title: Antiretroviral purchasing and prescription practices in Mexico: constraints, challenges and opportunities.
abstract: OBJECTIVE
  This study examines the antiretroviral (ARV) market characteristics for drugs procured and prescribed to Mexico's Social Protection System in Health beneficiaries between 2008 and 2013, and compares them with international data.
  
  
  METHODS
  Procurement information from the National Center for the Prevention and the Control of HIV/AIDS was analyzed to estimate volumes and prices of key ARV. Annual costs were compared with data from the World Health Organization's Global Price Reporting Mechanism for similar countries. Finally, regimens reported in the ARV Drug Management, Logistics and Surveillance System database were reviewed to identify prescription trends and model ARV expenditures until 2018.
  
  
  RESULTS
  Results show that the first-line ARV market is concentrated among a small number of patented treatments, in which prescription is clinically adequate, but which prices are higher than those paid by similar countries. The current set of legal and structural options available to policy makers to bring prices down is extremely limited.
  
  
  CONCLUSIONS
  Different negotiation policies were not successful to decrease ARV high prices in the public health market. The closed list approach had a good impact on prescription quality but was ineffective in reducing prices. The Coordinating Commission for Negotiating the Price of Medicines and other Health Supplies also failed to obtain adequate prices. To maximize purchase efficiency, policy makers should focus on finding long-term legal and political safeguards to counter the high prices imposed by pharmaceutical companies.
authors.affiliation: Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Claire
authors.initials: C
authors.lastname: Chaumont
authors.affiliation: Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bautista-Arredondo
authors.affiliation: Departamento de Enfermedades Infecciosas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Calva
authors.affiliation: Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Roberto Isaac
authors.initials: RI
authors.lastname: Bahena-González
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Gerda Hitz
authors.initials: GH
authors.lastname: Sánchez-Juárez
authors.affiliation: COFAPI México, México.
authors.forename: Arturo
authors.initials: A
authors.lastname: González de Araujo-Muriel
authors.affiliation: Centro Nacional para la Prevención y el Control del VIH y el SIDA, México, Distrito Federal, México.
authors.forename: Carlos
authors.initials: C
authors.lastname: Magis-Rodríguez
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernández-Ávila
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D002017:Budgets; D003363:Cost Control; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs / Q000331:legislation & jurisprudence / Q000639:trends; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008389:Marketing of Health Services; D008800:Mexico / Q000453:epidemiology; D017008:Negotiating; D010330:Patents as Topic; D010602:Pharmacopoeias as Topic; D011050:Policy Making; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents