmacies (Sugar City Pharmacy, Lautoka; Chovhan Pharmacy, Lautoka and Patel Pharmacy, Sigatoka issued a receipt without the company name, TIN number or company address. Madison Pharmacy, Suva gave a chit with company name and total price when a receipt was requested. In the Northern Division, Northern Drug Store, Labasa issued a receipt from My Chemist instead of a receipt specifically for Northern Drug Store. Ownership is the same for My Chemist and Northern Drug Store.

Executive Summary
11. 51% of total pharmacies under survey made inquiries on the prescription and the patient, while 49% of the pharmaciess dispensed the drugs without any further clarification on the prescription. 12. During the survey, none of the pharmacies asked whether the patient wanted generics or originator brand medications. The general rule amongst pharmacists is to dispense generic drugs when presented with a public hospital prescription. 13. Pharmacy Plus of Suva and Life Pharmacy Nadi had the incorrect patients name typed on the medicine pack. 14. Generally, the prices of medicine in the Western Division are higher than in Central and Northern Divisions. In the Central division, Superdrug Pharmacy, Suva and Central Pharmacy, Suva sold the 7 medicines under survey for $38.80 and $38.50 respectively.

Recommendation
These findings call for the implementation of some necessary actions that would address current problems and also benefit the consumers and the pharmaceutical sector. The following are recommended: 1. To acknowledge that there have been breaches and unfair trade practices by the pharmaceutical sector and that the enforcement agencies have not been vigilant; Pharmacy and Poisons Board together with PIB (Commerce Commission) to prosecute pharmacies if breaches have occurred. The Price Control Order (PCO) is now some 18 years out of date thus urgently needs to be reviewed and amended to address Fijis increasing cost of health care. Pharmacy and Poisons Board needs to take a more proactive role in regulating the industry and its practices. The law also establishes the Fiji Pharmaceutical Society (Section 32B). They need to strengthen their code of ethics and monitor market practices. FPS to ensure its members wear professional attire (e.g. white coat) so that the public can differentiate a pharmacist from other pharmacy staff. FSP should also require that pharmacies display the pharmacists name that is on duty at one particular period of time; FPS, the Ministry of Health and the Consumer Council of Fiji should educate consumers on the different categories of medicines generics, branded generics and originator brands, including labelling information; 9. 7. A price list of common drugs consumed for common illnesses should be prominently displayed at pharmacies. PIB/Commerce Commission to list these in a revised price order; The Ministry of Health to impose a strict Code of Conduct that must be practiced by all pharmacies. The Code of Conduct has to be a binding document and any breaches to it should lead to fines or cancellation of licenses. FPS and the Ministry of Health should set up guidelines for dispensing of drugs. Fiji Islands Revenue and Customs Authority (FIRCA) can investigate whether companies and their shareholders are accurately and truthfully declaring their income for tax purposes. There are violations, for example, nonpharmacists are shareholders in some cases and in a few cases the same shareholder(s) own multiple pharmacies according to the Registrar of Companies records;

8.

2.

3.

4.

5.

10. The Ministry of Health and Commerce Commission should also look at the importers and distributors of pharmaceuticals in Fiji to ensure competition. 11. The Government to implement the recommendations of this study so that Fijis citizens are not easily manipulated and their health interests are protected at all times.

6.

Introduction

Introduction

Medications are perhaps the only product where consumers cannot exercise their preference and therefore trust that professional guidance is provided by the pharmacist in good faith. Therefore, professional and ethical conduct of pharmacist is paramount in ensuring that consumers are treated fairly.

The pharmaceutical sector plays an important role in providing safe and affordable medications to the citizens of any country. Fiji is no exception. For this, a strong regulatory mechanism is required to monitor prices and availability of essential medicines to ensure that 34% in urban areas and 43% of people in rural areas living below the poverty line have access to affordable medications 2. A consumer depends solely on the doctors and the pharmacists to be treated fairly while prescribing and dispensing medicines. Medications are perhaps the only product where consumers cannot exercise their preference and therefore trust that professional guidance is provided by the pharmacist in good faith. Therefore, professional and ethical conduct of pharmacist is paramount in ensuring that consumers are treated fairly. Prescribing in the public sector is primarily by generic name, however in the private sector both brand and generic names are in use based on each individual pharmacists preferences. The existing legislation requires that in the private sector, the pharmacist must supply the brand prescribed by the doctor, however in practice, the pharmacist may discuss alternative generic products and prices with the patient who then makes the selection 3. Medicine prices is an important item on the Ministry of Healths agenda 4. In October 2009, the Ministry introduced a monitoring system of Pharmaceutical Prices in the Private Sector by encouraging the public to report any price-related issues. In November 2009, the Minister of Health, Dr Neil Sharma had raised issues of overcharging under the heading of professionalism and ethics in a written speech delivered to members of the Fiji Pharmaceutical Society 5. The Ministry of Health in July 2010 convened
2 Preliminary Report on Poverty and Household Incomes in Fiji in 2008-09, Bureau of Statistics. 2010 3 http://www.haiweb.org/medicineprices/surveys/200409FJ/survey_report.pdf 4 Ministry of Health (30 October, 2009) Naturopathic Medicine Retailing in Fiji 5 Speech of the Ministry for Health, Dr Neil Sharma delivered to members of the Fiji Pharmaceutical Society, Natadola, Nadi, 29th Nov 2009. www. www.

a Working Committee on medicine prices comprising health officials and representatives from the Consumer Council, Commerce Commission/Prices & Incomes Board (PIB) and the Ministry of Finance.

Price Control
All medicines in both public and private sectors in Fiji are imported. Medicines are on percentage price control as stipulated in the Price Control Order No.5, 1992 Ethical Medicine. Under the formula outlined in this Order, the wholesale profit margins for medicines are set at: Total into-store cost for pricing plus 20%, while the retail pharmacies are allowed a maximum mark-up of 30% for over the counter drugs and 35% for prescription drugs plus 45c for dispensing doctors prescriptions 6. The PIB (now merged with the Commerce Commission) is the agency that is charged with monitoring medicine prices and ensuring compliance by wholesalers and retailers of pharmaceutical products. There is no value-added tax (VAT) on dispensed medicines but this tax is payable on medicines purchased over the counter without prescription 7. However, since 1992, the PIB has not done any review of the PCO on medicines nor has it produced any formal monitoring report to gauge compliance. The Price Control Order is now some 18 years out of date and urgently needs a review and amendment to address Fijis increasing cost of health care. The fact that there is a trend towards private health care and a user-pay system to relieve pressure on state-funded services and facilities, price control is a way to mitigate any negative impacts on poor and low-income consumers.

Previous Surveys Conducted in 2007 and 2009

This investigation is a continuation of the Councils monitoring of retail prices of medicines in the local pharmaceutical market. Surveys were conducted in 2007 and 2009 to ascertain prices of essential prescription drugs for most
health.gov.fj/speeches/29/11/2009--Fiji-pharmaceutical-society natadola. html (Accessed 15 June 2010) 6 Fiji Republic Gazette Supplement, No.26, Friday 5th June, 1992; Legal Notice No.69, Counter-Inflation Act (Chapter 73), Counter-Inflation (Price Control), Ethical Medicine, No.5, Order, 1992. 7 http://www.haiweb.org/medicineprices/surveys/200409FJ/survey_report.pdf

Objectives of The Study

common ailments and diseases suffered by a growing number of people in Fiji such as diabetes, hypertension, heart diseases and other non-communicable diseases (NCDs). According to the Ministry of Health, NCDs are the leading causes of deaths in Fiji and hypertension prevalence is 19.1% 8. In the 2009 price survey the Council analysed the prices of essential drugs voluntarily provided by selected pharmacies. These prices were then compared with a similar survey held in 2007 to determine the extent of price increases. There were limitations to this method. The pharmacies would have rightly assumed that a price survey was underway and thus would have supplied prices that did not reflect what was actually charged to consumers. Also, out of 20 leading pharmacies approached in 2009, only 14 provided their prices. It was necessary then to acquire realistic prices by actually purchasing a number of prescribed medicines.

Objectives of The Study

The government has played its part by making prescribed medicines both duty and VAT exempt as well as placing these under price control. Despite all these measures, consumers are still complaining of high price variance between pharmacies and continued rising prices of pharmaceutical products. To this end, the Council carried out surveys in 2007 and 2009 to ascertain prices of commonly used prescription drugs which included medications used for diabetes, hypertension, heart disease and other non communicable diseases. The findings of these surveys were rejected by the Fiji Pharmaceutical Society (FPS) on the basis that they were technically flawed. The Councils drawback while conducting the survey then was lack of professional advice and non cooperation by the retail sector. The Council thus decided to carry out a comprehensive survey with the help and approval of the Ministry of Health and a technical expert. The objective of the survey was to to investigate prices of prescription medicines, pharmacy practices in dispensing drugs and anti-competitive behaviour (if any) in the pharmaceutical sector. However, it was equally important for the Council to establish whether the current Price Control on medicines under the Commerce Commission is actually benefiting the consumers. More specifically, the Council investigated the following aspects:

Aspects 1. Price of Medicine

Research questions a) Comparison of prices of prescription medicines of the same brand, same batch number, same country of origin and same quantity in different pharmacies around Fiji; b) Whether generics or originator brands were dispensed; c) Did the pharmacist offer choice between originator and generic medicines? e) Whether generic medicines were sold at an originator price; and f ) Comparison of prices of medication in those pharmacies with the same owner(s) a) Were pharmacists present at the outlets during dispensing of medications? b) Was there any interaction between the pharmacist and the consumer? c) Was the labelling of medications correct and whether directions on the labels were clearly written? d) Did the pharmacist disclose the prices of medications before dispensing the medicines? and e) Did the consumer receive an itemised receipt and whether price information on each medicine was clearly stated? a) Who are the owners of these pharmacies? Is there multiple ownerships? b) Is there price fixing if pharmacies are owned by the same person(s) or cartel like operation if ownership is different?

2.

Pharmacy Trade Practices

3.

Pharmacy Ownership

It should be noted that while the objective of the survey was to investigate prices of prescription medicines, scrutinise pharmacy practices and ascertain anti-competitive behaviour (if any), the ultimate goals have been to correct the anomalies in the pharmaceutical sector and providing relief to consumers. The first steps towards these goals have been taken as the Council has received very positive responses from the principal enforcement agency namely the Pharmacy & Poisons Board of the Ministry of Health. The Board was prompted to investigate the issues raised in the draft report and this had commenced in late 2010.
8 Panapasa G., 2010, Symposium on NCDs, Fiji Times, 6 July.

During the final stages of the publishing of this report, the Board informed the Council that a general warning letter had been issued to all retail pharmacies and specific cases are being addressed through its disciplinary procedures. Further, the Councils recommendation to make public the action taken against specific pharmacies would be discussed at its first meeting of 2011. It can be asserted here that the ultimate goals of the report are being gradually achieved and the Council is very optimistic that the full impact will soon be realised.

Survey Methodology

10

Survey Methodology
In order to understand the problems pertaining to price variations, pharmacy practices and pharmacy ownership, three separate investigations/ observations were conducted as outlined below: Nausori, Suva-Nasinu, Sigatoka, Nadi, Lautoka, Ba, Rakiraki, Tavua and Labasa. A total of 47 pharmacies were surveyed around Fiji. The total cost of the medicines from the 47 pharmacies was $1169.63. A total of 23 pharmacies were surveyed in the Central/Eastern Division along the Suva-Nausori corridor, while 21 were surveyed in the Western Division from Sigatoka to Rakiraki and 3 in the Northern Division (Labasa has only 3 pharmacies).

Prescription
To obtain the actual prices of medications that patients pay for required the Council to acquire a prescription from a medical doctor to purchase medicines from pharmacies around Fiji. The Council with the assistance of the Ministry of Health was able to obtain a prescription from a doctor at a public Hospital. (See Appendix 1 for a copy of the prescription). The prescription was prepared for an elderly male patient suffering from diabetes, cardiovascular ailments, high blood pressure and high cholesterol. It must be noted that the age of the patient is not stated on the prescription; instead Adult/m is used. Multiple copies of the same prescription were taken to pharmacies around Fiji. The staff posed as a relative, an employee, a neighbour or a friend of the patient when presenting the prescription for dispensing. The Council bought the medicines under the patients name. The survey was held from 26th April to 12th May 2010, covering

Medicines
A total of seven (7) medicines (amoxicillin, enalapril, simvastatin, metformin, frusemide, glipizide and aspirin) were prescribed with a maximum of 2 repeats for all except for amoxicillin which the prescription did not allow for a repeat (see Appendix 1 for details). Since the ailments addressed in the prescription are common in Fiji, it is expected that these medicines are readily available in around the country pharmacies. Table 1: No. of Pharmacies Surveyed in each Division
DIVISIONS Central/Eastern Western Northern TOTAL No. of Pharmacies 23 21 3 47

Pharmacy Trade Practices- Observation

The Council also prepared a checklist for observations regarding pharmacy practices while dispensing medicines. Some of these were: Presence of pharmacists on the premises and during dispensing; Labelling requirements as set by the Ministry of Health which require that the quantity of medication dispensed, directions for use, brand (if possible) and prices to be displayed on the labels; Was the patient given a choice to purchase a generic or an originator brand?; If information such as phone contact, age, etc of the patient was sought by the pharmacy; Was itemised receipt given with price information on each medicine and whether these were clearly stated? Pharmacist interaction with the patient; Disclosure of prices; and Issuance of receipts.

Pharmacy Ownership
This was done by retrieving pharmacy ownership documents from the Registrar of Companies. The idea is to ascertain ownership and investigate possibility of price fixing if more than one pharmacy is owned by the same person(s) or cartel like operation if ownership is different. The intention was to understand market practices in terms of competition, fair play and corporate social responsibility.

Key Findings

11

Key Findings
PRICE ANALYSIS
Out of the 47 pharmacies, 7 did not offer the full pack of medicines as prescribed. Six pharmacies did not dispense amoxicillin since the prescription was written a while a g o , while one did not have glipizide. Most pharmacies dispensed Minidiab brand of glipizide as generics are not readily available and with little price difference. However there
No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Pharmacy A.J. Swann Co Ltd, Suva Amy Street Pharmacy, Toorak Central Pharmacy, Suva City Centre Pharmacy, Suva Flagstaff Pharmacy, Suva Good Health Care Pharmacy, Suva Guardian Angel Pharmacy, L/Beach Holistic Pharmacy, Suva Laucala Bay Pharmacy, Suva Life Pharmacy, Nausori Madison Pharmacy, Suva Mega Care Pharmacy, Makoi, Nasinu Metro Pharmacy, Suva Nasese Pharmacy , Suva Nausori Pharmacy Ltd, Nausori Pharmacy Plus, Suva Rewa Pharmacy, Nausori Samabula Drug Store,Samabula Superdrug Pharmacy, Nabua Superdrug Pharmacy, Suva Suva City Pharmacy, Suva Wyse Pharmacy, Nakasi Wyse Pharmacy, Valelevu

is no excuse for dispensing Lasix instead of frusemide as this is readily available. In the analysis (see Appendix 2), all 47 pharmacies were considered depending on the type of information that was sought. For example, all 47 pharmacies were considered while investigating pharmacy practices and the cost of individual medicine while 40 pharmacies were considered for determining the cost of all 7 medicines.

