<p>In this week&rsquo;s edition, we focus on drug pricing determinants and problems depriving persons with disabilities from having decent jobs</p>
<hr>
<h2 dir="ltr"><span style="color: rgb(6, 71, 137);"><strong>Drug Pricing and Currency Crises</strong></span></h2>
<p dir="ltr" style="text-align: justify;">The Pharmaceutical Division of the Federation of the Chambers of Commerce has <a href="https://www.alarabiya.net/aswaq/exclusive/2024/03/13/-%D8%B4%D8%B9%D8%A8%D8%A9-%D8%A7%D9%84%D8%A3%D8%AF%D9%88%D9%8A%D8%A9-50-%D8%B2%D9%8A%D8%A7%D8%AF%D8%A9-%D9%85%D8%AA%D9%88%D9%82%D8%B9%D8%A9-%D8%A8%D8%A3%D8%B3%D8%B9%D8%A7%D8%B1-%D8%A7%D9%84%D8%AF%D9%88%D8%A7%D8%A1-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1-%D8%AE%D9%84%D8%A7%D9%84-3-%D8%A3%D8%B4%D9%87%D8%B1">demanded</a> a 50% price increase to reflect the increase in costs following the most recent currency devaluation. The demand comes after medication prices <a href="https://www.alarabiya.net/aswaq/special-stories/2024/01/28/%D8%B4%D8%B9%D8%A8%D8%A9-%D8%A7%D9%84%D8%A3%D8%AF%D9%88%D9%8A%D8%A9-%D8%A7%D8%B1%D8%AA%D9%81%D8%A7%D8%B9-%D8%A3%D8%B3%D8%B9%D8%A7%D8%B1-%D8%A7%D9%84%D8%AF%D9%88%D8%A7%D8%A1-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1-20-%D8%A7%D9%84%D8%B9%D8%A7%D9%85-%D8%A7%D9%84%D9%85%D8%A7%D8%B6%D9%8A-%D9%88-%D8%A7%D9%84%D8%B2%D9%8A%D8%A7%D8%AF%D8%A9-%D8%A7%D9%84%D8%B9%D8%A7%D8%AF%D9%84%D8%A9-100-#:~:text=%D9%82%D8%A7%D9%84%20%D8%B1%D8%A6%D9%8A%D8%B3%20%D8%B4%D8%B9%D8%A8%D8%A9%20%D8%A7%D9%84%D8%A3%D8%AF%D9%88%D9%8A%D8%A9%20%D8%A8%D8%A7%D8%AA%D8%AD%D8%A7%D8%AF,%D9%84%D8%B3%D8%B9%D8%B1%20%D8%A7%D9%84%D8%AF%D9%88%D9%84%D8%A7%D8%B1%20%D9%85%D9%86%D8%B0%20%D8%A3%D8%A8%D8%B1%D9%8A%D9%84%202022.">increased</a> by an average of 20% in 2023 due to the high cost of imported production inputs, which make up 90% of inputs used to manufacture pharmaceuticals domestically. This follows a 2012 decree of the minister of health that lifted the cap on price increases for medications, amid the steadily rising prices of foreign currency.&nbsp;</p>
<p dir="ltr" style="text-align: justify;">Drug pricing policies are unfair to consumers and small producers because they link the price of medications locally to prices in other countries without taking into consideration divergent per capita income levels and economic conditions in general.</p>
<h3 dir="ltr"><strong>Size of the pharmaceutical sector in Egypt</strong></h3>
<p dir="ltr" style="text-align: justify;">In 2021, the production of pharmaceutical firms in Egypt was <a href="https://www.capmas.gov.eg/Pages/Publications.aspx?page_id=5104&amp;Year=23591">valued</a> at EGP159.8 billion. Sales in the sector <a href="https://arabic.cnn.com/middle-east/article/2024/02/05/egypt-pharmaceutical-companies-request-an-average-price-increase-of-25">more than doubled</a> from 2018 to 2023, from EGP63 billion to EGP142 billion. There are <a href="https://arabic.cnn.com/middle-east/article/2024/02/05/egypt-pharmaceutical-companies-request-an-average-price-increase-of-25">191 licensed pharmaceutical plants</a> in Egypt with 799 production lines, according to the Egyptian Pharmaceutical Authority. Together, they cover 92% of the local market&rsquo;s needs, with the remaining 8% imported.</p>
<h3 dir="ltr"><strong>Pricing using an international benchmark</strong></h3>
