Promoting Access to Cancer Medicines in Mexico: Seguro Popular Key Policy Components

Abstract

In Mexico, Seguro Popular (SP) was created to reach universal health coverage, including cancer care, through the Fund for Protection Against Catastrophic Expenditure (FPGC). This chapter describes how SP addressed the components of the WHO Access to Medicines Framework on access to cancer medicines.

SP’s reimburserment guidelines cover medicines for basic cancer care and define reference prices, which are similar to international reference prices. Eight percent of SP’s resources are allocated to FPGC, of which 28% finance cancer care. Only accredited health facilities are reimbursed by SP, but their number is insufficient to satisfy demand. Different procurement mechanisms affect the availability of cancer medicines.

Appendices

Annex 1. List of Cancer Medicines Covered by SP and its Characteristics

Medicine	Dose		Generic/patented	Medicine in WHO-EML? (2015)	Reference price SP (USD) (2016)	Negotiated by CCNMPMIS in 2015?	Ratio survey price (2017)/SP ref. price	Ratio SP Ref$/IRP	CCNPMIS$/MRP
Amifostine	500 mg	Package with one vial	Generic	No	137.16
Anastrozole	1 mg	Package with 28 tablets	Generic	Yes	38.41		0.95	2.57
Aprepitant	125 mg - 80 mg	Package with one 125 mg capsule and two 80 mg capsules	Patented	No	39.19	Yes			0.03
Bleomycin	15 UI/5 ml	Package with vial and 5 ml thinner	Generic	Yes	12.25			1.00
Buserelin	9.45 mg	Package with pre-filled syringe with implant	Patented	No	266.99	Yes
Busulfan	2 mg	Package with 25 tablets	Patented	No	21.39	Yes		1.52
Capecitabine	500 mg	Package with 120 tablets	Generic	Yes	101.70		1.39	0.50
Carboplatin	150 mg	Package with vial	Generic	Yes	8.27		1.23	0.55
Carmustine	100 mg/3 ml	Package with vial and 3 ml thinner	Generic	No	43.81
Cyclophosphamide	50 mg	Package with 30 tablets	Generic	Yes	7.42			0.80
Cyclophosphamide	50 mg	Package with 50 tablets	Generic	Yes	8.73			0.57
Cyclophosphamide	200 mg	Package with five vials	Generic	Yes	7.03		1.14	0.33
Cyclophosphamide	500 mg	Package with two vials	Generic	Yes	7.71		0.97	0.47
Cisplatin	10 mg	Package with one vial	Generic	Yes	1.39			0.56
Cytarabine	500 mg	Package with one vial	Generic	Yes	6.73		1.19	1.43
Dacarbazine	200 mg	Package with one vial	Generic	Yes	6.37			0.92
Dactinomycin	0.5 mg	Package with one vial	Generic	Yes	24.34			2.76
Daunorubicin	20 mg	Package with one vial	Generic	Yes	6.22		1.01	0.32
Dexrazoxane	500 mg	Package with one vial	Generic	No	141.31
Docetaxel	80 mg/6 ml	Package with 80 mg vial and 6 ml thinner	Generic	Yes	223.98
Docetaxel	20 mg/1.5 ml	Package with 20 mg vial and 1.5 ml thinner	Generic	Yes	64.82
Docetaxel trihydrate	80 mg	Package with 80 mg and 4 ml vial	Generic	Yes	223.98		0.99	12.63
Docetaxel trihydrate	20 mg	Package with 20 mg and 1 ml vial	Generic	Yes	64.82		1.04	12.37
Doxorubicin	20 mg/10 ml	Package with 10 ml (2 mg/ml) vial	Generic	No	161.31
Doxorubicin	10 mg	Package with one vial	Generic	Yes	7.57		0.53	3.52
Doxorubicin	50 mg	Package with one vial	Generic	Yes	7.68		1.36	1.04
Epirubicin	10 mg	Package with one vial	Generic	No	6.59		1.04	1.20
Etoposide	100 mg/5 ml	Package with ten vials of 5 ml	Generic	Yes	24.68		1.06	6.31
Exemestane	25 mg	Package with 15 tablets	Generic	No	57.49			1.81
Exemestane	25 mg	Package with 30 tablets	Generic	No	114.97		0.97	1.81
Exemestane	25 mg	Package with 90 tablets	Generic	No	344.92			1.81
Filgrastim	300 μg	Package with five vials or syringes	Generic	Yes	63.58			1.57
Finasteride	5 mg	Package with 30 tablets	Generic	No	1.43
Fludarabine	10 mg	Package with 15 tablets	Patented	Yes	291.63
Fluorouracil	250 mg	Package with ten vials of 10 ml	Generic	Yes	9.58		1.12	0.36
Flutamide	250 mg	Package with 90 tablets	Generic	No	19.43			1.92
Folinic acid	3 mg/ml	Package with six vials of 1 ml	Generic	Yes	4.13
Folinic acid	15 mg/5 ml	Package with five vials of 5 ml	Generic	Yes	17.47