Prescription Pack: Price Differences, Lowest and Highest

The comparison is made for all (7) prescribed medicines purchased by the Council staff irrespective of generics and originator brand as choice was not offered by any of the pharmacy. Table 2 below provides what a consumer is most likely to pay for the 7 medicines from 47 pharmacies.
Total Price $19.40 $18.85 $38.50 $28.26 $28.75 $18.35 $15.35 $15.15* $18.60 $14.50* $19.90 $23.25* $25.20* $29.85 $25.26 $20.30 $13.60* $15.90 $23.30* $38.80 $21.40* $29.65 $24.50

Location 21 Thomson St, Suva 120 Amy St, Toorak Lot 1, Cumming St, Mid city, Suva MHCC, Suva 7 Rewa St, Flagstaff Nasese Medical Centre,62 Ratu Sukuna Rd Vivras Plaza, Laucala Bch 1 Nina Street, Suva Sport City,1 Grantham Rd, Laucala Bay Lot 1, NG Patel Rd, Nausori 83 Cumming St,Suva Matanikorovatu Road, Makoi Renwick Road, Suva 36 Ratu Sukuna Rd, Nasese,Suva Kings Rd, Nausori 190 Renwick Rd, Suva Wing Zoing Wah Bldg, Main Street, Nausori 77 Ratu Mara Rd, Samabula 550 Rt Mara Rd, Nabua Suva Central Bldg, Suva 10 Thomson St, Suva Tebara Shopping Mall, Nakasi Shop 4,Daniva Rd, Valelevu

CENTRAL/EASTERN DIVISION

Key Findings
WESTERN DIVISION 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 Budget Pharmacy, Nadi Care Chemist, Sigatoka Chandulals Pharmacy, Lautoka Chovhan Pharmacy Ltd, Lautoka Health Care Chemist, Tavua Health First Pharmacy, Nadi Hyperchem Pharmacy, Ba Hyperchem Pharmacy, Lautoka Island Pharmacy Complex, Nadi Island Pharmacy, Ba Life Pharmacy Ltd, Nadi Midway Pharmacy, Ba MS Pharmacy, Nadi Nadi Chemist, Nadi Naidus Medical Centre Namaka Medisure Pharmacy, Nadi Patel Pharmacy Ltd, Sigatoka Sugar City Pharmacy Ltd, Lautoka Thakorlals Pharmacy, Lautoka Thakorlals Pharmacy, Nadi Western Medicare Pharmacy, Ba My Chemist, Labasa Nasea Chemist, Labasa Northern Drug Store, Labasa Shop 3, Namaka Lane, Nadi Suewing Bldg,Sigatoka 23 Yasawa St, Lautoka 5 Yasawa St, Lautoka Market St, Tavua 40 Lodia St, Nadi Town Main St, Ba 101 Vitogo Parade, Lautoka Main St, Nadi 62 Bank St, Ba 41 Lodhia St, Nadi Kings Rd, Ba 9 Caly St, Nadi Town Clay St, Nadi Town Vaileka Street, Rakiraki Namaka Lane, Nadi Box 12,Sigatoka 23 Naviti St, Lautoka 1003 Vitogo Parade, Lautoka 347 Main St, Nadi Main Street, Ba Shop 5 Nasekula Rd, Labasa Shop1,168 Nasekula Rd,Labasa R.B.Patel Building, Labasa $18.00 $20.31 $19.80 $31.00 $30.70 $32.08 $21.55 $44.25 $24.55 $28.50 $22.00 $18.00 $25.35 $13.45 $30.50 $31.00 $30.50 $21.55 $30.17 $40.10 $40.50 $23.40 $21.80 $25.50

12

NORTHERN DIVISION

*pharmacies that did not dispense all 7 medicine

Pharmacies in the Western Division had both the most expensive and lowest priced pack. The most expensive pack was $44.25 purchased at Hyperchem Pharmacy in Lautoka, while the lowest priced pack was $13.45 at Nadi Chemist. The highest price in the Central/Eastern area was $38.80 recorded at Superdrug Pharmacy (Suva Central Bldg), while the lowest priced pack was sold by Guardian Angel Pharmacy (Vivraz Plaza, Laucala Beach) for $15.35. There were not much price differences between the three pharmacies in the Northern Division. The Northern Drug Store had the highest price of $25.50, while Nasea Chemist had the lowest at $21.80. Table 3 below shows percentage difference in each division and at the national level. Table 3: Highest & Lowest Prices (Full Pack)
DIVISION All/National Central/Eastern Western Northern LOWEST PRICE $13.45 $15.35 $13.45 $21.80 HIGHEST PRICE $44.25 $38.80 $44.25 $25.50

The percentage difference between the highest and lowest prices for the full complement of prescribed medicines was 229%. This means that a consumer who pays the highest price of $44.25 for the prescribed medicine pack was paying 229% more or three times more than the one who pays the lowest price of $13.45. The Northern Division had the lowest price difference which reflects the limited choice consumers have in this division. In essence we can deduce that huge price gaps exists between the pharmacies (irrespective of originator brand or generics) and many consumers may be unaware of this and are buying medicines at exorbitant prices.

% Difference 229% 153% 229% 17%

Key Findings

Pharmacies that sold 6 generics and one originator medicine

A comparison was also made for 16 pharmacies that sold 6 generics and 1 originator brand from the prescribed 7 medicines. From these 16 pharmacies, nine (9) are in the Central/Eastern, 4 in the Western and 3 in the Northern division.

13

Table 4: National Analysis Pharmacies with 6 generics and one originator brand (Glipizide Minidiab)
Number of pharmacies compared Highest Price (Chovhan Pharmacy Lautoka) Lowest Price (Guardian Angel Pharmacy, Laucala Beach, Nasinu) Price difference between lowest and highest price Percentage price difference between lowest and highest price 16 $31.00 $15.35 $15.65 102%

The highest price was charged by Chovhan Pharmacy Lautoka at $31.00, while Guardian Angel Pharmacy, Laucala Beach Nasinu had the lowest price of $15.35. The percentage price difference between the lowest and highest priced pharmacy in this group was 102%. Below are the price differences per division. Table 5: Divisional Analysis- Pharmacies with 6 generics and one originator brand (Glipizide Minidiab)
CENTRAL/EASTERN Lowest price Highest price Price difference between lowest and highest price Percentage price difference between lowest and highest price $15.35 $29.85 $14.50 94% WESTERN $20.80 $31.00 $10.20 49% NORTHERN $21.80 $25.50 $3.70 17%

The price difference for the same packs (6 generics and 1 originator brand) in 3 division show the same medicines are sold at a higher price in the Western and Northern divisions compared to the Central division. Consumers have limited choice in costs in the Western and Northern divisions. The percentage differences between the lowest and highest prices were: Central/Eastern 94%; Western 49%; and Northern 17%. In Labasa, consumer choice is restricted because there are only three pharmacies where two have common ownership.

All Generics
Only three (3) pharmacies dispensed all 7 generic medicines listed as per prescription. These were Midway Pharmacy, Ba; Health Care Chemist, Tavua and Nadi Chemist. Amongst the All Generics Group, the Health Care Chemist in Tavua charged a higher price of $30.70 while Nadi Chemist charged $13.45 for all 7 generic medication. A consumer in Tavua paid $17.25 more for the same medicine. This is a case of generics being sold at a price of originator drugs to unsuspecting consumers. Interestingly, 36 pharmacies who sold either one or more originator medicine had a lower total pack price than Health Care Chemist in Tavua.

Comparison of Prices per Medicine

For price comparison of individual medicines sold in all 47 pharmacies see Appendix 2. However, listed below are examples of medicines on which price comparisons were made for the same brand with identical quantity and the same manufacturer offered by the pharmacies (see Appendix 3).

Key Findings

14

Frusemide
Twenty (20) pharmacies dispensed Microlab frusemide, 19 sold Lasix, while 6 dispensed Apo. One pharmacy dispensed Durin, while another gave Flamingo frusemide. Midway Pharmacy- Ba and Chovhan pharmacy- Lautoka dispensed the same drug as Nadi Chemist (Microlab) but charged 460% more i.e. $4.65 compared to Nadi Chemist which sold the same drug for 0.83cents. This is a case of unethical practice where consumers were duped into buying generic medicine but at an originator drug price. A similar case is with Apo where Nasea Chemist in Labasa sold Apo for $1.35 while Northern Drug Store, Thakorlal Pharmacy, Nadi and Wyse Pharmacy, Nakasi charged $4.65 for the same drug, a price difference of 244%! Table 6: Price Analysis Frusemide Same Dosage/Quantity
Manufactures Name Not stated Medicine Name FrusemideMicrolab No. of Quantity pharmacies 20 30/40mg Lowest Price $0.83 Nadi Chemist Highest Price $4.65 Midway Pharmacy- Ba & Chovhan Pharmacy LtdLautoka charged originator brand price for generic medicine. $4.65 Northern Drug Store, Wyse Pharmacy, Nakasi & Thakorlal Pharmacy-Nadi charged originator brand price for generic medicine. % price Difference 460%

Not stated

FrusemideApo

30/40mg

$1.35 Nasea Chemist,Labasa

244%

Aspirin
Aspirin is a common drug available in Fiji. The Care Chemist in Sigatoka sold Cardiprinan originator brand for $4.61 instead of generic aspirin which is sold for $0.60. A consumer could have saved $4.01 if the pharmacist had given the consumer the option to choose. Table 7: Aspirin
Medicine Name Aspirin India No of pharmacy 26 Quantity 15/300mg Lowest Price $0.60 Mega Care Pharmacy, Holistic Pharmacy, Rewa Pharmacy, Wyse Pharmacy Valelevu $0.73 Health First Pharmacy, Life Pharmacy Ltd -Nadi, Nadi Chemist $2.25 Wyse Pharmacy, Nakasi Highest Price $2.70 Midway Pharmacy, Ba % price Difference 350%

Aspirin India Aspirin India

15

30/300mg

$2.00 Western Medicare Pharmacy, Lautoka $2.70 Chovhan Pharmacy Ltd

174%

20/300mg

20%

From the above table it can be deduced that it was cheaper to obtain 30 tablets at $0.73 or 2 months supply than to get 15 tablets for $0.60 which was enough for a month. Midway Pharmacy, Ba sold 15 tablets at $2.70, i.e. 350% more for the same quantity and same brand of medicine available at Mega Care Pharmacy, Holistic Pharmacy, Rewa Pharmacy, and Wyse Pharmacy Valelevu that sold aspirin for $0.60. Health First Pharmacy- Nadi, Life Pharmacy Ltd -Nadi, Nadi Chemist sold 30 tablets at $0.73 compared to Western Medicare Pharmacy, Lautoka which sold the same tablets in the same quantity at $2.00, which is a price difference of 174%. These are examples of unfair trade practices. The pharmacies have engaged in profiteering thus defeating the whole purpose of placing medicines under Price Control.

Key Findings

Metformin
There are pharmacies that sell originator drugs rather than generic drugs for maximum profits. For example Life Pharmacy Ltd, Nadi and Namaka Medisure Pharmacy, Nadi sold Glucophage while MS Pharmacy in Nadi and Western Medicare Pharmacy, Lautoka and Super Drug Pharmacy, Suva sold Diaformin - both are originator brands although generic metformin is readily available for diabetic patients as diabetes is a common ailment in Fiji. Table 8: Metformin
Manufacturer Name Name No of pharmacy 10 Quantity 30/500mg Lowest Price Highest Price % price Difference 94%

15

Pure Pharma Ltd, Pure India Pharma

$1.05 $2.00 Wyse Pharmacy Valelevu, AJ Swann Mega Care PharmacyPharmacy, Suva Makoi, Holistic Pharmacy Suva $1.48 Health First Pharmacy, Nadi and Nadi Chemist $1.35 Nasea Chemist and Northern Drug Store in Labasa. $1.38 Amy St. Pharmacy - Suva. $2.70 Midway Pharmacy, Ba $1.95 My Chemist,Labasa $1.95 Rewa Pharmacy Nausori

Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Windlas Biotech Ltd, India

Flamingo

11

30/500mg

82%

Flamingo

15/300mg

44%

Metofen

30/500mg

41%

Comparing the same batch numbers and source of medicines, Midway Pharmacy, Ba sold the most expensive Flamingo metformin at $2.70, while Health First Pharmacy Nadi and Nadi Chemist sold the tablets at $1.48. Price difference was 82%. The most common price was $1.95 charged by Nausori Pharmacy, Suva City Pharmacy, Chadulals Pharmacy, Lautoka and Hyperchem Pharmacy, Ba. Ten (10) pharmacies in the Central/Eastern Divison sold the same batch of metformin (Pure Pharma, batch number 80002). AJ Swann Suva sold at $2.00 while Mega Care Pharmacy Makoi sold the same quantity at $1.05, a price difference of 94%.

