title: Quality use of medicines within universal health coverage: challenges and opportunities.
abstract: BACKGROUND
  Medicines are a major driver of quality, safety, equity, and cost of care in low and middle-income country health systems. Universal health coverage implementers must explicitly address appropriate use of medicines to realize the health benefits of medicines, avoid wasting scarce resources, and sustain the financial viability of universal health coverage schemes.
  
  
  CONCLUSIONS
  Medicines are major contributors to the health and well-being of individuals and populations when used appropriately, and they waste resources and endanger health when used unnecessarily or incorrectly. Stakeholders need to balance inherently competing objectives in the pharmaceutical sector. Emerging and expanding UHC schemes provide potential levers to balance competing system objectives.To use these levers, sustainable universal coverage programs will require a) information systems that can track medicines utilization, expenditures, and quality of medicines use; b) routine monitoring of indicators of medicines availability, access, affordability, and use; c) policies and programs that facilitate appropriate medicines use by prescribers, dispensers, and patients; d) transparency in setting priorities for medicines coverage under resource constraints; and e) a system perspective to engage diverse actors.As they operationalize paths toward universal health coverage and include targeted medicines coverage policies and programs, systems can build on, and innovate, pharmaceutical policy frameworks and management tools from different countries' settings.
  
  
  CONCLUSIONS
  Ensuring that medicines which achieve important health outcomes are available, accessible to all, used appropriately, and sustainably affordable is essential for realizing universal health coverage. Stakeholder cooperation and use of information and financing system levers provide opportunities to work toward this goal.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02115, USA. awagner@hms.harvard.edu.
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Quick
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D006801:Humans; D054539:Medication Therapy Management / Q000191:economics / Q000592:standards*; D011786:Quality Control; D012052:Reimbursement, Incentive / Q000191:economics; D019472:Universal Health Insurance