<p dir="ltr" style="text-align: justify;">Since 2012, drugs <a href="http://minofia-pharmacy-inspection.weebly.com/1602158515751585-158516021605-499-1604158716061577-2012.html">have been priced</a> according to the external reference rule, meaning they are guided by the price of the drug in a range of other countries. If the drug is an original preparation containing a new or innovative active ingredient, the Egyptian company seeking to register it must submit a survey of its market price in 36 other countries. The drug is then sold on the Egyptian market for the lowest price in the surveyed countries.</p>
<p dir="ltr" style="text-align: justify;">Medicines that contain the same active ingredient of an original product which are imported by the manufacturer or are made locally are priced 35&ndash;40% lower than the price of the same product in other countries.</p>
<p dir="ltr"><img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1710706075imageEd 64_2-2 copy.png" alt="" width="405" height="203"></p>
<p dir="ltr" style="text-align: justify;">The price of drugs <a href="https://correspondents.org/2016/12/19/%D8%A7%D9%84%D8%AF%D9%88%D8%A7%D8%A1-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1-%D9%86%D9%82%D8%B5-%D8%AD%D8%A7%D8%AF%D9%91-%D9%88%D8%B3%D9%88%D9%82-%D8%B3%D9%88%D8%AF%D8%A7%D8%A1-%D9%88%D8%A3%D8%B3%D8%B9/">was</a> hiked by 20% in 2016 before the Egyptian pound was floated. The government then raised prices again in early 2017 to reflect the change in the exchange rate. Drug companies&rsquo; requests for <a href="https://link.springer.com/chapter/10.1007/978-3-319-12169-7_4">re-pricing</a> are constantly under consideration, and the price of many types of medications will likely increase as the value of the pound continues to fall.</p>
<p dir="ltr" style="text-align: justify;">Although Turkey <a href="https://www.valueinhealthjournal.com/article/S1098-3015(14)00235-6/fulltext">follows</a> the same pricing system as Egypt, drug prices are affordable there because the state subsidizes the cost of essential medicines or covers them completely for certain categories of patients.&nbsp;</p>
<p dir="ltr"><img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1710706120imageEd 64_4 EN.png" alt="" width="405" height="404"></p>
<h3 dir="ltr"><strong>How to make medicine affordable for everyone</strong></h3>
<ul>
<li dir="ltr" style="text-align: justify;" role="presentation">Fair prices should be negotiated with pharmaceutical companies, provided that the Egyptian Pricing Committee has the scientific mechanisms necessary to evaluate the pharmaceutical product and determine its actual cost.</li>
<li dir="ltr" style="text-align: justify;" role="presentation">The comprehensive health insurance system should be activated to reduce out-of-pocket spending on drugs; Egyptian firms should be allowed to participate in tenders to supply medications to the insurance system in a way that ensures real profitability and fair pricing.</li>
<li dir="ltr" style="text-align: justify;" role="presentation">The production of raw pharmaceutical materials must be localized so that the price of drugs becomes insulated from exchange rate fluctuations and supply chain disruptions.</li>
<li dir="ltr" style="text-align: justify;" role="presentation">Egypt should take advantage of the exceptions in <a href="https://api-aps.aucegypt.edu/uploads/articlesAttachments/1621761110pdfAtm%20English%20Policy%20Brief_draft%205.pdf">TRIPS</a> (the Trade-Related Aspects of Intellectual Property Rights) agreement to obtain licenses to produce patented pharmaceuticals without the consent of the patent owner, especially in cases of health crises. Egypt has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176525/">previously used such exceptions</a> to locally produce generic medicines for the treatment of hepatitis C at a lower cost.&nbsp;</li>