Key Findings

16

Simvastatin
Six (6) pharmacies dispensed Arrow simvastatin (SAWH0019). The highest price was recorded in the three Labasa pharmacies at $9.45. Budget Pharmacy Nadi had the cheapest price of $2.95. The three northern pharmacies charged 220% more than the cheapest Arrow simvastatin purchased. Winstatin was sold by Amy Street Pharmacy; Good Health Care, Suva; Guardian Angel, L/Beach for $3.15 while Western Medicare Ltd charged $10.00. This is a price difference of 217%, which is three times more than what a consumer would pay for in Suva. Five (5) pharmacies dispensed Arrow simvastatin (SAWH0023). Chovhan Pharmacy Lautoka charged $7.50, which was 143% more expensive than the lowest price offered by Nadi Chemist which was $3.08. Arrow (Batch No: SAWH0021) was sold by Patel Pharmacy in Sigatoka for $15.00 while Hyperchem Pharmacy, Ba sold the same tablets for $5.10, a price difference of 194% Table 9: Simvastatin
Manufacturer Name Not Stated Name Arrow Batch No: SAWH0019 No of pharmacy 6 Quantity 30/20mg Lowest Price $2.95 Budget Pharmacy, Nadi Highest Price % price Difference

$9.45 220% My Chemist, Nasea Chemist and Northern Drug Store in Labasa $10.00 Western Medicare Ltd 217%

Windlas Biotech Ltd, India

Winstatin

30/20mg

$3.15 Amy Street Pharmacy; Good Health Care, Suva; Guardian Angel, L/Beach;

Not Stated

Arrow Batch No: SAWH0021

30/20mg

$5.10 $15.00 Hyperchem Pharmacy, Patel Ba Pharmacy, Sigatoka $3.08 Nadi Chemist, Nadi $11.55 Central Pharmacy, Suva $11.59 Health First Pharmacy, Nadi

194%

Not Stated

Arrow Batch# SAWH0023 Simcard

30/20mg

275%

Cipla Ltd, Ltd

11

30/20mg

$9.75 Flagstaff Pharmacy in Suva, Mega Care Pharmacy in Makoi and Thakorlals Pharmacy in Nadi. $5.85 Thakor lal Pharmacy, Lautoka

19%

Crescent Pharma Ltd

Crescsent

28/20mg

$18.00 207% Health Care Chemist, Tavua

Key Findings

Enalapril
The most popularly dispensed enalapril was Flaminopril (17 pharmacies). The most expensive, Flaminopril (same batch #1868) was recorded in the Western Division, at Chovhan Pharmacy in Lautoka. It was selling it for $5.00, while the lowest price of $1.50 was recorded in the Centra/Eastern Divison at Life Pharmacy in Nausori, a difference of about 233%. This drug was commonly priced at $1.95 by three pharmacies - Pharmacy Plus, Samabula Drug Store and Suva City Pharmacy. Nine (9) pharmacies sold Invoril enalapril from Ranbaxy Laboratories Ltd, India. The medicine had the same batch number 1952512 and expiry date of 08/2010. The highest price was recorded by Wyse Pharmacy Nakasi at $4.50 and interestingly Wyse Valelevu offered the lowest price of $2.25. The price difference between the two Wyse branches for the same medicine is 100%. There was a price difference of 189% between two pharmacies selling Flaminopril (Batch No: 106). Hyperchem Pharmacy, Ba sold this drug for $1.73 while Midway Pharmacy, Ba sold the same drug for $5.00. AJ Swann Suva sold Sunapril enalapril at 66% more than two pharmacies selling the same batch Metro Pharmacy Suva and Superdrug Nabua. Table 10: Enalapril
Manufacturer Name Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Ranbaxy Laboratories Ltd, India Suvik Hitek Pvt Lt, India Name No of Quantity pharmacy 14 30/10mg Lowest Price Highest Price % price Difference 233%

17

Flaminopril Batch No: 1868 Flaminopril Batch No: 106 Invoril

$1.50 Life Pharmacy Ltd, Nausori $1.73 Hyperchem Pharmacy, Ba

$5.00 Chovhan Pharmacy, Lautoka $5.00 Midway Pharmacy, Ba

30/10mg

189%

30/10mg

$2.25 $4.50 Guardian Angel, L/Beach; Wyse Pharmacy, Wyse Pharmacy, Valelevu Nakasi $1.95 Super Drug, Nabua and Metro Pharmacy, Suva $9.00 Western Medicare Lautoka $3.69 Amy Street Pharmacy, Suva $3.25 AJ Swann Pharmacy, Suva $13.01 Hyperchem Pharmacy, Lautoka $3.75 City Centre Pharmacy & Good Health Care Pharmacy, Suva and Rewa Pharmacy, Nausori

100%

Sunapril

30/10mg

66%

Merck Sharp Renitec Dohme(Australia) Pty Ltd Global Pharma Health Care Pvt Ltd, India Priloten

30/10mg

45%

30/10mg

1.6%

Key Findings

18

Amoxicillin
Apo, a most popular generic was dispensed in three different quantities 9/500mg; 10/500mg and 15/500mg. For the 9/500mg quantity the highest price was $4.00 by Chovhan Pharmacy Ltd, Lautoka and lowest of $1.67 by Life Pharmacy, Nadi (percentage price difference of 89%). Stalmox amoxicillin, manufactured by Stallion Laboratories Pvt Ltd, India was dispensed by Guardian Angel Pharmacy, L/Beach for $1.85 while Island Pharmacy, Ba dispensed the same drug for $7.00, a price difference of 278%. GSK was sold for $3.60 by MS Pharmacy, Nadi and the same medicine was sold for $7.24 by Thakorlals Pharmacy, Lautoka, a price difference of 101%. See table below for more details. Table 11: Amoxicillin
Manufacturer Name Stallion Laboratories Pvt Ltd, India (Prawil Laboratories Ltd) Glaxo Smith Kline Australia Pty Ltd Not stated Name Stalmox No of Quantity pharmacy 2 10/500mg Lowest Price $1.85 Guardian Angel Pharmacy, L/Beach $1.61 Amy Pharmacy, Suva $3.60 MS Pharmacy, Nadi $1.67 Life Pharmacy, Nadi $1.85 Wyse Pharmacy, Nakasi Highest Price $7.00 Island Pharmacy, Ba $4.00 Midway Pharmacy, Ba $7.24 Thakorlals Pharmacy, Lautoka $4.00 Chovhan Pharmacy Ltd, Lautoka $2.65 Flagstaff Pharmacy, Suva % price Difference 278%

Amoxywil GSK 2

9/500mg 9/500mg

148% 101%

Apo

10

9/500mg

89%

Pure Pharma Ltd, India

Peemox

10/500mg

43%

Glipizide
With the same source and batch number, six pharmacies dispensed the same Minidiab glipizide (batch L927B). The highest price was recorded at Island Pharmacy Ba ($3.50) while the cheapest was sold by Madison Suva ($3.00). Ten pharmacies dispensed the same Minidiab glipizide (batch L942A). The highest price recorded was $3.75 by City Centre Pharmacy Suva and Nasea Chemist Labasa, while the lowest was sold by Central Pharmacy Suva for $3.00. The price difference was $0.75 or 25%. An interesting observation was that Life Pharmacy Nausori sold this same batch medicine but at a higher dosage of 40/5mg for $2.50. Most of the 30/5mg dosage sold cost more than $2.50. The generic DHA glipizide was sold for $4.45 (Midway Pharmacy-Ba) and lowest at $3.00 (Health Care Chemist, Tavua), a percentage price difference of 48%. Table 12: Glipizide
Manufacturer Name Name No of pharmacy 10 Quantity 30/5mg Lowest Price $3.00 Central Pharmacy, Suva Highest Price $3.75 City Centre Pharmacy, Suva and Nasea Chemist in Labasa. $4.45 Chovhan Pharmacy, Lautoka $4.85 Superdrug Pharmacy, Nabua and Flagstaff Pharmacy, Suva $4.45 Midway Pharmacy, Ba % price Difference 25%

Pfizer Australia Minidiab Pty Ltd Batch No: L942A Pfizer Australia Minidiab Pty Ltd Batch No: M111A Pfizer Australia Minidiab Pty Ltd Batch No: M111A Drug House of Australia (Asia) Pte Ltd Singapore DHA

15

30/5mg

$3.08 Care Chemist, Sigatoka $4.05 Superdrug Pharmacy, Suva and Thakorlals Pharmacy, Nadi $3.00 Health Care Chemist,Tavua

44.5%

40/5mg

20%

30/5mg

48%

Key Findings

Price Variance- Same Medicine and Same Quantity

Pharmacists are charging higher prices for the same drug and quantity which has no credible explanation other than overpricing. The following table would illustrate this point: Table 13: Comparison of same drug and quantity
Manufacturers Name Microlab Drug Name Frusemide Quantity 30 Weight 40mg Lowest Price $0.83 - Nadi Chemist Highest Price $4.65 Midway Pharmacy- Ba & Chovhan Pharmacy Ltd-Lautoka charged originator brand price for generic medicine. $4.65 Northern Drug Store, Wyse Pharmacy, Nakasi & Thakorlal Pharmacy-Nadi charged originator brand price for generic medicine. $2.70 Midway Pharmacy, Ba $2.00 Western Medicare Pharmacy, Lautoka $2.00 A.J. Swan Pharmacy, Suva $2.70 Midway Pharmacy, Ba $9.45 My Chemist, Nasea Chemist and Northern Drug Store, Labasa $11.55 Central Pharmacy Suva % difference 460%

19

Apo

Frusemide

30

40mg

$1.35 - Nasea Chemist,Labasa

244%

Aspirin India

15

300mg

$0.60 - Mega Care Pharmacy, Holistic Pharmacy, Rewa Pharmacy, Wyse Pharmacy Valelevu $0.73 - Health First Pharmacy, Life Pharmacy Ltd -Nadi, Nadi Chemist $1.05 - Wyse Pharmacy Valelevu, Mega Care Pharmacy-Makoi, Holistic Pharmacy Suva $1.48 - Health First Pharmacy, Nadi Chemist $2.95 - Budget Pharmacy Nadi

350%

Aspirin - India Pure Pharma Ltd Pure Pharma Metformin FlamingoMetformin ArrowSimvastatin Batch # SAWH0019 ArrowSimvastatin Batch # SAWH0023 Crescent Pharma Ltd Windlas Biotech Ltd Crescent Batch# 08016 WinstatinSimvastatin FlaminoprilEnalapril Flaminopril Batch No: 106 InvorilEnalapril SunaprilEnalapril RenitecEnalapril ApoAmoxicillin Stallion Laboratories Pty Ltd Prawil Laboratories Ltd Glaxo Smith Kline Pfizer Australia Pty Ltd StalmoxAmoxicillin Amoxywil GSKAmoxicillin MinidiabGlipizide

30 30

300mg 500mg

174% 94%

Flamingo Pharmaceuticals Ltd

30 30

500mg 20mg

82% 220%

30

20mg

$3.08 - Nadi Chemist, Nadi

275%

28 30

20mg 20mg

$5.85 - Thakor lal Pharmacy, Lautoka $3.15 - Amy Street Pharmacy; Good Health Care, Suva; Guardian Angel, L/Beach; $1.50 - Holistic Pharmacy, Suva $1.73 - Hyperchem Pharmacy, Ba

$18.00 Health Care Chemist, Tavua $10.00 Western Medicare Ltd $5.00 Nadi Chemist, Patel Pharmacy, Sigatoka $5.00 Midway Pharmacy, Ba $4.50 Wyse Pharmacy, Nakasi $3.25 A.J.Swan Pharmacy, Suva $13.01 Hyperchem, Lautoka $4.00 Chovhan Pharmacy Ltd,Lautoka $7.00 Island Pharmacy, Ba $4.00 Midway Pharmacy, Nadi $7.24 Thakorlals Pharmacy, Lautoka $4.45 Chovhan Pharmacy, Lautoka

207% 217%

Flamingo Pharmaceuticals Ltd Flamingo Pharmaceuticals Ltd, India Ranbaxy Laboratories Ltd Suvik Hitek Pvt Ltd Merck Sharp Dohme Pty Ltd

30 2

10mg 30/10mg

233% 189%

30 30 30 9 10 9 9 30

10mg 10mg 10mg 500mg 500mg 500mg 500mg 5mg

$2.25 - Guardian Angel, L/Beach; Wyse Pharmacy, Valelevu $1.95 - Super Drug, Nabua $9.00 - Western Medicare Lautoka $1.67 - Life Pharmacy, Nadi $1.85 - Guardian Angel Pharmacy, L/Beach $1.61 - Amy Street Pharmacy, Suva $3.60 - MS Pharmacy, Nadi $3.00 - Madison Pharmacy, Suva; Central Pharmacy, Suva

100% 66% 45% 89% 278% 148% 101% 48%

Key Findings

20

Meaningless Pricing
This survey clearly demonstrates anomalies in pricing despite placing medicines under Price Control. A few examples of meaningless pricing are outlined below: Midway Pharmacy, Ba sold 15 aspirin for $2.70, Wyse Pharmacy, Nakasi sold 20 aspirin for $2.25 whereas Health First Pharmacy, Life Pharmacy, Nadi, and Nadi Chemist sold 30 aspirin for $0.73. Why sell 15 aspirin for $2.70 but 30 aspirin for $0.73? Sugar City Pharmacy, Lautoka sold 15 amoxicillin (Apo) for $3.45 while Chovhan Pharmacy Ltd, Lautoka sold 9 tablets of amoxicillin (Apo) for $4.00. 10 Amoxywil was sold for $2.00 by Hyperchem, Ba where as Midway Pharmacy Ltd sold 9 tablets of Amoxywil for $4.00. Island Pharmacy, Ba dispensed 30 Crescent, aimvastitin for $9.00 while Thakorlal Pharmacy, Lautoka dispensed 28 tablets for $5.85. Why does it cost $3.15 for only two extra tablets?

Profitability VS. Profiteering

The above analysis clearly shows that the majority of pharmacies in Fiji are unnecessarily charging higher prices thus indulging in profiteering. The trade margins in pharmaceuticals are astronomical. The difference in price is over 400%! The pharmaceutical sector owes an explanation to the Government (provider of incentives) and the public (consumers) for these absurd anomalies in prices. Although prescribed medicines are placed under Price Control with a percentage mark up of 35%, the Councils survey still reveals very high trade margins. For example, drugs such as Microlab frusemide (with 460% price difference); aspirin (India) (with 350% price difference); Stalmox amoxicillin (with 278% price difference) are only a tip of the iceberg. It was also noted that several pharmacies sold originator brand for maximum profits. Consumers are forced to pay for a very inflated cost, which could have been easily reduced by retailers and still make reasonable profits.

Letter to Editor
coming so my wife thought it was a genuine mistake and left.

Medicine price
My wife returned home to Australia recently after spending time with sick Mum in Suva and related a rather disquieting story. After a visit to their family doctor, her Mum was given a prescription for 30 tablets which they took to a pharmacy in the Nabua area. The sales assistant was very helpful and polite. While she was browsing, the sales assistant told her that the prescription would cost $30.75. She was surprised at the high cost, but as the need was urgent she gave approval for the prescription to be filled. When the medication was brought to her in a plastic zip lock bag, she decided to check the contents and noticed only 20 tablets instead of the 30 prescribed. The sales assistant was embarrassed, but rectified the problem through the pharmacist. While an apology was given, no further explanation was forth-

However she decided to share the experience with her sister who uses a pharmacy in Laucala Bay area. What she found was that her sister had paid only $6.75 for the same prescription the previous month at the Laucala Bay pharmacy. They rang the Laucala Bay pharmacist who was very helpful and explained that the medication from Nabua pharmacy was most likely the original, hence the exorbitant price. It came to light after my wife checked with the pharmacy in Nabua that the medication was indeed the original, hence the excessive cost. It was ironic that a few days later, the local newspapers featured an article on generic brands versus original brands and how some pharmacies were not giving the public the option to choose. The other disconcerting thing is that, the Nabua and nearby areas are serviced by possibly one pharmacy. This leaves members of the public little or no choice and at the mercy of a monopolistic trader. COLIN DEOKI Australia

Published in Fiji Times - 19/12/2010

Pharmacy Trade Practices

Pharmacy Trade Practices

This part of the report deals with non-price issues in particular pharmacy practices in dispensing medicines to consumers.

