Boston University



Novartis Access EvaluationMedicine Price Data Collection Form - MidlineUse a separate form for each facility/Drug outletData collector: Introduce yourself to the respondentOld facilities"My name is [First name, Last name], from Innovations for Poverty Action (IPA). May I talk to [Name of Participant]? About a year ago, we visited you to collect data on the availability and price of medicines for four chronic diseases (Asthma, breast cancer, diabetes, and cardiovascular diseases - hypertension, dyslipidemia and heart failure). Since then, we might have also called you on phone or visited you a few times in person to collect the same data. As you would remember, this is part of a study being conducted by Boston University in collaboration with IPA. We are mid-way through the study and following up with all of the health facilities/drug outlets we interviewed during baseline (about a year ago) for another round of data collection on the availability and price of medicines in your facility. We would be grateful if you could show us the following medicines in your facility and also answer any additional question we have on them. Thank you so much for giving us this opportunity. This survey will take about 30 minutes. Are you ready to begin now? NO (Not interested in participating)________ (STOP! Thank the participant for their time) NO, not now but later, …….. (Ask him/her to give you a time they can speak to you. Thank the participant for his/her time)YES________ (proceed with interview) Section A: Facility/Drug outlet informationDate : _______________ **Health facility unique survey ID:**County: __________?**Name of health facility:GPS locator **Name of person who provided baseline data (if applicable)Name of person(s) providing midline data if different from name of person who provided baseline data ?Tel. No.1………………?Tel. No. 2………………Type of phone:Smart phoneNot a Smart phoneBothName of data collector(s):**Level of health facilityLevel 5 (Teaching and Referral Hospital )Level 4 (County Referral )Level 3 (Health Centers)Level 2 (Dispensaries)**SectorPublic health facility Private non-profit health facilityPrivate pharmacy or drug store(For private-for-profit drug outlets / chemists) onlyWhich of the following categories of staff work in your drug outlet/chemist (select all that apply)?PharmacistPharmacy Technician NurseShop attendant with no health qualificationOther (Specify)*** To be pre-filled with data from baseline/surveillance (if available)We would be grateful if you could show us the following medicines if you have them in your facility/drug outlet and answer a few questions on each.Section B: Medicines availability and priceGeneric name, dosage form, strengthMedicine TypeAvailable yes/no Brand or product name(s)Manufacturer Pack size recommendedPack size foundPrice of pack found (patient price)Unit patient price (4 decimal places)Amitriptyline 25mg Tablet/Capsule?Originator brand??Tryptizol?Merck Sharp & Dohme (MSD)100??per Tablet/CapsuleLowest-priced generic ???100??per Tablet/CapsuleAmlodipine 10mg Tablet/Capsule??Originator brand?Norvasc?Pfizer90??per Tablet/CapsuleNovartis Access Medicine????SandozOther (specify)90??per Tablet/CapsuleLowest-priced generic ???90??per Tablet/CapsuleAmlodipine 5mg Tablet/Capsule??Originator brand??Norvasc?Pfizer 30??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per Tablet/CapsuleLowest-priced generic ???30??per Tablet/CapsuleAmoxicillin 250mg Dispersible tablet??Originator brand??Amoxil Glaxo Smithkline20??per dispersible tabletNovartis Access Medicine???SandozOther (specify)20??per dispersible tabletLowest-priced generic ???20??per dispersible tabletAmoxicillin 125mg Dispersible tabletOriginator brand??Amoxil Glaxo Smithkline20??per dispersible tabletNovartis Access Medicine???SandozOther (specify)20??per dispersible tabletLowest-priced generic ???20??per dispersible tabletAmoxicillin 250mg Tablet /Capsule?Originator brand??Amoxil Glaxo Smithkline?20??per Tablet/CapsuleLowest-priced generic???20???Amoxicillin 500mg Tablet/Capsule?Originator brand??Amoxil Glaxo Smithkline?21??per Tablet/CapsuleLowest-priced generic ???21??per Tablet/CapsuleAnastrozole 1mg Tablet/Capsule ??Originator brand??Arimidex?AstraZeneca30??per tablet/CapsuleNovartis Access Medicine?? ?SandozOther (specify)30??per tablet/CapsuleLowest-priced generic ???30??per tablet/CapsuleAtenolol 50mg Tablet/Capsule ?Originator brand??Tenormin?AstraZeneca60??per Tablet/CapsuleLowest-priced generic ???60??per Tablet//CapsuleBisoprolol 10mg