</ul>
<hr>
<h2 dir="ltr"><strong><span style="color: rgb(6, 71, 137);">Persons with Disabilities Denied the Right to Decent Jobs</span></strong></h2>
<p dir="ltr" style="text-align: justify;">President Abdel Fattah al-Sisi <a href="https://www.sis.gov.eg/Story/271488/%D8%A7%D9%84%D8%B1%D8%A6%D9%8A%D8%B3-%D8%A7%D9%84%D8%B3%D9%8A%D8%B3%D9%8A-%D9%8A%D8%B4%D9%87%D8%AF-%D8%A7%D8%AD%D8%AA%D9%81%D8%A7%D9%84%D9%8A%D8%A9-%D9%82%D8%A7%D8%AF%D8%B1%D9%88%D9%86-%D8%A8%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%81-%D9%84%D8%B0%D9%88%D9%8A-%D8%A7%D9%84%D9%87%D9%85%D9%85-%D9%88%D8%A3%D8%B5%D8%AD%D8%A7%D8%A8-%D8%A7%D9%84%D9%82%D8%AF%D8%B1%D8%A7%D8%AA-%D8%A7%D9%84%D8%AE%D8%A7%D8%B5%D8%A9?lang=ar">directed</a> EGP10 billion from the Ras al-Hikma deal, valued at USD35 billion, to the <a href="https://www.sis.gov.eg/Story/270944/%D8%B5%D9%86%D8%AF%D9%88%D9%82-%D9%82%D8%A7%D8%AF%D8%B1%D9%88%D9%86-%D8%A8%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%81?lang=ar#:~:text=%22%D8%B5%D9%86%D8%AF%D9%88%D9%82%20%D9%82%D8%A7%D8%AF%D8%B1%D9%88%D9%86%20%D8%A8%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%81%22%20%D9%87%D9%88%20%D8%B5%D9%86%D8%AF%D9%88%D9%82,%D8%A8%D8%A7%D9%84%D9%82%D8%A7%D9%86%D9%88%D9%86%20%D8%B1%D9%82%D9%85%20200%20%D9%84%D8%B3%D9%86%D8%A9%202020.">Differently Abled Fund</a>. As important as financial support is for persons with disabilities&mdash;who number 11.4 million in Egypt&mdash;the most important thing is to integrate them into the labor market where they can obtain a stable income and health insurance.</p>
<p dir="ltr" style="text-align: justify;"><a href="https://www.capmas.gov.eg/Admin/News/PressRelease/2023123125121_%D8%A7%D9%84%D9%8A%D9%88%D9%85%20%D8%A7%D9%84%D8%B9%D8%A7%D9%84%D9%85%D9%8A%20%D9%84%D9%84%D8%A7%D8%B4%D8%AE%D8%A7%D8%B5%20%D8%B0%D9%88%D9%8A%20%D8%A7%D9%84%D8%A7%D8%B9%D8%A7%D9%82%D9%87.pdf">Some 73%</a> of persons with disabilities in Egypt who wanted to work could not find a decent job in 2022. The high percentage is due to the <a href="https://www.forbes.com/sites/andrewpulrang/2022/10/31/why-is-the-employment-gap-for-people-with-disabilities-so-consistently-wide/?sh=3788d178276b">difficulty</a> of using transportation and the <a href="https://www.edf-feph.org/majority-of-persons-with-disabilities-locked-out-of-quality-employment/">low quality</a> of educational services they receive to qualify them for good jobs.</p>
<h3 dir="ltr"><strong>Challenges of entering the labor market for persons with disabilities</strong></h3>
<p dir="ltr" style="text-align: justify;">Although the law <a href="https://idsc.gov.eg/Article/details/8860">requires</a> that persons with disabilities make up 5% of the workforce in public and private sector institutions&mdash;with violators subject to one year in prison&mdash;in reality the percentage does not exceed <a href="https://www.parlmany.com/News/7/125997/%D8%AD%D9%82%D9%88%D9%82-%D8%A7%D9%84%D9%85%D8%B9%D8%A7%D9%82%D9%8A%D9%86-%D9%87%D9%84-%D8%AA%D9%83%D9%81%D9%89-%D8%A7%D9%84%D9%805-%D9%88%D8%B8%D8%A7%D8%A6%D9%81">&nbsp;0.5% of the workforce</a>. About 35.2% of persons with significant to absolute disabilities <a href="https://www.capmas.gov.eg/Admin/News/PressRelease/2023123125121_%D8%A7%D9%84%D9%8A%D9%88%D9%85%20%D8%A7%D9%84%D8%B9%D8%A7%D9%84%D9%85%D9%8A%20%D9%84%D9%84%D8%A7%D8%B4%D8%AE%D8%A7%D8%B5%20%D8%B0%D9%88%D9%8A%20%D8%A7%D9%84%D8%A7%D8%B9%D8%A7%D9%82%D9%87.pdf">report</a> that they have jobs but are not assigned work, <a href="https://documents.aucegypt.edu/Docs/GAPP/Public%20Policy%20Hub%20Webpage/4-%20Employing%20People%20with%20Disability%20in%20Egypt%20Policy%20Paper.pdf">suggesting</a> that they face discrimination in the work environment.&nbsp;</p>