21

Non-disclosure of individual medicine prices

Table 14: Non-disclosure of individual medicine prices
PHARMACY 1 2 3 4 5 6 7 8 9 10 A.J.Swann Co Ltd Life Pharmacy Wyse Pharmacy Chovahan Pharmacy Ltd Midway Pharmacy Western Medicare Pharmacy Island Pharmacy Patel Pharmacy Ltd Naidus Medical Centre Health Care Chemist Location/Division Suva/Central Eastern Nausori/ Central Eastern Nakasi/ Central Eastern Lautoka/Western Ba/ Western Lautoka/ Western Ba/ Western Sigatoka/ Western Rakiraki/Western Tavua/ Western

It should be noted that 10 pharmacies (see Table 14) did not provide price information on individual receipts or on the package. Instead the total cost of medicine purchased was provided. Seven (7) of these pharmacies are in the Western Division while 3 are in the Central/Eastern Divisions. All 3 pharmacies in Labasa provided itemised receipts. However, Northern Drug Store, Labasa issued a My Chemist receipt. To obtain individual prices of medicines, 11 pharmacies were contacted via telephone by Council staff. The team was unable to obtain pricing information from Naidus Medical Centre in Rakiraki. Furthermore, some pharmacies which issued receipts with total cost of medicine did have prices on individual medication packs but only on some of them. Other packets did not have prices on them. For example Life Pharmacy in Nadi did not provide prices on the packets of simvastatin, metformin and frusemide. Some of these pharmacies, for example, Chovhan Pharmacy Ltd, Midway Pharmacy, Ba did not provide itemised receipts but sold generics at originator brand price.

Issues with Receipts

This research has also highlighted many problems with the receipting procedures of these pharmacies. None of the 47 pharmacies provided individual medicine names on their receipts however, nineteen (19) provided itemised receipts using codes. Thirty two (32) pharmacies provided medicine price on their labels. Out of the 32 pharmacies that provided prices on their labels, 15 did not provide itemised receipts. Three (3) pharmacies did not supply the basic information required by Fiji laws such as the company name, tax number, and company address and so on. These were Sugar City Pharmacy- Lautoka and Chovhan Pharmacy also in Lautoka and Patel Pharmacy in Sigatoka. Madison Pharmacy, Suva provided a chit with total price when requested for a receipt by our staff. In the Northern Division, Northern Drug Store, Labasa issued a receipt from My Chemist instead of a receipt specifically for Northern Drug Store. The owners are the same for both Drug Stores. There were some pharmacies with receipts that had one code such as 005785 Prescription instead of the names of each medicine. There was no way a consumer could have known how much he/she paid for each medication. An interesting finding here was that Wyse Pharmacies in Nakasi and Valelevu have the same owner but Valelevu branch had prices clearly marked on each medication pack whereas the one in Nakasi did not do this. Wyse Nakasi instead provided a receipt with the total amount. One would assume that the same business would have similar practices however in this case the practice of pricing was different. Some of the practices used by the pharmacies in issuing receipts are a breach of Counter Inflation Act (Cap 73)

Pharmacy Trade Practices

22

Presence of Pharmacist
A pharmacist is required to check the prescriptions before dispensing medicines. 35 out of 47 pharmacies surveyed did not have a pharmacist visible within the premises. The Council staff, who were posing as consumers were either served by the Pharmacy Assistant or the Sales Assistant. However, a more firm conclusion about the presence of the pharmacist would have been possible, if there was a whole days surveillance in each pharmacy. The Council wishes to state that the onus is on the regulatory authorities to look into this and to be more vigilant on this issue. FPS should encourage pharmacists to wear a coat so that the public can identify a pharmacist from other staff. The name of the pharmacist on duty should be made visible at all times.

Queries on prescription
51% of pharmacies under survey made inquiries on the prescription and the patient, while 49% dispensed drugs without any further clarification. The two questions posed by the pharmacies were age and the patients phone number. One pharmacy Hyperchem Pharmacy, Ba requested the address of the patient, while Thakorlals Pharmacy Nadi commented that the patient must be very sick and dying It should be noted that the higher number of queries on the prescription were made by the pharmacies in the Western Division. This was probably due to two factors; the prescription was from a Suva-based doctor and the purchaser was non-Indian when the prescription was for an elderly Indian man.
No. of Pharmacies 23 21 3 47 Queries made 3 11 0 24 No queries made 20 10 3 23

DIVISIONS Central/ Eastern Western Northern TOTAL

% 13 52.4 0 51

% 87 47.6 100 49

Choice over generic or originator brand medicines

During our survey, none of the pharmacies asked the buyer whether he/she wanted generics or originator brand of medicines. The general rule amongst pharmacists is to dispense generic drugs when presented with a hospital prescription 9. Some pharmacies dispensed originator brand even though generic versions are commonly available. For example, 500mg of generic metformin was available at Budget Pharmacy for at $0.85 while an originator brand was sold for $7.95 at Namaka Medisure Pharmacy, Nadi which is ten times more.

6 Wrong Name on Medicine Packets

Pharmacy Plus of Suva incorrectly entered the patients name on the medicine packs. The purchasers name (Alisi) appeared on the packs instead of the patients name (Hari Ram) as per prescription (Case 1). Similarly, Life Pharmacy in Nadi incorrectly entered the patients second name (Ram) and had Prasad instead (Case 2).

9 Information provided by our industry expert.

Pharmacy Trade Practices

Wrong strength dispensed

One common practice among pharmacies is to dispense the correct medicine but with an incorrect dosage. There is a general assumption that a pharmacist as a professional would dispense the correct dosage of medication as and when required. Too little or too much of any medication could have adverse effect on ones health. There are several examples of this. Thakorlals Pharmacy in Lautoka dispensed 5 mg enalapril as seen on the packet but the label stated 10mg as per prescription. A consumer unknowingly would have consumed a lower dose which is contrary to the doctors recommendation. Such mistakes can be fatal. This pharmacy also incorrectly stated that the doctor was from Lautoka Hospital instead of CWM hospital.

23

Sugar City Pharmacy in Lautoka dispensed 15 amoxicillin capsules when the prescription required a dosage of 9 capsules. The prescription clearly stated no repeats for this particular anti-biotic. In another case Wyse Pharmacy in Valelevu dispensed 30 tablets of 100mg

Aspirin tablets with instructions on the label to take one tablet daily after food. The prescription stated a dosage 150mg aspirin per day for a month. In other cases, Thakorlals Pharmacy, Nadi dispensed 28 tablets of 20mg of simvastatin - Crescent rather than 30 tablets of 20mg. Life Pharmacy, Nausori dispensed 40 tablets of 5g of glipizide Minidiab instead of 30 and Naidus Medical Centre issued 20 tablets of 5mg of glipizide Minidiab. Rewa Pharmacy Nausori changed the dose and dispensed 20/40mg of simvastatin Arrow instead of 30/20mg.

Fraudulent Sale
Three pharmacies were found selling generic medication labelled as originator brand and also charging originator brand price. Thakorlal Pharmacy in Nadi, and Wyse Pharmacy in Nakasi dispensed generic frusemide tablets Apo but labelled it as Laxis which is an originator brand tablet and also charged the price of Laxis ($4. 65) which is much more expensive than generic Apo ($1.35

Pharmacy Trade Practices

24

Problems with labels

Nineteen (19) pharmacies violated labelling requirements in one way or another. An apparent issue with labelling was the directions for use of the medicine. For example, Life PharmacyNausori had hand written directions on all the labels of its medication. The problem here was that these instructions could easily fade through handling or if it gets wet. A number of pharmacies did not have any directions for the use of medication on their labels while there were some which not only had clear directions for use but also had auxiliary labels with additional cautionary advice such as avoid taking alcohol or grape fruit juice while taking the medication. There needs to be a standardisation of practice in the labelling of labelling medication.

10

Pharmacy located in same building as medical practitioners or near each other

In Nadi, two pharmacies situated on Lodhia Street are each housed in the same building as medical practitioners. Life Pharmacy is located next door in the same building as Faizals Medical Centre. The next building is Health First Pharmacy housed under the same building as Zens Medical Centre. The survey found a $10.08 prescription pack price difference between Life Pharmacy ($22.00) and Health Pharmacy ($32.08). In Suva, the same goes for Amy Street Pharmacy located within the Suva Private Hospital pharmacy. The issue here is the restriction of consumer choice as doctors are more likely to recommend these pharmacies to their patients. Moreover, inpatient and outpatients choice on pharmacies can be very limited in this case.

Pharmacy Ownership

Pharmacy Ownership
Pharmacy ownership laws are totally exploited by selected individuals through false information. In some cases names are lent to operate limited liability companies but the people whose names are used had migrated as far back as 1987 or are working for some other organisation or are non pharmacists. Non pharmacists who appear as owners must have been given token shares for use of their names. Under the Pharmacy and Poisons Act (Cap 115), Section 18 (d) all the share capital of the body corporate is owned by registered pharmacists. Our company search has found that there are 9 non-pharmacists who have shares in pharmacies. This does not include others who had migrated. The Council expects the reasons for including of nonpharmacists are for financial assistance to start the company. However, financial help also amounts to direct interference in the independence of pharmacies and the ability of a pharmacist to make decisions based on ethics rather than purely on financial gains. This was evident in the survey where originator brand medicine was dispensed instead of generics which are widely available and the same brand and quantity sold at exorbitant price. Over charging was evident which is a direct result of interference. It must be noted that when a few individuals are involved in a web of cross ownership of pharmacies and subsidiaries, we cannot discount the high probability of cartel-like behaviour or price fixing. In one case the company documents of Flagstaff Pharmacy, Metro Pharmacy and Nasese Pharmacy were faxed from the same source where information for Superdrug Pharmacy, Nabua; Central Pharmacy, Suva; Superdrug Pharmacy, Suva; and City Centre Pharmacy was faxed. The ownership of pharmacies by medical practitioners while illegal under the current laws is also a very worrying trend as both diagnosis and dispensing can be compromised for maximum profits. Fiji Islands Revenue and Customs Authority (FIRCA) should determine through its own investigation s whether companies and their shareholders are accurately declaring their income for tax purposes. There are violations, for example nonpharmacists are shareholders in some cases and in a few cases the same shareholder(s) own multiple pharmacies according to the Registrar of Companies records. Table16: Pharmacy Ownership
Non-pharmacist Swadesh Prabha Ram Virendra Shantilal Patel Barti Ben Hamida Khan Jone Finiasi Jone Finiasi Dr Bijend Ram Kalyan Sunil Kumar Ajay Ram Khelawan Pharmacy having ownership in Sugar City Pharmacy Patel Pharmacy Namaka Medisure Metro Pharmacy Suva Nasese Pharmacy Suva Rewa Pharmacy Laucala Bay Pharmacy Nausori Pharmacy

25

There are certain pharmacy

owners who own more than two pharmacies, they would have to either sell or close down the additional pharmacies they operate.

Dr. Neil Sharma - Minister of Health, Fiji.

Conclusion and Recommendations

26

Conclusion and Recommendations

The Consumer Council of Fiji survey adds credibility to the notion that some pharmacies are overcharging consumers either by pricing more expensive brands first or deliberately not informing consumers of the availability of cheaper generic medicine. It will be interesting to see what action is taken to ensure consumers are made aware of their right to proper medication at a price that is justified and fair.
Editorial comment Fiji Times (19/11/2010)

The Consumer Council found a majority of those pharmacies surveyed were engaging in profiteering. A consumer simply trusts the pharmacist, and believes that the prescription issued by the medical doctor will be dispensed in good faith by the pharmacist. Unfortunately, consumers trust in pharmacists for their health care had been violated by not allowing them the freedom to choose a generic or an originator brand of medication, not issuing proper receipts and engaging in fraudulent practices. The study has indicated that information is not readily available to patients/consumers (even to the educated citizens) on medicines and prices which they should know. Due to the lack of such information, consumers are solely dependent on the local pharmacies/chemists for the information on types, prices, alternatives and other parameters for the selection of medicines. It was also observed that whatever little communication that exists between the pharmacists and consumers it often not easily understood. The survey was done realistically and objectively keeping in view the importance of the health sector. It should be reiterated that the role of the pharmaceutical sector is to conduct business within the laws of the country as well as keeping the citizens health and well being in mind. Profits are important for any business but it must not be at the expense of the innocent patients or consumers. The medical field has advanced so much that this day and age the main focus globally is access to affordable drugs. The pharmaceutical sector needs to work with relevant Government agencies in making the accessibility and affordability of medicines a genuine concern for the well being and health of our citizens.

RECOMMENDATIONS
Based on these findings, the Council recommends the following measures be adopted by the Ministry of Health and other concerned organizations dealing with healthcare issues and ensuring a better dispensing services of medicines at affordable prices: 1. To acknowledge that there have been breaches and unfair trade practices by the pharmaceutical sector and that the enforcement agencies have not been vigilant; Pharmacy and Poisons Board together with PIB (Commerce Commission) to prosecute pharmacies if breaches have occurred. The Council will supply the dispensed medications as evidence, if required. This must be done by thoroughly scrutinising all invoices which are less than 3 months of supply date as purchases would have been made within that time frame. This must be done urgently because the Council wishes to recover money spent on the purchase of these medications; The Price Control Order is now some 18 years out of date thus urgently needs to be reviewed and amended to address Fijis increasing cost of health care. PIB has neither carried out any review of the Price Control Order on medicines nor has it produced any formal monitoring report to gauge compliance. PIB/Commerce Commission should play a more active role in monitoring and enforcing Price Control Orders and where possible prosecute offending pharmacists;

2.

3.