Folinic acid	50 mg/4 ml	Package with 4 ml vial	Generic	Yes	9.99			4.22
Folinic acid	15 mg	Package with 12 tablets	Generic	Yes	9.90			0.63
Gemcitabine	1 g	Package with one vial	Generic	Yes	18.77		1.25	0.73
Goserelin	3.6 mg	Package with syringe with implant	Patented	No	89.55	Yes
Goserelin	10.8 mg	Package with syringe with implant	Patented	No	201.49	Yes
Granisetron	20 mg/100 ml	Package with 30 ml and dispenser	Generic	No	2.20
Granisetron	1 mg	Package with two tablets	Generic	No	8.56			31.70
Granisetron	3 mg/3 ml	Package with 3 ml vial	Generic	No	5.72
Hydroxycarbamide	500 mg	Package with 100 tablets	Patented	Yes	64.25			2.92
Ifosfamide	1 g	Package with one vial	Generic	Yes	15.34		0.94	1.40
Imatinib	400 mg	Package with 30 tablets	Patented	Yes	352.07	Yes	1.00	0.46	0.16
Imatinib	100 mg	Package with 60 tablets	Patented	Yes	183.93	Yes	1.00	4.37	0.20
Irinotecan	100 mg/5 ml	Package with 5 ml vial	Generic	Yes	30.04		1.24	1.03
Lapatinib	250 mg	Package with 70 tablets	Patented	No	524.97	Yes			0.61
L-Asparaginase	10,000 UI	Package with one vial	Patented	Yes	43.64		1.35	0.81
Letrozole	2.5 mg	Package with 30 tablets	Generic	No	3.12		1.35	0.25
Leuprorelin	11.25 mg/2 ml	Package with vial, 2 ml thinner vial and dispenser equipment	Generic	No	171.12
Melphalan	2 mg	Package with 25 tablets	Generic	No	39.66
Mercaptopurine	50 mg	Package with 20 tablets	Patented	Yes	44.46	Yes	0.80	0.98
Mesna	400 mg/4 ml	Package with five vials of 4 ml (100 mg/ml)	Generic	Yes	11.30			3.71
Methotrexate	50 mg	Package with one vial	Generic	Yes	3.83		0.85	0.79
Methotrexate	500 mg	Package with one vial	Generic	Yes	11.02		1.09	0.23
Methotrexate	1 g	Package with one vial	Generic	Yes	22.05
Methotrexate	2.5 mg	Package with 50 tablets	Generic	Yes	2.87		1.12	0.36
Mitomycin	5 mg	Package with one vial	Generic	No	10.22			0.40
Mitoxantrone	20 mg/10 ml	Package with 10 ml vial	Generic	No	49.10
Nilutamide	150 mg	Package with 30 tablets	Patented	No	108.46	Yes
Ondansetron	8 mg	Package with 10 tablets	Generic	Yes	1.31			0.51
Ondansetron	8 mg/4 ml	Package with three vials of 4 ml	Generic	No	0.75			0.19
Oxaliplatin	50 mg	Package with one vial	Generic	Yes	22.75		1.00	0.78
Oxaliplatin	100 mg	Package with 20 ml vial	Generic	Yes	34.00		0.10	0.45
Paclitaxel	300 mg/50 ml	Package with 50 ml vial, with equipment for free venoclysis of polyvinylchloride (PVC) and filter with membrane no greater than 0.22 μm	Generic	Yes	37.28		1.20	0.57
Palonosetron	0.25 mg/5 ml	Package with 5 ml vial	Patented	No	24.36
Pegfilgrastim	6 mg/0.60 ml	Package with vial with pre-filled syringe with 6 mg/0.60 ml	Patented	No	726.93				0.02
Rituximab	100 mg/10 ml	Package with 10 ml vial	Patented	Yes	69.99			0.51
Rituximab	100 mg/10 ml	Package with two vials of 10 ml	Patented	Yes	139.99	Yes	1.00	0.51
Rituximab	500 mg/50 ml	Package with 50 ml vial	Patented	No	289.30	Yes	1.00	0.32
Rituximab	500 mg/50 ml	Package with two vials of 50 ml	Patented	No	578.61			0.32
Tamoxifen	20 mg	Package with 14 tablets	Generic	Yes	1.09			0.68
Temozolomide	100 mg	Package with five tablets	Generic	No	112.17			1.13
Temozolomide	100 mg	Package with ten tablets	Generic	No	224.34			1.13
Temozolomide	100 mg	Package with 20 tablets	Generic	No	448.67			1.15
Temozolomide	20 mg	Package with five tablets	Generic	No	35.62
Temozolomide	20 mg	Package with ten tablets	Generic	No	71.23
Temozolomide	20 mg	Package with 20 tablets	Generic	No	142.46
Trastuzumab	440 mg/20 ml	Package with vial with powder and 20 ml thinner vial	Patented	Yes	1159.88	Yes	1.00
Tropisetron	5 mg	Package with vial	Generic	No	22.79			9.38
Vinblastine	10 mg/10 ml	Package with vial and 10 ml thinner vial	Generic	Yes	6.52			2.53
Vincristine	1 mg/10 ml	Package with vial and 10 ml thinner vial	Generic	Yes	2.71		1.06	0.82
Vinorelbine	30 mg	Package with one tablet	Generic	No	101.17
Vinorelbine	10 mg/ml	Package with 1 ml vial	Generic	Yes	10.24			0.46
Zoledronic acid	4.0 mg/5 ml	Package with vial	Generic	No	3.48			0.15