<p dir="ltr"><img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1710706174imageEd 64_6 EN.png" alt="" width="405" height="405"></p>
<p dir="ltr" style="text-align: justify;">While 70% of workers in Egypt are employed in the private sector, the formal private sector <a href="https://www.parlmany.com/News/7/125997/%D8%AD%D9%82%D9%88%D9%82-%D8%A7%D9%84%D9%85%D8%B9%D8%A7%D9%82%D9%8A%D9%86-%D9%87%D9%84-%D8%AA%D9%83%D9%81%D9%89-%D8%A7%D9%84%D9%805-%D9%88%D8%B8%D8%A7%D8%A6%D9%81">circumvents</a> the 5% requirement by placing persons with disabilities on their payroll to meet the quota without assigning any tasks to them. Also, firms pay them modest salaries that can be classified as social allowances.</p>
<p dir="ltr" style="text-align: justify;">In the informal private sector, there are <a href="https://documents.aucegypt.edu/Docs/GAPP/Public%20Policy%20Hub%20Webpage/4-%20Employing%20People%20with%20Disability%20in%20Egypt%20Policy%20Paper.pdf">no human resources departments</a> so they are not subject to the 5% quota or any other rules that guarantee the rights of workers with disabilities. Most of the jobs held by persons with disabilities are administrative in nature. The state <a href="https://borgenproject.org/disability-and-poverty-in-egypt/">offers</a> meager incentives to encourage companies to hire them, compounding the link between poverty and individuals with disabilities.&nbsp;</p>
<p dir="ltr"><img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1710706321imageEd 64_6 EN copy.png" alt="" width="405" height="405"></p>
<h3 dir="ltr"><strong>Low level of education is an obstacle to employment</strong></h3>
<p dir="ltr" style="text-align: justify;">In 2020/21, there were <a href="https://www.dostor.org/3648486">just 8.9 students</a> per class in schools for students with special needs. Among student dropouts from these schools, 37% left school due to circumstances related to their disability conditions while 19.2% left because they were unable to adapt to teachers and peers. Other reasons for leaving school were the difficulty of reaching it and the family&rsquo;s limited financial capabilities.&nbsp;</p>
<div dir="ltr" align="left">
<p dir="ltr"><img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1710707788imageEd 64_6 EN copy 2.png" alt="" width="405" height="405"></p>
<p dir="ltr">Teachers&rsquo;&nbsp;<a href="https://idsc.gov.eg/upload/DocumentLibrary/AttachmentA/8911/%D8%A7%D9%84%D9%85%D9%86%D8%B8%D9%88%D9%85%D8%A9%20%D8%A7%D9%84%D8%B1%D9%82%D9%85%D9%8A%D8%A9%D8%A7%D9%84%D8%B4%D8%A7%D9%85%D9%84%D8%A9.pdf">poor skills</a> in dealing with students with disabilities, as well as the lack of conviction of some that students with disabilities <a href="https://erf.org.eg/app/uploads/2018/09/1215.pdf">can be</a> active citizens of society, is a huge problem in the educational process.</p>
<h3 dir="ltr"><strong>Difficulty in transportation reduces the desire of disabled persons to work</strong></h3>