Conclusion and Recommendations

4. Pharmacy and Poisons Board needs to take a more proactive role in regulating the industry and its practices. The governing legislation, Pharmacy and Poisons Act appears to regulate registration and deregistration of pharmacists under Section 5 and 33 respectively. This law needs to be better enforced. The Council calls for an urgent review of the Pharmacy and Poisons Board to make this body effective and efficient in enforcing the laws and in attending to complaints. Membership should include representatives from enforcement agencies, consumer groups and NGOs for transparency and effectiveness of the board; The law also establishes the Fiji Pharmaceutical Society (Section 32B). They need to strengthen their code of ethics and monitor market practices. The society also needs to undertake regular training and education to up-skill its members and ensure that they are up to date with the changing role of pharmacists in the health sector. They should have merit system whereby certain points are acquired to qualify for annual registration. Registration requirements should be made clearer in the legislation and should include what is considered bad marketing practices; A price list of common drugs consumed for common illnesses should be prominently displayed at pharmacies. PIB/Commerce Commission to list these in a revised price order; The Ministry of Health to impose a strict Code of Conduct that must be practised by all pharmacies. The Code of Conduct has to be a binding document and any breaches to it should lead to fines or cancellation of licenses; Fiji Islands Revenue and Customs Authority (FIRCA) can investigate whether companies and their shareholders are accurately and truthfully declaring their income for tax purposes. There are violations, for example nonpharmacists are shareholders in some cases and in a few cases the same shareholder(s) own multiple pharmacies according to the Registrar of Companies records; 9. FPS to ensure its members wear professional attire (e.g white coat) so that the public can differentiate a pharmacist from other pharmacy staff. FSP should also require that pharmacies display the pharmacists name that is on duty at one particular period of time;

27

10. FPS, the Ministry of Health and the Consumer Council of Fiji should educate consumers on the different categories of medicines generics, branded generics and originator brands, including labelling information; 11. Pharmacies should display information on the prices of essential, commonly used drugs. Such information will assist consumers to compare prices before purchasing medicines; 12. FPS and the Ministry of Health should set up guidelines for dispensing of drugs. Providing consumer drug information for all parties involved will empower consumers to make informed decisions thus safeguarding their rights to health and information; 13. The Ministry of Health/Commerce Commission should also look at the importers and distributors of pharmaceuticals in Fiji to ensure competition. The Councils coverage of this survey did not include this aspect but this is an important feature which should be looked at separately by relevant agencies; and 14. The Government to implement the recommendations of the study so as to empower the citizens of Fiji and rid of any room for manipulation by pharmacies to protect their health interests.

5.

6.

7.

8.

References

28

References
Bailey, M. 2004. Affordability of Medicines in Fiji. http://www.haiweb.org/medicineprices/surveys/200409FJ/survey_report. pdf Fiji Bureau of Statistics (2010), Preliminary Report : Poverty and Household Incomes in Fiji in 2008-09. Fiji Republic Gazette Supplement, No.26, Friday 5th June, 1992; Legal Notice No.69, Counter-Inflation Act (Chapter 73), Counter-Inflation (Price Control), Ethical Medicine, No.5, Order, 1992. MedilinePlus online service of the United States National Library of Medicine, From the National Institutes of Health, www. nlm.nih.gov/medlineplus/druginfo (Accessed 12 June 2010) Medicine description and use (Table 1). Ministry of Health, October 2009. Monitoring of Pharmaceutical Prices in Private Sector. Ministry of Health, October 2009. Naturopathic Medicine- Retailing in Fiji. Panapasa G., 2010, Symposium on NCDs, Fiji Times, 6 July. Speech of the Ministry for Health, Dr Neil Sharma delivered to members of the Fiji Pharmaceutical Society, Natadola, Nadi, 29th Nov 2009. Www. www.health.gov.fj/speeches/29/11/2009--fiji-pharmaceutical-societynatadola.html (Accessed 15 June 2010)

Response From Pharmacy and Poisons Board

Appendix
Response From Pharmacy and Poisons Board

29

Response From Fiji Pharmaceutical Society

30

Response From Fiji Pharmaceutical Society

Response From Fiji Pharmaceutical Society

31

32

Individual Medicine Prices & Comments

Total Price Comments/Notes

CENTRAL/EASTERN DIVISION

No

Pharmacy

Medication

Frusemide 30/500mg Pure Pharma $2.00 (Pure Pharma Ltd) Batch # SAWH0022 Expiry Date: 10/2011 Expiry Date: 12/2012 Expiry Date: 11/2011 Metofen $1.38 (Windlas Biotech Ltd) Batch # M111A Expiry Date: 09/2012 Batch # W05002E Expiry Date: 08/2011 Pure Pharma $1.95 (Pure Pharma Ltd) Batch # SAWH0023 Expiry Date: 10/2011 Expiry Date: 08/2011 Batch # N3219 Expiry Date: 09/08/2011 Batch # 80002 Expiry Date: 06/2011 Arrow $11.55 Renitec $13.35 (Merck Sharp & Dohme Pty Ltd Amoxywil $2.25 (Prawil Laboratories Ltd Expiry Date:08/2011 Expiry Date: 09/2012 Minidiab $3.00 (Pfizer Pty Ltd) Batch # L942A Expiry Date: 07/2012 $38.50 Batch # W28001E Batch # 890 Winstatin $3.15 (Windlas Biotech Ltd) Priloten $3.69 (Global Pharma Health Care Pvt Ltd) Amoxywil $1.61 (Prawil Laboratories Ltd) Minidiab $3.49 $18.85 Batch # STL/801 Expiry Date: 07/2012 Batch # 0002 Batch # L927B Batch # 80002 Expiry Date: 06/2011 Arrow $5.00 Sunapril $3.25 (Suvik Hitek Pvt Ltd) Stalmox $2.45 (Stallion Laboratories Pvt Ltd) Minidiab $3.45 (Pfizer Pty Ltd) $19.40 30/20mg 30/10mg 9/500mg 30/5mg

Aspirin

Metformin

Simvastatin

Enalapril

Amoxicilllin

Glipizide

30/40mg

30/150mg

*1

A.J. Swann Co Ltd, Suva

Microlab $2.00

(India) $1.25

-Prices were itemized on the receipt but medicine names were not mentioned to show what the cost of each medicine was. -Medicine packets also did not have prices.

Amy Street Pharmacy

Lasix $4.18

(India) $1.36

Central Pharmacy, Suva

Lasix $4.65

India $1.75

-Receipt had only total cost of medicine purchased. -For the medicine packets, prices were only found on Lasix, Enalapril, and Amoxicillin & Metformin while Aspirin, Simvastatin & Minidiab packets did not have any price on them. -

Individual Medicine Prices & Comments

(Sanofis Aventis Australia Pty Ltd)

Batch # Not Stated

Expiry Date: 10/2012 Pure Pharma $1.95 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Batch # G97838 Expiry Date: 05/2012 Simcard $11.55 (Cipla Ltd Priloten $3.75 (Global Pharma Health Care Pvt Ltd) Batch # 890 Expiry Date: 09/2012 Apo $1.71 Minidiab $3.75 (Pfizer Pty Ltd) Batch # L942A Expiry Date: 07/2012 $28.26

City Centre Pharmacy, Suva

Lasix $4.35

(India) $1.20

Individual Medicine Prices & Comments (continued).

Pure Pharma $1.95 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Xmet $1.95 $3.75 (Global Pharma Health Care Pvt Ltd) Batch # 890 Expiry Date: 09/2012 Expiry Date: 05/2012 Stalmox $1.85 (Stallion Laboratories Pvt Ltd) Batch # L942A Expiry Date: 07/2012 Batch # STL/801 Expiry Date: 11/2010 NA Minidiab $3.45 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 $15.15 Medicine packets had auxiliary labels with additional cautionary advice to help patients take precautions while on medication. Minidiab $3.45 (Pfizer Pty Ltd $15.35 Invoril $2.25 (Ranbaxy Laboratories Ltd) Batch # 1952512 Expiry Date: 08/2010 Flaminopril $1.65 (Flamingo Pharmaceuticals Ltd) Batch # 1868 Expiry Date: 08/2011 Batch # 80456 $1.71 Winstatin $3.15 (Windlas Biotech Ltd) Batch # W28001E Expiry Date: 09/2011 Loose Tabs $1.95 Winstatin $3.15 (Windlas Biotech Ltd) Batch # W28001E Expiry Date: 09/2011 Pure Pharma $1.05 (Pure Pharma Ltd) Batch # SAWH0022 Expiry Date: 10/2011 Batch # 80002 Expiry Date: 06/2011 Arrow $4.05 Priloten Generics DHA $2.25 (Drug Houses of Australia(Asia) Pte Ltd, Singapore) $18.35 Expiry Date: 05/2012 Expiry Date: 08/2010 Expiry Date: 03/2011 Expiry Date: 09/2012 Batch # G97838 Batch # 1952512 Batch # 90001 Batch # M111A Simcard $9.75 (Cipla Ltd) Invoril $3.45 (Ranbaxy Laboratories Ltd) Peemox $2.65 (Pure Pharma Ltd) Minidiab (40) $4.85 (Pfizer Pty Ltd) $28.75 Quantity of tablets was not mentioned on any of the seven medications.

Flagstaff Pharmacy, Suva

Lasix $4.65

(India) $1.45

Good Health Care Pharmacy, Suva

Lasix $4.35

(India) $1.20

Guardian Angel Pharmacy, L/ Beach Nasinu

Microlab $1.95

(India) $0.75

Individual Medicine Prices & Comments

Holistic Pharmacy, Suva

Lasix $4.35 (Sanofis Aventis Australia Pty Ltd)

(India) $0.60

Batch # 8048826

Expiry Date: 10/2012 Pure Pharma $1.65 (Pure Pharma Ltd) Batch # SAWH0025 Expiry Date: 10/2011 Batch # 80002 Expiry Date: 06/2011 Arrow $6.45 Flaminopril $2.25 (Flamingo Pharmaceuticals Ltd) Batch # 1868 Expiry Date: 08/2011 Peemox $2.25 Pure Pharma Ltd Expiry Date: 03/2011 Minidiab $3.45 (Pfizer Pty Ltd) Batch# M111A Expiry Date: 09/2012 $18.60 -Prices were itemized on the receipt but medicine names were not mentioned to show what the cost of each medicine was. -For the medicine packets, prices were only found on Enalapril, Simvastatin, Metformin & Glipizide whereas Aspirin, Frusemide & Amoxicillin did not have prices on the packets.

Laucala Bay Pharmacy, Suva

Microlab $1.20

(India) $1.35

33

34

Individual Medicine Prices & Comments (continued).

Pure Pharma $1.50 (Pure Pharma Ltd) -No proper labelling with no mention of pharmacy name, contact etc. Batch # SAWH0023 Expiry Date: 10/2011 Batch # 1868 Expiry Date: 07/2012 Expiry Date: 08/2011 Arrow $7.50 Batch # SAWH0019 Expiry Date: 07/2011 Batch # 1868 Expiry Date: 07/2012 Expiry Date: 08/2011 NA $23.25 Expiry Date: 06/2011 - Receipt had only total cost of medicine purchased. -Aspirin packet had no price. Minidiab $3.45 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 Batch # PXFB0304 Batch # L927B Flaminopril $3.45 (Flamingo Pharmaceuticals Ltd) Pulmoxyl $2.45 (Flamingo Pharmaceuticals Ltd) Minidiab $3.00 (Pfizer Pty Ltd) $19.90 Did not issue proper receipt, just provided a chit with total price in hand written when request was made for a receipt by our staff. Batch # L942A Batch # 80002 Expiry Date: 06/2011 Flamingo $1.50 (Flamingo Pharmaceuticals Ltd) Batch # 227 ExpiryDate: 05/2011 Pure Pharma $1.05 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Pure Pharma $1.95 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Pharmacor $3.45 (Pharmacor Ltd) Batch # KW9G59 Expiry Date: 09/2012 Expiry Date: 05/2012 Batch # G97838 Batch # 1952512 Expiry Date: 08/2010 Simcard $11.55 (Cipla Ltd) Invoril $4.05 (Ranbaxy Laboratories Ltd) Expiry Date: 05/2012 Expiry Date: 12/2012 Peemox $2.45 (Pure Pharma Ltd) Batch # 80006 Expiry Date: 02/2011 Batch # G97838 Batch # 0002 Simcard $11.55 (Cipla Ltd) Sunapril $1.95 (Suvik Hitek Pvt Ltd) NA Expiry Date: 05/2012 Expiry Date: 08/2010 Batch # G97838 Batch # 1952512 Simcard $9.75 (Cipla Ltd) Invoril $4.05 (Ranbaxy Laboratories Ltd) Arrow $6.00 Flaminopril $1.50 (Flamingo Pharmaceuticals Ltd) NA Minidiab (40) $2.50 (Pfizer Pty Ltd) $14.50 -Labels are hand written.

*10

Life Pharmacy, Nausori

Mircolab $1.50

(India) $1.50

11

Madison Pharmacy, Suva

Microlab $1.00

(India) $1.00

12

Mega Care Pharmacy, Makoi, Nasinu

Lasix $4.35

(India) $0.60

Individual Medicine Prices & Comments

13

Metro Pharmacy, Suva

Lasix $4.65

(India) $1.35

Minidiab $3.75 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 Minidiab (40) $4.45 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012

$25.20

14

Nasese Pharmacy , Suva

Microlab $1.95

(India) $1.95

$29.85

Individual Medicine Prices & Comments (continued).

Flamingo $1.95 (Flamingo Pharmaceuticals Ltd) Batch # G97838 Expiry Date: 05/2012 Expiry date: 08/11 Arrow $7.95 Batch # SAWH0021 Expiry Date: 10/2011 Batch # 1868 Expiry Date: 09/2012 Expiry Date: 08/2011 Arrow (20/40mg) $3.65 Batch # SAFH0015 Expiry Date: 01/2011 Expiry Date: 09/2012 Apo $1.80 Minidiab $3.45 (Pfizer Pty Ltd) Batch # L942A Expiry Date: 07/2012 $15.90 Arrow $4.05 Batch # SAWH0023 Expiry Date: 10/2011 Batch # 1868 Expiry Date: 08/2011 Simcard $11.55 (Cipla Ltd) Batch # G97838 Expiry Date: 05/2012 Sunapril $1.95 (Suvik Hitek Pvt Ltd) Batch # 0002 Expiry Date: 12/2012 NA Minidiab (40) $4.85 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 $23.30 Flaminopril $1.95 (Flamingo Pharmaceuticals Ltd) Batch # 890 Expiry Date: 08/2011 Priloten $3.75 (Global Pharma Health Care Pvt Ltd) Amoxywil $1.71 (Prawil Laboratories Ltd) NA $13.60 -Instead of 30Simvastatin tablets only 20 were dispensed and the direction for use of this medication was wrongly written on the label. The direction stated take half (1/2) tablet at night (bedtime) when in actual fact the direction should be take one tablet daily. Batch # M111A Flaminopril $1.95 (Flamingo Pharmaceuticals Ltd) Apo $2.45 Minidiab $3.15 (Pfizer Pty Ltd) $20.30 Had the wrong patient name on the medicine packets. The name of our purchaser Alisi appeared on the medicine packets instead of patients name (Hari Ram) on the prescription. Batch # 1868 Expiry Date: 09/2012 Batch # M111A Batch # 227 Expiry Date: 05/2011 Flamingo $1.65 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Metofen $1.95 (Windlas Biotech Ltd) Batch # W05002E Expiry Date: 08/2011 Flamingo $1.65 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Pure Pharma $1.95 (Pure Pharma Ltd) Batch # 8002 Expiry Date: 06/2011 Simcard $11.55 (Cipla Ltd) Flaminopril $3.45 (Flamingo Pharmaceuticals Ltd) Apo $1.71 Minidiab $3.45 (Pfizer Pty Ltd) $25.26

15

Nausori Pharmacy Ltd, Nausori

Microlab $1.95

(India) $1.20

16

Pharmacy Plus, Suva

Apo $1.95

(India) $1.20

17

Rewa Pharmacy, Nausori

Microlab $1.95

(India) $0.60

Individual Medicine Prices & Comments

18

Samabula Drug Store,Samabula

Durin $1.95

(India) $1.05

19

Superdrug Pharmacy, Nabua

Microlab $1.95

(India) $1.05

35

36

Individual Medicine Prices & Comments (continued).