1. ^aMedicine prices converted from Mexican pesos to US dollars using the average exchange rate in 2017 as reported by the Bank of Mexico (Banco de México 2019) and adjusted for inflation (Inflation Calculator 2019)

Annex 2. Number of Healthcare Facilities with SP Accreditation to Treat FPGC Interventions

State	Number of SP beneficiaries (2017)	Number of accredited facilities for FPGC per 100,000 SP affiliates (2017)	Number of facilities with accreditation for cancer < 18 years per 100,000 SP affiliates (2017)
Aguascalientes	379,869	2.11	0.26
Baja California	997,251	1.00	0.30
Baja California Sur	207,118	2.41	0.00
Campeche	474,324	1.05	0.21
Coahuila	705,624	1.28	0.14
Colima	253,182	2.37	0.39
Chiapas	3,470,352	0.02	0.002
Chihuahua	1,220,272	1.31	0.33
Mexico City	2,749,580	1.53	0.29
Durango	736,442	0.01	0.00
Guanajuato	3,011,165	0.76	0.10
Guerrero	2,241,345	0.31	0.04
Hidalgo	1,666,161	0.36	0.06
Jalisco	3,014,388	0.56	0.10
Mexico State	7,077,137	0.57	0.01
Michoacan	2,309,934	0.26	0.04
Morelos	977,755	0.92	0.10
Nayarit	526,660	1.14	0.19
Nuevo Leon	1,174,818	0.77	0.17
Oaxaca	2,637,811	0.23	0.08
Puebla	3,349,337	0.33	0.03
Queretaro	881,601	1.02	0.11
Quintana Roo	600,393	1.17	0.17
San Luis Potosi	1,484,429	0.61	0.07
Sinaloa	1,068,594	1.12	0.09
Sonora	868,430	0.69	0.12
Tabasco	1,472,861	0.61	0.14
Tamaulipas	1,293,441	1.55	0.15
Tlaxcala	786,202	0.89	0.13
Veracruz	4,050,186	0.25	0.12
Yucatan	949,958	0.63	0.21
Zacatecas	868,567	0.69	0.12
Total	53,505,187	0.25	0.04

1. Source: Accredited health units (Secretaría de Salud 2019d), SPS affiliation (Seguro Popular 2017), SPS reports (Sistema de Protección Social en Salud 2017)