Prescription Medicine in Mexico

In the last century, the progress of the science of medicine has moved forward in leaps and bounds.  A number of major diseases are now curable or treatable, even as changes in the environment and behavior have caused created more health hazards.  Although it is a desirable goal to encourage universal self-medication (World Health Organization: "it is desirable to encourage self-medication"), it is recognized that not everyone has the required knowledge and information to make correct medical decisions in all circumstances (World Health Organization: "every attempt should be made to ensure its appropriate use and to guard against any acceptable risks it may entail").  Thus, in some countries of the world, pharmaceutical drugs are divided into (1) Over-The-Counter (OTC) drugs which can be purchased by anyone without restrictions and used reasonably safely and (2) prescription drugs, which must be prescribed by qualified medical personnel because of the dire consequences and side-effects if improperly used.

We will now cite some survey data taken from the TGI Mexico study.  This is a survey of 6,200 persons between the ages of 12 and 64 years old conducted in 2001.  Among these survey respondents, 19% of them indicated that they have taken prescription medications for the following conditions: allergy, asthma, diabetes, gastroenteritis, migraines, heart disease, high blood pressure, high cholesterol, infections, insomnia, weight control and other unspecified conditions.

The following table shows the incidence by demographic characteristics:

Insofar as the age/sex distribution goes, we would expect to see more health problems among the elderly.  The interpretation of the socio-economic data is more complicated, since there are multiple factors operating here.  

• If prescription medicine were just a pricey commodity, access would be an increasing function of socio-economic level.  In Mexico, prescription medicine can be obtained in two primary ways.  In about one-third of the cases, the prescription medicine is purchased by the government and dispensed to eligible citizens at subsidized rates through the social security system.  In the remaining cases, people must procure their own prescription medicine, either by paying directly or else obtaining some form of prescription medicine insurance coverage.  So access to prescription medicine is not solely a function of socio-economic level.
• The need for prescription medicine is itself a function of socio-economic level.  On one hand, people in the upper socio-economic level are in better health conditions due to better living conditions, nutrition and primary health care.  This would be borne out by the life expectancies of the socio-economic classes.  On the other hand, people in the lower socio-economic level may leave untreated any condition that is not life-threatening.  They may also resort to cheaper alternatives other than prescription drugs.

Mexico also has a price regulatory system to protect consumers who have to purchase their own prescription medicine.  The pharmaceutical manufacturers negotiate with the Secretaría de Economía to determine maximum prices, and every drug is pre-packaged and stamped with that maximum price.  Comparative studies have shown that drug prices in Mexico are consistently and significantly lower than in the USA for the same brands.  This may be quite fair, since product pricing should be made relative to the average spending power in a country.  As an unintended consequence, Tijuana (Mexico) has the highest density of pharmacies in the country, as many Americans flock across the border to purchase cheap drugs.

The Mexico-USA comparison takes an even odder turn when we realized that prescription drugs in one country may be OTC in another.  For example, the top-selling allergy drug Claritin is a prescription drug in USA but OTC in Mexico.  Usually, a prescription drug can be released for self-medication via OTC when years of marketing experience of that drug has shown that unsupervised distribution at a particular dosage level with proper labeling would be safe.  When that happens, the price of the drug goes down significantly as it switches from prescription status to OTC.

To the lay observer, the different statuses of the same drug in different countries do not have logical explanations.  Instead, we are stuck with these uncomfortable possibilities: (1) consumers in the USA are less knowledgeable and informed than their counterparts in Mexico; (2) the health risks from the misapplication of the drugs are more acceptable in Mexico than in the USA; and/or (3) the profit motive is what drives the fight to preserve the prescription status of the drugs in specific countries.

(posted by Roland Soong, 6/15/2001)

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