Diaformin $6.15 (Alpha Pharma) Batch # A144G Expiry Date: 12/2012 Expiry Date: 06/2011 NA Minidiab (40) $4.45 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 $21.40 Arrow $7.50 Batch # SAWH0007 Expiry Date: 10/2011 Batch # 1868 Expiry Date: 08/2011 Simcard $11.55 (Cipla Ltd) Batch # G97838 Expiry Date: 05/2012 Expiry Date: 08/2010 Invoril $2.25 (Ranbaxy Laboratories Ltd) Batch # 1952512 Expiry Date: 08/2010 Expiry Date: 02/2011 Peemox $1.53 (Pure Pharma Ltd) Simcard $11.55 (Cipla Ltd) Batch # G87618 Expiry Date: 03/2011 Minidiab $3.15 (Pfizer Pty Ltd) Batch # L927B Expiry Date: 07/2012 Batch # 1952512 Expiry Date: 03/2011 Expiry Date: 07/2012 $24.50 Batch # 90001 Batch # L942A Invoril $4.50 (Ranbaxy Laboratories Ltd) Peemox $1.85 (Pure Pharma Ltd) Minidiab (40) $3.55 (Pfizer Pty Ltd) $29.65 -Wyse Pharmacy in Nakasi & Valelevu has the same owner but Wyse Pharmacy in Valelevu had prices clearly marked on each medication packets whereas the one in Nakasi did not do this; instead give a receipt with total amount only. -Dispensed generic Frusemide tablets APO but labelled it as Laxis which is a branded tablet & also charged the price of branded Laxis which is much more expensive than generic APO. Flamingo $1.95 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Pure Pharma $1.85 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Pure Pharma $1.05 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Flaminopril $1.95 (Flamingo Pharmaceuticals Ltd) Expiry Date: 05/2012 Expiry Date: 08/2012 Batch # 1333 Expiry Date: 09/2012 Batch # G97838 Batch # 9179 Batch # M111A Simcard $11.55 (Cipla Ltd) Sunapril $3.45 (Suvik Hitek Pvt Ltd) GSK $7.95 (Glaxao Smith Kline) Minidiab $4.05 (40) (Pfizer Pty Ltd) $38.80 Medicine packets had auxiliary labels with additional cautionary advice to help patients take precautions while on medication.

20

Superdrug Pharmacy, Suva

Lasix $4.65

(India) $1.00

21

Suva City Pharmacy, Suva

Lasix $4.35

(India) $1.20

*22

Wyse Pharmacy, Nakasi

Microlab $4.10

(India) (20/300mg) $2.25

Individual Medicine Prices & Comments

23

Wyse Pharmacy, Valelevu

Lasix $4.35 (Sanofis Aventis Australia Pty Ltd)

(India) $0.60

Batch # 8050691

Expiry Date: 01/2012

WESTERN DIVISION

Individual Medicine Prices & Comments (continued).

Metofen $1.65 (Windlas Biotech Ltd) Batch # SAWH0019 Expiry Date: 07/2011 Expiry Date: 09/2012 Arrow $3.28 Batch #: SAWH0019 Expiry Date: 07/2011 Batch # 1868 Expiry Date: 09/2012 Expiry Date: 08/2011 Arrow $4.05 Batch # SAWH0007 Expiry Date: 01/2011 Expiry Date: 07/2012 Batch # L942A M-Enalapril $4.95 Apo $3.15 Minidiab $3.45 (Pfizer Pty Ltd) $19.80 Batch # M111A Flaminopril $3.42 (Flamingo Pharmaceuticals Ltd) Apo $2.44 Minidiab $3.08 (Pfizer Pty Ltd) $20.31 Expiry Date: 09/2012 Batch # 890 Batch # M111A Batch # W05002E Expiry Date: 08/2011 Flamingo $1.53 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Flamingo $1.95 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Pure Pharma $2.70 (Pure Pharma Ltd) Batch # 80002 Expiry Date: 06/2011 Expiry Date: 08/2011 Expiry Date: 10/2011 Batch # 1868 Batch # SAWH0023 Arrow $7.50 Apo $4.00 Minidiab $4.45 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 $31.00 -Receipt issued did not have company name, tax number, company address etc. - Receipt had only total cost of medicine purchased. -Medicine packets also did not have prices. Flaminopril $5.00 (Flamingo Pharmaceuticals Ltd) Arrow $2.95 Priloten $3.70 (Global Pharma Health Care Pvt Ltd) Amoxywil $1.65 (Prawil Laboratories Ltd) Minidiab $3.20 (Pfizer Pty Ltd) $18.00

24

Budget Pharmacy, Nadi

Lasix $4.20

(India) $0.85

25

Care Chemist, Sigatoka

Flamingo $1.95

Cardiprin (30/100mg) $4.61

Batch # 917701

Expiry Date: 01/05/2011

26

Chandulals Pharmacy

Microlab $1.35

(India) $0.90

Individual Medicine Prices & Comments

*27

Chovhan Pharmacy Ltd, Lautoka

Microlab $4.65

(India) (20/300mg) $2.70

37

38

Individual Medicine Prices & Comments (continued).

Flamingo $1.50 (Flamingo Pharmaceuticals Ltd) -Medicine packets also did not have prices. (Flamingo Pharmaceuticals Ltd) Batch # 1868 Expiry Date: 08/2011 Flaminopril $3.29 (Flamingo Pharmaceuticals Ltd) Batch # 1333 Expiry Date: 06/2011 Expiry Date: 09/2012 Batch # M111A Batch # 1868 Expiry Date: 08/2011 Arrow $5.10 Batch # SAWH0021 Expiry Date: 10/2011 Batch # 106 Expiry Date: 05/2010 Simcard $9.83 (Cipla Ltd) Batch# G97838 Expiry Date: 05/2012 Expiry Date: 04/2011 Xmet $1.65 Sunapril $2.25 (Suvik Hitek Pvt Ltd) Batch # 9179 Expiry Date: 08/2012 Expiry Date: 02/2012 GSK $7.20 (Glaxao Smith Kline) Batch # 1333 Expiry Date: 06/2011 Minidiab $3.15 (Pfizer Pty Ltd) Batch #: L927B Expiry Date: 07/2012 $24.55 -Prices were itemized on the receipt but medicine names were not mentioned to show what the cost of each medicine was. -Medicine packets also did not have prices. Actavis $6.45 (Relon Chem Ltd) Batch # K2044 Batch # N2047 Batch # 1342 Expiry Date: 07/2011 Renitec $13.01 (Merck Sharp & Dohme (Australia) Pty Ltd GSK $6.16 (Glaxao Smith Kline) Expiry Date: 08/2011 Expiry Date: 07/2012 Batch # PC007 Batch # L927B Flaminopril $1.73 (Flamingo Pharmaceuticals Ltd) Amoxywil $2.00 (Prawil Laboratories Ltd) Minidiab (40) $4.20 (Pfizer Pty Ltd) $21.55 GSK $7.17 (Glaxao Smith Kline) Minidiab $3.19 (Pfizer Pty Ltd) $32.08 Expiry Date: 05/2012 Batch # 80456 Batch # 224 Expiry Date: 05/2011 Flamingo $1.48 (Flamingo Pharmaceuticals Ltd) Batch # G97838 Expiry Date: 05/2012 Batch # 227 Expiry Date: 05/2011 Flamingo $1.95 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Glucophage $6.73 (Alpha Pharma) Batch #: 100046 Expiry Date: 07/2013 Simcard $11.59 (Cipla Ltd) Expiry date: 02/2011 Batch # 08016 Crescent (28/20mg) $18.00 (Crescent Pharma Ltd) Flaminopril $3.00 Blue-yellow $2.95 DHA $3.00 (Drug Houses of Australia(Asia) Pte Ltd, Singapore) $30.70 - Receipt had only total cost of medicine purchased.

*28

Health Care Chemist, Tavua

Microlab $1.50

(India) $0.75

29

Health First Pharmacy, Nadi

Lasix $4.63

(India) $0.73

30

Hyperchem Pharmacy, Ba

Lasix $4.38

(India (30/81mg) $2.21

Individual Medicine Prices & Comments

31

Hyperchem Pharmacy, Lautoka

Lasix $4.18

Solprin (16/300mg) $1.25

Minidiab $3.08 (Pfizer Pty Ltd) Batch # L927B Expiry Date: 09/2012

$44.25

Batch # 817203

Expiry Date: 01/06/2010

32

Island Pharmacy Complex, Nadi

Lasix $2.85 (Sanofis Aventis Pakistan Pty Ltd)

(India) $1.00

Batch # HC044

Expiry Date: 08/2014

Individual Medicine Prices & Comments (continued).

Xmet $2.00 Batch # 0002 Expiry Date: 12/2012 Expiry Date: 11/2010 Apo $1.67 Batch# M111A Expiry Date: 09/2012 Minidiab $3.12 (Pfizer Pty Ltd) $22.00 Batch # STL/801 ExpiryDate: 07/2012 Wrong name on the label. Hari Prasad instead of Hari Ram. Batch # L927B Crescent $9.00 (Crescent Pharma Ltd) Batch # 08016 Expiry date: 02/2011 Glucophage $6.70 (Alpha Pharma) Batch # 100046 Expiry Date :07/2013 Expiry Date: 08/2011 Arrow $7.50 Batch # SAWH0021 Expiry Date: 10/2011 Batch # 106 Expiry Date: 05/2010 Winstatin $3.45 (Windlas Biotech Ltd) Batch # W28001E Expiry Date: 09/2011 Expiry Date: 09/2012 Batch # 890 Priloten $3.70 (Global Pharma Health Care Pvt Ltd) GSK $3.60 (Glaxao Smith Kline) Expiry Date: 08/2011 Expiry Date: 05/2012 Minidiab $3.50 (Pfizer Pty Ltd) Batch#: M111A Expiry Date: 09/2012 $25.35 Batch # 80456 Batch # PC007 $18.00 - Receipt had only total cost of medicine purchased. -Medicine packets also did not have prices Flamingo $2.70 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Diaformin $6.00 (Alpha Pharma) Batch # A633F Expiry Date: 10/2012 Flaminopril $5.00 (Flamingo Pharmaceuticals Ltd) Amoxywil $4.00 (Prawil Laboratories Ltd) DHA $4.45 (Drug Houses of Australia(Asia) Pte Ltd, Singapore) Expiry Date: 07/2011 Batch # 1868 Batch # SAWH0019 Arrow $4.05 Flaminopril $1.73 (Flamingo Pharmaceuticals Ltd) Sunapril $3.00 (Suvik Hitek Pvt Ltd) Stalmox $7.00 (Stallion Laboratories Pty Ltd) Minidiab $3.50 (Pfizer Pty Ltd) $28.50 - Receipt had only total cost of medicine purchased.

*33

Island Pharmacy, Ba

Microlab $2.50

(India) $1.50

34

Life Pharmacy Ltd, Nadi

Lasix $4.00

(India) $0.73

*35

Midway Pharmacy, Ba

Microlab $4.65

(India) $2.70

Individual Medicine Prices & Comments

36

MS Pharmacy, Nadi

Lasix $4.18 (Sanofis Aventis Australia Pty Ltd)

(India) $0.90

Batch # 8048826

Expiry Date: 10/2012 Arrow $3.08 Batch #: SAWH0023 Expiry Date: 10/2011 Flamingo $1.48 (Flamingo Pharmaceuticals Ltd) Batch #: 227 Expiry Date: 05/2011 Flaminopril $1.73 (Flamingo Pharmaceuticals Ltd) Batch # 1868 Expiry Date: 08/2011 Apo $2.11 DHA $3.49 (Drug Houses of Australia(Asia) Pte Ltd, Singapore) $13.45

37

Nadi Chemist, Nadi

Microlab $0.83

(India) $0.73

39

40

Individual Medicine Prices & Comments (continued).

Pure Pharma No Price (Pure Pharma Ltd) -Medicine packets also did not have prices Batch # 80002 Expiry Date: 06/2011 Expiry Date: 08/2010 Expiry Date: 01/2012 $31.00 Expiry Date: 05/2012 Batch # 1952512 Expiry Date: 03/2011 Batch # K841A Batch # G97838 Batch # 90001 No Price (Pfizer Pty Ltd) Simcard No Price (Cipla Ltd) Invoril No Price (Ranbaxy Laboratories Ltd) Peemox (20) No Price (Pure Pharma Ltd) Minidiab (20) $30.50 - Receipt had only total cost of medicine purchased.