<p dir="ltr" style="text-align: justify;">Although the government <a href="https://hrightsstudies.sis.gov.eg/%D8%AF%D8%B1%D8%A7%D8%B3%D8%A7%D8%AA-%D9%88%D8%AA%D9%82%D8%A7%D8%B1%D9%8A%D8%B1/%D8%AF%D8%B1%D8%A7%D8%B3%D8%A7%D8%AA/%D8%AD%D9%82%D9%88%D9%82-%D8%B0%D9%88%D9%8A-%D8%A7%D9%84%D8%A5%D8%B9%D9%80%D9%80%D9%80%D8%A7%D9%82%D8%A9-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1#:~:text=%EF%80%AD%20%D9%83%D9%85%D8%A7%20%D9%86%D8%B5%D8%AA%20%D8%A7%D9%84%D9%85%D8%A7%D8%AF%D8%A9%20(30,%D9%82%D9%8A%D9%85%D8%AA%D9%87%D8%A7%20%D8%A7%D9%84%D9%85%D8%AF%D9%81%D9%88%D8%B9%D8%A9%D8%8C%20%D9%88%D8%B0%D9%84%D9%83%20%D8%A8%D8%A7%D9%84%D9%86%D8%B3%D8%A8%D8%A9%20%D9%84%D9%84%D8%B4%D8%AE%D8%B5">offers</a> discounts on public transportation for persons with disabilities&mdash;up to 100% within cities and even between governorates&mdash;many of them <a href="https://aps.aucegypt.edu/en/articles/781/accessibility-of-transport-for-persons-with-disabilities">still have difficulties</a> with mobility and so are deprived of decent transportation. In the countryside, the <a href="https://aps.aucegypt.edu/en/articles/1362/egypts-sovereign-fund-and-public-transportation-who-are-the-beneficiaries">dearth</a> of public transportation makes it more difficult for them to get around, while in large cities like Cairo, sidewalks and means of transport that are equipped and accessible to persons with disabilities <a href="https://aps.aucegypt.edu/en/articles/781/accessibility-of-transport-for-persons-with-disabilities">are scarce</a>, and metro stations are not disability friendly.</p>
<ul>
<li dir="ltr" style="text-align: justify;">In order to meet constitutional requirements to reduce barriers for persons with disabilities and prevent discrimination against them, the following actions are needed:&nbsp;</li>
<li dir="ltr" style="text-align: justify;" role="presentation">Regularly <a href="https://aps.aucegypt.edu/en/articles/781/accessibility-of-transport-for-persons-with-disabilities">update</a> the number of persons with disabilities and classify them based on type of disability to help plan a transit system and public utilities that take their needs into account.</li>
<li dir="ltr" style="text-align: justify;" role="presentation">Adopt inclusive urban designs to ensure that citizens with disabilities can easily reach educational institutions, work, and service facilities.</li>
<li dir="ltr" style="text-align: justify;" role="presentation">Completely <a href="https://idsc.gov.eg/upload/DocumentLibrary/AttachmentA/8911/%D8%A7%D9%84%D9%85%D9%86%D8%B8%D9%88%D9%85%D8%A9%20%D8%A7%D9%84%D8%B1%D9%82%D9%85%D9%8A%D8%A9%D8%A7%D9%84%D8%B4%D8%A7%D9%85%D9%84%D8%A9.pdf">change</a> the system of schools dedicated to persons with disabilities to focus on digital solutions so that a trained teacher, using databases supported by artificial intelligence and data analysis, can identify the condition and needs of each student and the necessary cognitive interventions in the event of difficulty in the educational process.</li>
</ul>
<hr></div>
<p dir="ltr"><em><a href="https://aucegypt.us17.list-manage.com/subscribe?u=5e42bef7fee7e6a299c3d932d&amp;id=e0d95df1c1&amp;mibextid=Zxz2cZ">Subscribe to the weekly edition&nbsp;</a></em></p>
<div style="text-align: justify;"><em>"Adasa" is a weekly policy digest by Alternative Policy Solutions. </em><em>"Adasa" provides an analysis of a select number of policy developments and their effect on inclusive development and socioeconomic change.</em></div>

عدسة

Adasa

الوصول إلى الرعاية الصحية والتغطية

Health Care Access and Coverage

إتاحة الدواء

Access to Medicine

العمل والتوظيف

Labor and Employment

التنمية الشاملة

Inclusive Development

حماية اجتماعية

Social Protection

كيفية تسعير الدواء وتوظيف ذوي الإعاقة

How to Price Drugs and Employ Persons with Disabilities  

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