Taxes on Medicines
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Taxes on Medicines. Margaret Ewen Coordinator, Global Projects (Pricing) Health Action International (HAI) Amsterdam. Background. High prices are a principal barrier to access to needed medicines

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Taxes on Medicines

Margaret Ewen

Coordinator, Global Projects (Pricing)

Health Action International (HAI)




High prices are a principal barrier to access to needed medicines

Domestic taxes are often the third largest component of the final patient price (after the manufacturers’ price and mark-ups in the supply chain)

Andrew Creese reviewed the role of domestic taxes and how they affect access to medicines


  • Richer countries raise more tax, as a percentage of their gross domestic product, than poorer countries.

  • Tax revenue averaged 36% of gross domestic product for OECD countries. Examples from lower income countries: 8.5% in Bangladesh, 4.2% in Chad, 11% in Indonesia

  • Direct taxes: levied by governments on income of individuals and corporations. Make up about two thirds of total government revenue in high-income countries

  • Indirect taxes: added to the prices of goods and services (VAT, sales tax). Major source of government revenue in low-income countries

  • Direct taxes are progressive - broadly equitable as the better-off pay more than the poor

  • Indirect taxes are regressive - inequitable as the amount paid on a medicine is a percentage of its price and is the same for everyone, rich and poor

Domestic taxes on medicines in high income countries
Domestic taxes on medicines in high income countries

Source: PPRI

  • USA has state-specificsalestaxon medicines rangingfrom 0% to 7%

  • Somehigh-incomecountries do nottax medicines eg. Australia, Japan, Korea

Domestic taxes on medicines in low and middle income countries
Domestic taxes on medicines in low- and middle-income countries

Source: HAI price database

Somecountries 0% VAT/salestaxon medicines eg. Colombia, Ethiopia, Malaysia, Pakistan

Impact of taxes price changes on access to treatment
Impact of taxes/price changes on countriesaccess to treatment


  • Review of studies in US showeda 10% increase in patient prices resulted in a 2-6% drop in medicine use and increased use of services for chronic conditions (such as diabetes)

  • UK study on the effects of prescription charge increases showed a 7.5% fall in the per capita use of medicines in those paying charges while access to medicines in the exempt group rose by 1%

    Low- and middle-income countries:

    Study in severalAfricancountriesoninsecticide-treated bed nets foundthatpurchasesincreasedbyabout 27% whentariffs and taxes fell significantly (from 42% to zero for insecticide and from 40% to 5% for netting material).

Impact of taxes price changes on access to treatment1
Impact of taxes/price changes on access to treatment countries

Kuwait - 4% customs duty on medicines abolished in 2003

Kyrgyzstan – VAT and regional sales tax on medicines abolished in 2004

Pakistan – 12.5% sales tax on medicines was abolished in 2003

Peru - sales tax and VAT were waived for a range of cancer medicines and antiretrovirals in 2001 Peru there was little change in retail prices following the tax removal.

Must consider supporting regulation, for example on retail mark-ups, so patients benefit from the removal of a tax

The case for taxing medicines
The case countriesfortaxing medicines

  • For national treasuries, a tax on medicines offers an often large potential revenue source

  • Raising money on medicines is relatively easy, as record-keeping for prescribed medicines is relatively good

  • Demand is relatively inelastic - at least for some groups of people and some medicines

The case against taxing medicines
The case countriesagainsttaxing medicines

  • Essential medicines reduce pain and suffering and improve quality of life and life expectance

  • Taxing medicines which restore and maintain peoples’ health is a tax on economic potential

  • Taxes add, often substantially, to prices. The higher the price of a medicine, the less of it is consumed, particularly by the poor.

  • To ensure an allocation of health care towards those in need, many national health systems provide essential medicines free to patients, with general taxation or social insurance paying the cost.

Healthier ways of raising public revenue
Healthier ways of raising public revenue countries

Eliminate taxes on essential medicines and recoup the lost revenue by higher taxes on tobacco, alcohol, and unhealthy diet items


5% VAT alone yields just under $ 1 billion annually

Tobacco consumption reduces life expectancy 6 to 10 years and results in 1 million avoidable deaths per year

Excise tax of 38% on tobacco purchases. Doubling tax potentially adds $ 3.1 billion in revenue to government and save 3.4 million lives

Savings would allow a complete waiver of VAT on medicines and a $2 billion increase in government revenue


Reported to be introducing a tax on foods high in fat, sugar and salt

Revenue from “junk food” tax estimated to be $ 1.3 billion

Could be used to eliminate several times over the current 9% VAT on medicines which brings in a mere US$ 200 million on current annual total medicines expenditure of about US$ 2.2 billion. countries/medicineprices