*38

Naidus Medical Centre

Apo

(India)

No Price

No Price

39

Namaka Medisure Pharmacy, Nadi Batch # G87618 Expiry Date: 03/2011 Expiry Date: 08/2010 $30.50 Arrow $15.00 Batch # L942A Expiry Date: 07/2012 Batch # 1952512 Expiry Date 07/2012 Batch # 2002564 Batch # L942A

Apo

$2.55 Batch # 102655 Expiry Date: 05/2013 Flamingo $1.80 (Flamingo Pharmaceuticals Ltd) Batch # :227 Expiry Date:05/2011 Expiry Date:10/2011 Arrow $5.85 $3.45 $3.15 (15) M-Enalapril Apo Flamingo $1.95 (Flamingo Pharmaceuticals Ltd) Batch # 201 Batch # SAWH0023 Expiry Date:10/2011 Expiry Date:09/2010 SAWH0021 Expiry Date: 08/2011 Batch # Batch # 1868

(India) (25/300mg)

$1.45

Glucophage $7.95 (Lipha Pharmaceuticals)

Simcard $9.45 (Cipla Ltd)

Invoril $4.05 (Ranbaxy Laboratories Ltd)

Rambaxy $5.40 (Ranbaxy Laboratories Ltd)

Minidiab $3.45 (Pfizer Pty Ltd)

*40

Patel Pharmacy Ltd, Sigatoka

Microlab

(India)

$1.50

$1.00

Pulmoxyl $3.70 (Microlabs Ltd)

Minidiab $3.50 (Pfizer Pty Ltd)

-Receipt issued did not have company name, tax number, company address etc. - Receipt had only total cost of medicine purchased. -Medicine packets also did not have prices

Flaminopril $4.00 (Flamingo Pharmaceuticals Ltd)

41

Sugar City Pharmacy Ltd, Lautoka

Microlab

(India) (30)

$21.55 Minidiab $4.05 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012

$1.65

$1.45

-Receipt issued did not have company name, tax number, company address etc. - Dispensed 15 Amoxicillin capsules when prescription stated a dose of 9capsules. Overdose of medicine.

Individual Medicine Prices & Comments

Individual Medicine Prices & Comments (continued).

Diaformin $6.10 (Alpha Pharma) Batch # 196D Expiry Date: 05/2012 Expiry Date: 02/2011 Pure Pharma $3.45 (Pharmacor Ltd) Batch # KW9G59 Expiry Date: 09/2012 Expiry Date: 08/2011 Minidiab (30) $3.15 (Pfizer Pty Ltd) Batch # M111A Expiry Date: 09/2012 $40.50 - Receipt had only total cost of medicine purchased. -Medicine packets also did not have prices Diaformin $6.00 (Alpha Pharma) Batch # A462D Expiry Date: 05/2012 Expiry Date: 09/2011 Expiry Date: 04/2011 Batch # W28001E Batch # N2047 Batch # 1333 Winstantin $10.00 (Windlas Biotech Ltd) Renitec $9.00 (Merch Sharp & Dohme (Australia) Pty Ltd) GSK $5.85 (Glaxao Smith Kline) Expiry Date: 05/2012 Batch # N3219 Expiry Date: 02/2011 Expiry Date: 09/2012 Batch # G97838 Batch # DT9327 Batch # M111A Simcard $9.75 (Cipla Ltd) Rentic $13.05 (Merch Sharp & Dohme (Australia) Pty Ltd) Novamox-LB $3.69 (Cipla Ltd) Minidiab (40) $4.05 (Pfizer Pty Ltd) $40.10 Expiry Date: 11/2012 Batch # 08016 Expiry Date: 07/2012 Batch# 9217 Expiry Date: 06/2011 Batch # L942A Crescent (28) $5.85 (Crescent Pharma Ltd) Sunapril (5mg) $2.07 (Suvik Hitek Pvt Ltd) GSK $7.24 (Glaxo Smith Kline) Minidiab $3.22 (Pfizer Pty Ltd) $30.17 -Under dose of medicine. Dispensed 5mg of Enalapril given once daily instead of the prescribed 10mg.

42

Thakorlals Pharmacy, Lautoka

Lasix $4.63 (Sanofis Aventis Australia Pty Ltd)

(India) $1.06

Batch #: 8048862

Expiry Date: 10/2012

43

Thakorlals Pharmacy, Nadi

Apo $4.65

(India) (3) $1.45

-Dispensed generic Frusemide tablets APO but labelled it as Laxis which is a branded tablet & also charged the price of branded Laxis which is much more expensive than generic APO.

*44

Western Medicare Pharmacy, Ba

Microlab $4.50

(India) (30) $2.00

NORTHERN DIVISION
Arrow $9.45 Batch# SAWH0019 Expiry Date: 07/2011 Expiry Date: 08/2010 Batch# 1952512 Flamingo $1.95 (Flamingo Pharmaceuticals Ltd) Batch # 227 Expiry Date: 05/2011 Invoril $4.05 (Ranbaxy Laboratories Ltd) Apo $1.80 Minidiab $3.45 (Pfizer Pty Ltd) Batch # L942A Expiry Date: 07/2012 $23.40

Individual Medicine Prices & Comments

45

My Chemist, Labasa

Microlab $1.95

(India) $0.75

41

42

Individual Medicine Prices & Comments (continued).

Arrow $9.45 Batch # SAWH0019 Expiry Date: 07/2011 Expiry Date: 08/2010 Arrow $9.45 Batch# SAWH0019 Expiry Date: 07/2011 Expiry Date: 08/2010 Expiry Date: 07/2012 Batch # 1952512 Batch#: L942A Invoril $4.05 (Ranbaxy Laboratories Ltd) Apo $1.80 Minidiab $3.45 (Pfizer Pty Ltd) $25.50 Issuing same receipt as My Chemist. Expiry Date: 07/2012 Batch # 1952512 Batch # L942A Flamingo $1.35 (Flamingo Pharmaceuticals Ltd) Batch #: 227 Expiry Date: 05/2011 Flamingo $1.35 (Flamingo Pharmaceuticals Ltd) Batch #: 227 Expiry Date: 05/2011 Invoril $3.45 (Ranbaxy Laboratories Ltd) Apo $1.71 Minidiab $3.75 (Pfizer Pty Ltd) $21.80

46

Nasea Chemist, Labasa

Apo $1.35

(India) $0.75

47

Northern Drug Store, Labasa

Apo $4.65

(India) $0.75

Individual Medicine Prices & Comments

NB: *Pharmacies that were called for medicine prices

Price Comparisons: Same medicine, batch number, manufacturer/source country.

Manufacturer Batch No Expiry Date Comments (Pure Pharma Ltd, India) (Pure Pharma Ltd, India) Flagstaff Pharmacy, Suva sells it for $2.65 while Wyse Pharmacy, Nakasi for $1.85, a difference of $0.80 (Stallion Laboratories Pvt Ltd, India) (Stallion Laboratories Pvt Ltd, India) (Stallion Laboratories Pvt Ltd, India) (Glaxao Smith Kline Australia Pty Ltd) (Glaxao Smith Kline, Australia Pty Ltd) 1333 1333 06/2011 06/2011 A small price difference of $0.03 between Health First and Island Pharmacy, Nadi. STL/801 STL/801 STL/801 11/2010 11/2010 11/2010 90001 90001 03/2011 03/2011

Pharmacy Name Medicine/Drug Name AMOXICILLIN Peemox Amoxicillin, same #, source country, 10/500mg Wyse Pharmacy, Nakasi Peemox $1.85 Flagstaff Pharmacy, Suva Peemox $2.65 Stalmox Amoxicillin, same #, source country 10/500mg A.J. Swann Co Ltd, Suva Stalmox $2.45 Guardian Angel Pharmacy, L/Beach Stalmox $1.85 Island Pharmacy, Ba Stalmox $7.00 GSK Amoxicillin 9/500mg Health First Pharmacy, Nadi GSK $7.17 Island Pharmacy Complex, Nadi GSK $7.20

Guardian Angel Pharmacy, Suva sold Stalmox amoxicillin for $1.85 while Island Pharmacy, Ba sold the same for $7.00, a difference of $5.15 or 278%.

** ASPIRIN No comparisons aspirin tablets were loose tablets whereby there were no manufacturer name, batch number and expiry dates given.

ENALAPRIL

Flaminopril Enalapril 30/10mg

Price Comparisons: Same medicine, batch number, manufacturer/source country

Highest t price of Flaminopril enalapril (1868) was $5.00 recorded in the West at Chovhan Pharmacy Lautoka, while lowest prices of $1.50 was recorded at Life Pharmacy Nausori. Price difference 233%. Same price of $1.95 offered by Pharmacy Plus, Samabula Drug Store and Suva City Pharmacy. Life Pharmacy, Nadi and Nadi Chemist also had the same price of $1.73.

Holistic Pharmacy, Suva Laucala Bay Pharmacy, Suva Life Pharmacy, Nausori Madison Pharmacy, Suva Pharmacy Plus, Suva Samabula Drug Store,Samabula Suva City Pharmacy, Suva Care Chemist, Sigatoka Chovhan Pharmacy Ltd, Lautoka Health Care Chemist, Tavua Health First Pharmacy, Nadi Life Pharmacy Ltd, Nadi Nadi Chemist, Nadi Nausori Pharmacy Ltd Patel Pharmacy Ltd, Sigatoka Invoril Enalapril 30/10mg

Flaminopril $1.65 Flaminopril $2.25 Flaminopril $1.50 Flaminopril $3.45 Flaminopril $1.95 Flaminopril $1.95 Flaminopril $1.95 Flaminopril $3.42 Flaminopril $5.00 Flaminopril $3.00 Flaminopril $3.29 Flaminopril $1.73 Flaminopril $1.73 Flaminopril $3.45 Flaminopril $4.00

Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India (Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India) Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India)

1868 1868 1868 1868 1868 1868 1868 1868 1868 1868 1868 1868 1868 1868 1868

08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011 08/2011

43

44

Price Comparisons: Same medicine, batch number, manufacturer/source country (continued).

Ranbaxy Laboratories Ltd, India Ranbaxy Laboratories Ltd, India Ranbaxy Laboratories Ltd, India Ranbaxy Laboratories Ltd, India Ranbaxy Laboratories Ltd, India Ranbaxy Laboratories Ltd, India (Ranbaxy Laboratories Ltd, India (Ranbaxy Laboratories Ltd, India (Ranbaxy Laboratories Ltd, India Nine (9) pharmacies sold Invoril enalapril from Ranbaxy Laboratories Ltd, India. The medicine bore the same batch number 1952512 and expiry date of 08/2010. The highest price was recorded by Wyse Pharmacy Nakasi at $4.50 and interestingly Wyse Valelevu has the lowest price of $2.25. The price difference between the two Wyse branches for the same medicine is a 100%. Guardian Angel pharmacy also sold it at the lowest price of $2.25. In the Northern Division, Nasea Chemist sold Invoril enalapril for $3.45 while the other 2 pharmacies for $4.05, a price difference of $0.60. Global Pharma Health Care Pvt Ltd, India 890 890 890 890 09/2012 09/2012 09/2012 09/2012 Priloten enalapril of the same batch number was sold by 4 pharmacies, all from the Central/Eastern Division. Amy Street Pharmacy sold Priloten enalapril for $3.69, a mere $0.06 lower than the other three selling the same medicine. Global Pharma Health Care Pvt Ltd, India Global Pharma Health Care Pvt Ltd, India Global Pharma Health Care Pvt Ltd, India 1952512 1952512 1952512 1952512 1952512 1952512 1952512 1952512 1952512 08/2010 08/2010 08/2010 08/2010 08/2010 08/2010 08/2010 08/2010 08/2010

Flagstaff Pharmacy, Suva Guardian Angel Pharmacy, L/Beach Nasinu Mega Care Pharmacy, Makoi, Nasinu Wyse Pharmacy, Nakasi Wyse Pharmacy, Valelevu Nasese Pharmacy , Suva My Chemist, Labasa Nasea Chemist, Labasa Northern Drug Store, Labasa Priloten Enalapril 30/10mg

Invoril $3.45 Invoril $2.25 Invoril $4.05 Invoril $4.50 Invoril $2.25 Invoril $4.05 Invoril $4.05 Invoril $3.45 Invoril $4.05

Amy Street Pharmacy

Priloten $3.69

City Centre Pharmacy, Suva

Priloten $3.75

Good Health Care Pharmacy, Suva

Priloten $3.75

Rewa Pharmacy, Nausori

Priloten $3.75

Sunapril Enalapril 30/10mg A.J. Swann Co Ltd, Suva Metro Pharmacy, Suva Superdrug Pharmacy, Nabua Renitec Enalapril 30/10mg Suvik Hitek Pvt Ltd, India Suvik Hitek Pvt Ltd, India Suvik Hitek Pvt Ltd, India (Merck Sharp & Dohme (Australia) Pty Ltd N2047 N2047 106 106 05/2010 05/2010 04/2011 04/2011 (Merch Sharp & Dohme (Australia) Pty Ltd) (Flamingo Pharmaceuticals Ltd, India) (Flamingo Pharmaceuticals Ltd, India) 0002 0002 0002 12/2012 12/2012 12/2012

Sunapril $3.25 Sunapril $1.95 Sunapril $1.95

AJ Swanns price for Sunapril Enalapril (0002) was $3.25 which was 66% more expensive than the other two pharmacies selling the same Metro Pharmacy Suva & Superdrug Nabua - $1.95.

Hyperchem Pharmacy, Lautoka

Renitec $13.01

Western Medicare Pharmacy, Ba

Renitec $9.00

Hyperchem Lautoka and Western Medicare Ba , Lautoka sold Renitec enalapril by the same manufacturer and having the same batch number. Hyperchem ($13.01) was 45% more expensive than Western Medicare ($9.00)

Flaminopril Enalapril 30/10gm Hyperchem Pharmacy, Ba

Flaminopril $1.73

Midway Pharmacy, Ba

Flaminopril $5.00

Priloten Enalapril 30/10mg (Global Pharma Health Care Pvt Ltd, India) 890 890 (Global Pharma Health Care Pvt Ltd, India) 09/2012

Midway Pharmacy Ba sold Flaminopril enalapril (Flamingo Pharmaceuticals, India) for $5.00 while Hyperchem Ba sold the same for just $1.73.Consumers would easily be paying 189% more for this medicine if they did not check the pricing in these outlets which are within walking distance of each other.

Budget Pharmacy, Nadi

Priloten $3.70

Same price of $3.70 charged by the two pharmacies for Priloten enalapril. 09/2012

MS Pharmacy, Nadi

Priloten $3.70

FRUSEMIDE Lasix Frusemide 30/40mg Central Pharmacy, Suva Sanofis Aventis Australia Pty Ltd Sanofis Aventis Australia Pty Ltd Sanofis Aventis Australia Pty Ltd

Price Comparisons: Same medicine, batch number, manufacturer/source country

Holistic Pharmacy, Suva

Lasix $4.65 Lasix $4.35

Not Stated 8048826 8050691

10/2012 10/2012 01/2012

Wyse Pharmacy, Valelevu

Lasix $4.35

Three pharmacies in Suva sold Lasix from the same manufacturer. Central Pharmacy Suva did not have the batch number visible, however comparing the medicine on basis of same manufacture is sufficient. Central Pharmacys price ($4.65) was just 6.9% higher than Holistic Suva and Wyse Valelevu.

GLIPIZIDE

Price Comparisons: Same medicine, batch number, manufacturer/source country (continued).

(Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) L927B L927B L927B L927B L927B L927B 07/2012 07/2012 07/2012 07/2012 07/2012 07/2012 Six pharmacies dispensed the same Minidiab batch (L927B), three each in the Central/Eastern and Western divisions. The highest price was recorded at Island Pharmacy Ba ($3.50) while the cheapest was sold by Madison Suva ($3.00). The price difference between the highest and lowest price was 16.6%.

Minidiab $3.45 Minidiab $3.00 Minidiab $3.15 Minidiab $3.08 Minidiab $3.15 Minidiab $3.50

Minidiab $3.00 Minidiab $3.75 Minidiab $3.45 Minidiab$3.45 Minidiab $3.45 Minidiab $3.50 Minidiab $3.22 Minidiab $3.45 Minidiab $3.75 Minidiab $3.45

(Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pte Ltd) (Pfizer Australia Pte Ltd) (Pfizer Australia Pte Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd)

L942A L942A L942A L942A L942A L942A L942A L942A L942A L942A

07/2012 07/2012 07/2012 07/2012 07/2012 07/2012 07/2012 07/2012 07/2012 07/2012

Ten pharmacies dispensed the same Minidiab batch L942A. The highest price recorded was $3.75 by City Centre Pharmacy Suva and Nasea Chemist Labasa, while the lowest was sold by Central Pharmacy Suva for $3.00. The price difference was $0.75 or 25%. (Note: Life Pharmacy Nausori sold the same batch medicine but higher dosage of 40/5mg for $2.50)

Highest price of $4.45 recorded Chovhan Pharmacy Lautoka, while the cheapest was sold by Care Chemist Sigatoka for $3.08, price difference being 44.5%. Holistic Suva, Laucala Bay Pharmacy, Mega Care Makoi and Nausory Pharmacy all sold Minidiab glipizide (M111A) at $3.45. The two Lautoka pharmacies Chovhan and Sugar City Pharmacy sold the medicine for prices above $4.00.

Minidiab $3.49 Minidiab $3.45 Minidiab $3.45 Minidiab $3.45 Minidiab $3.75 Minidiab $3.45 Minidiab $3.15 Minidiab$3.20 Minidiab$3.08 Minidiab$4.45 Minidiab$3.12 Minidiab$3.50 Minidiab$4.05 Minidiab$3.19 Minidiab$3.15

(Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pte Ltd) (Pfizer Australia Pte Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pte Ltd)

M111A M111A M111A M111A M111A M111A M111A M111A M111A M111A M111A M111A M111A M111A M111A

09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012

Price Comparisons: Same medicine, batch number, manufacturer/source country

Superdrug, Flagstaff, Nasese, Superdrug Nabua and Suva City Pharmacy sold same batch Minidiab glipizide at 40/5mg. The highest price in this group was charged by Flagstaff Pharmacy and Superdrug Nabua at $4.85, while Superdrug Suva charged $0.80 less at $4.05 than its Nabua branch.

Minidiab Glipizide 30/5mg same batch # A.J. Swann Co Ltd, Suva Madison Pharmacy, Suva Wyse Pharmacy, Valelevu Hyperchem Pharmacy, Lautoka Island Pharmacy Complex, Nadi Island Pharmacy, Ba Minidiab Glipizide 30/5mg same batch # Central Pharmacy, Suva City Centre Pharmacy, Suva Guardian Angel Pharmacy, L/Beach Chandulals Pharmacy Namaka Medisure Pharmacy, Nadi Patel Pharmacy Ltd, Sigatoka Thakorlals Pharmacy, Lautoka My Chemist, Labasa Nasea Chemist, Labasa Northern Drug Store, Labasa Minidiab Glipizide 30/5mg same batch # Amy Street Pharmacy Holistic Pharmacy, Suva Laucala Bay Pharmacy, Suva Mega Care Pharmacy, Makoi, Nasinu Metro Pharmacy, Suva Nausori Pharmacy Ltd, Nausori Pharmacy Plus, Suva Budget Pharmacy, Nadi Care Chemist, Sigatoka Chovhan Pharmacy Ltd, Lautoka Life Pharmacy Ltd, Nadi MS Pharmacy, Nadi Sugar City Pharmacy Ltd, Lautoka Health First Pharmacy, Nadi Western Medicare Pharmacy, Ba Minidiab Glipizide 40/5mg same batch # Superdrug Pharmacy, Suva Flagstaff Pharmacy, Suva Nasese Pharmacy , Suva Superdrug Pharmacy, Nabua Suva City Pharmacy, Suva Thakorlals Pharmacy, Nadi DHA Minidiab Glipizide 30/5mg (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pty Ltd) (Pfizer Australia Pte Ltd) M111A M111A M111A M111A M111A M111A 09/2012 09/2012 09/2012 09/2012 09/2012 09/2012

Minidiab $4.05 Minidiab $4.85 Minidiab $4.45 Minidiab $4.85 Minidiab $4.45 Minidiab$4.05

45

46

Price Comparisons: Same medicine, batch number, manufacturer/source country (continued).

80456 80456 05/2012 Price difference of $1.45 for DHA Minidiab glipizide sold by these two pharmacies. Midway Ba sold it at 48% higher than Health Care Chemist Tavua. 05/2012 (Drug Houses of Australia(Asia) Pte Ltd, Singapore) Drug Houses of Australia (Asia) Pty Limited, Singapore

Health Care Chemist, Tavua

DHA $3.00

Midway Pharmacy, Ba

DHA $4.45

Windlas Biotech Ltd,India Windlas Biotech Ltd, India Price difference of $0.57 or 41%. 05/2011

W05002E W05002E

08/2011 08/2011

Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 05/2011 Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India Flamingo Pharmaceuticals Ltd, India 227 227 227

227 227 227 227 227 227 227 227 227 227 227 227

Midway Pharmacy sold the most expensive at $2.70, while Health First Pharmacy Nadi and Nadi Chemist were the cheapest at $1.48. Price difference between cheapest and most expensive price 82%. The most common price was $1.95 charged by five pharmacies Nausori Pharmacy, Suva City Pharm., Chadulal and Hyperchem Ba.

The three Northern pharmacies dispensed 15/300mg of the same metformin. My Chemist was the highest priced $1.95 while the other two charged for $1.35, a $0.60 difference (44%)

Price Comparisons: Same medicine, batch number, manufacturer/source country

Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd, India Pure Pharma Ltd,India Pure Pharma Ltd,India Pure Pharma Ltd, India Pure Pharma Ltd, India Alpha Pharm, Australia Alpha Pharm, Australia 100046 100046 07/2013 07/2013

80002 80002 80002 80002 80002 80002 80002 80002 80002 80002 80002 80002

06/2011 06/2011 06/2011 06/2011 06/2011 06/2011 06/2011 06/2011 06/2011 06/2011 06/2011 06/2011

AJ Swann Suva sold the most expensive at $2.00 while the cheapest was found at Mega Care Pharmacy Makoi, Holistic Pharmacy, Suva and Wyse Pharmacy Valelevu ($1.05). Price difference between cheapest and most expensive 94%.

METFORMIN Metofen Metformin 30/500mg Amy Street Pharmacy Metofen$1.38 Rewa Pharmacy, Nausori Metofen$1.95 Flamingo Metformin same batch#, source country 30/500mg Madison Pharmacy, Suva Flamingo $1.50 Nausori Pharmacy Ltd, Nausori Flamingo $1.95 Pharmacy Plus, Suva Flamingo $1.65 Samabula Drug Store, Samabula Flamingo $1.65 Suva City Pharmacy, Suva Flamingo $1.95 Care Chemist, Sigatoka Flamingo $1.53 Chandulals Pharmacy, Lautoka Flamingo $1.95 Health First Pharmacy, Nadi Flamingo $1.48 Hyperchem Pharmacy, Ba Flamingo $1.95 Midway Pharmacy, Ba Flamingo $2.70 Nadi Chemist, Nadi Flamingo $1.48 Patel Pharmacy Ltd, Sigatoka Flamingo $1.80 Flamingo Metformin, same batch#, source country 15/300mg My Chemist, Labasa Flamingo $1.95 Nasea Chemist, Labasa Flamingo $1.35 Northern Drug Store, Labasa Flamingo$1.35 Pure Pharma Metformin 30/500mg, same batch A.J. Swann Co Ltd, Suva Pure Pharma $2.00 Central Pharmacy, Suva Pure Pharma $1.95 City Centre Pharmacy, Suva Pure Pharma $1.95 Flagstaff Pharmacy, Suva Pure Pharma $1.95 Holistic Pharmacy, Suva Pure Pharma $1.05 Laucala Bay Pharmacy, Suva Pure Pharma $1.65 Life Pharmacy, Nausori Pure Pharma $1.50 Mega Care Pharmacy, Makoi, Nasinu Pure Pharma $1.05 Metro Pharmacy, Suva Pure Pharma $1.95 Super Drug Pharmacy, Nabua Pure Pharma $1.95 Wyse Pharmacy, Nakasi Pure Pharma $1.85 Wyse Pharmacy, Valelevu Pure Pharma $1.05 Glucophage Metformin, same batch#, source country 30/500mg Hyperchem Pharmacy, Lautoka Glucophage $6.73 Life Pharmacy Ltd, Nadi Glucophage $6.70 Same manufacturer, batch # & expiry date. Difference of $0.03.

SIMVASTATIN Arrow Simvastatin, same batch# 30/20mg

Price Comparisons: Same medicine, batch number, manufacturer/source country (continued).

NOT STATED NOT STATED NOT STATED NOT STATED NOT STATED NOT STATED Highest price charged by Central Pharmacy, Suva at $11.55, cheapest at Nadi Chemist $3.08. Price difference 275% SAWH0023 SAWH0023 SAWH0023 SAWH0023 SAWH0023 SAWH0023 10/2011 10/2011 10/2011 10/2011 10/2011 10/2011

Cipla Ltd, India Cipla Ltd, India Cipla Ltd, India Cipla Ltd, India Cipla Ltd, India (Cipla Ltd, India) Cipla Ltd, India Cipla Ltd, India Cipla Ltd, India Cipla Ltd, India Cipla Ltd, India

G97838 G97838 G97838 G97838 G97838 G97838 G97838 G97838 G97838 G97838 G97838

05/2010 05/2010 05/2012 05/2012 05/2012 05/2012 05/2012 05/2012 05/2012 05/2012 05/2012

Eleven (11) pharmacies sold Simcard simvastatin (#G97838), with 6 of them selling it at $11.55. The highest price was at Health First Pharmacy Nadi for $11.59 while Flagstaff, Mega Care Makoi and Thakorlals Nadi sold the cheapest ($9.75). Price difference between lowes/highest 19%.

Windlas Biotech Ltd, India Windlas Biotech Ltd, India Windlas Biotech Ltd, India Windlas Biotech Ltd, India

W28001E W28001E W28001E W28001E

09/2011 09/2011 09/2011 09/2011

Winstatin was sold by Amy Street Pharmacy; Good Health Care, Suva; Guardian Angel, L/Beach for $3.15 while Western Medicare Ltd charged $10.00. This is a price difference of 217%, which is three times more than what a consumer would pay for in Suva.

NOT STATED NOT STATED NOT STATED NOT STATED NOT STATED NOT STATED

SAWH0019 SAWH0019 SAWH0019 SAWH0019 SAWH0019 SAWH0019

07/2011 07/2011 07/2011 07/2011 07/2011 07/11

Highest price recorded in the three Labasa pharmacies at $9.45. Budget Pharmacy Nadi had the cheapest price of $2.95. The three northern pharmacies have charged 220% more than the cheapest Arrow Simvastatin purchased.

Life Pharmacy, Nausori Arrow $6.00 Samabula Drug Store,Samabula Arrow $4.05 Chovhan Pharmacy Ltd, Lautoka Arrow $7.50 Central Pharmacy, Suva Arrow $11.55 Nadi Chemist, Nadi Arrow $3.08 Sugar City Pharmacy Ltd, Lautoka Arrow $5.85 Simcard Simvastatin, same #, source country, 30/20mg City Centre Pharmacy, Suva Simcard $11.55 Flagstaff Pharmacy, Suva Simcard $9.75 Mega Care Pharmacy, Makoi, Nasinu Simcard $9.75 Metro Pharmacy, Suva Simcard $11.55 Nausori Pharmacy Ltd, Nausori Simcard $11.55 Superdrug Pharmacy, Nabua Simcard $11.55 Superdrug Pharmacy, Suva Simcard $11.55 Wyse Pharmacy, Nakasi Simcard $11.55 Health First Pharmacy, Nadi Simcard $11.59 Hyperchem Pharmacy, Lautoka Simcard $9.83 Thakorlals Pharmacy, Nadi Simcard $9.75 Winstatin Simvastatin, same #, source country 30/20mg Good Health Care Pharmacy, Suva Winstatin $3.15 Guardian Angel Pharmacy, L/Beach Nasinu Winstatin $3.15 Western Medicare Pharmacy, Ba Winstantin $10.00 MS Pharmacy, Nadi Winstatin $3.45 Arrow Simvastatin, same #, 30/20mg Budget Pharmacy, Nadi Arrow $2.95 Care Chemist, Sigatoka Arrow $3.28 Life Pharmacy Ltd, Nadi Arrow $4.05 My Chemist, Labasa Arrow $9.45 Nasea Chemist, Labasa Arrow $9.45 Northern Drug Store, Labasa Arrow $9.45 Arrow Simvastatin, same #, 30/20mg Hyperchem Pharmacy, Ba Arrow $5.10 Midway Pharmacy, Ba Arrow $7.50 Patel Pharmacy Ltd, Sigatoka Arrow $15.00 Winstatin Simvastatin, same #, 30/20mg NOT STATED NOT STATED NOT STATED SAWH0021 SAWH0021 SAWH0021 10/2011 10/2011 10/2011 Patel Pharmacy Sigatoka charged 194% more than Hyperchem Ba Arrow simvastatin (SAWH0021)

Crescent, Simvastitin same #, source country 28/20mg Crescent Pharma Ltd Crescent Pharma Ltd Crescent Pharma Ltd 08016 08016 08016 02/2012 02/2012 02/2012 Crescent was sold by Thakorlal Pharmacy, Lautoka; $5.85 while Health Care Chemist, Tavua charged $18.00. This is a price difference of 207%.

Price Comparisons: Same medicine, batch number, manufacturer/source country

Health Care Chemist, Tavua Thakor Lal Pharmacy, Lautoka Island Pharmacy, Ba (30/20mg)

Crescent $18.00 Crescent $5.85 Crescent $9.00

47

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Notes