Tablet/Capsule??Originator brand??ZiakMerck KgaA100??per tablet/CapsuleNovartis Access Medicine??SandozOther (specify)100??per tablet/CapsuleLowest-priced generic ???100??per tablet/CapsuleBisoprolol 2.5mg Tablet/Capsule ??Originator brand??ZiakMerck KgaA30??per tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per tablet/CapsuleLowest-priced generic ???30??per tablet/CapsuleBisoprolol 5mg Tablet/Capsule??Originator brand??Ziak Merck KgaA100??per tablet/CapsuleNovartis Access Medicine?? ?SandozOther (specify)100??per tablet/CapsuleLowest-priced generic ???100??Per tablet/CapsuleCaptopril 25mg Tablet/Capsule ?Originator brand?Capoten Bristol-Myers Squibb60??per Tablet//CapsuleLowest-priced generic ???60??per Tablet//CapsuleCeftriaxone 1 g/vial Injection?Originator brand??RocephinRoche?1??per InjectionLowest-priced generic ???1??per InjectionCiprofloxacin 500mg Tablet/Capsule?Originator brand??Ciproxin/Ciprobay ?Bayer10??per Tablet/CapsuleLowest-priced generic ???10??per Tablet/CapsuleCo-trimoxazole (sulfamethoxazole+ trimethoprim) 8+40mg/ml 8+40mg/ml suspensionOriginator brand??Bactrim/Septrim Roche ?1 bottle 100ml??per bottle of suspensionLowest-priced generic ???1 bottle 100ml??per bottle of suspensionDiazepam 5mg Tablet/Capsule?Originator brand??Valium ?Roche100??per Tablet/CapsuleLowest-priced generic ???100??per Table/Capsule Diclofenac 100mg Tablet/Capsule ?Originator brand??Voltaren/Voltarol/Cataflam ?Novartis 100??per Tablet/CapsuleLowest-priced generic ???100??per Tablet/CapsuleDiclofenac 50mg Tablet/Capsule ?Originator brand??Voltaren/Voltarol/Cataflam ?Novartis 100??per Tablet/CapsuleLowest-priced generic ???100??per Tablet/CapsuleFurosemide 40mg Tablet/Capsule??Originator brand??Lasix?Sanofi-Aventis50??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)50??per Tablet/CapsuleLowest-priced generic ???50??per Tablet/CapsuleGlibenclamide 5mg Tablet/Capsule?Originator brand??Daonil?Sanofi-Aventis60??per Tablet/CapsuleLowest-priced generic ???60??per Tablet/CapsuleGlimeperide 1mg Tablet/Capsule??Originator brand??Amaryl ?Sanofi-Aventis30??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per Tablet/CapsuleLowest-priced generic ???30??per Tablet/CapsuleGlimeperide 2mg Tablet/Capsule??Originator brand???Amaryl?Sanofi-Aventis90??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)90??per Tablet/CapsuleLowest-priced generic ???90??per Tablet/CapsuleGlimeperide 4mg Tablet/Capsule ??Originator brand???Amaryl?Sanofi-Aventis90??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)90??per Tablet/CapsuleLowest-priced generic ???90??per Tablet/CapsuleGlimeperide 5mg Tablet/Capsule Originator brand???Amaryl?Sanofi-Aventis90??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)90??per Tablet/CapsuleLowest-priced generic ???90??per Tablet/CapsuleHydrochlorothiazide 50mg Tablet/Capsule??Originator brand??HydrosaluricMerck Sharp & Dohme (MSD)30??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per Tablet/CapsuleLowest-priced generic ???30??per Tablet/CapsuleHydrochlorothiazide 25mg Tablet/Capsule??Originator brand??HydrosaluricMerck Sharp & Dohme (MSD) ?30??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per Tablet/CapsuleLowest-priced generic ???30??per Tablet/CapsuleLetrozole 2.5mg Tablet/Capsule??Originator brand??Femara?Novartis30??per tablet/CapsuleNovartis Access Medicine???NovartisOther (specify)30??per tablet/CapsuleLowest-priced generic ???30??per tablet/CapsuleMetformin 1000mg Tablet/Capsule??Originator brand??GlucophageMerck KgaA 60??per tablet/CapsuleNovartis Access Medicine??SandozOther (specify)60??per tablet/CapsuleLowest-priced generic ???60??per tablet/CapsuleMetformin 850mg Tablet/CapsuleOriginator brand?GlucophageMerck KgaA60??per tablet/CapsuleNovartis Access Medicine??Sandoz?Other (specify)60??per tablet/CapsuleLowest-priced generic ??60??per tablet/CapsuleMetformin 500mg Tablet/Capsule??Originator brand??GlucophageMerck KgaA60??per tablet/CapsuleNovartis Access Medicine???Sandoz?Other (specify)60??per tablet/CapsuleLowest-priced generic ???60??per tablet/CapsuleOmeprazole 20 mg Tablet/Capsule?Originator brand?Losec??AstraZeneca30??per ablet/CapsuleLowest-priced generic ???30??per Tablet. /CapsuleParacetamol 24mg/ml 24 mg/ml Syrup/Suspension?Originator brand??Panadol?Glaxo Smithkline/ Sterling Winthrop1 bottle 60ml??per SuspensionLowest-priced generic ???1 bottle 60ml??per SuspensionRamipril 10mg Tablet/Capsule??Originator brand??Tritace?Sanofi-Aventis100??per tablet/CapsuleNovartis Access Medicine???Sandoz100??per tablet/CapsuleLowest-priced generic ???100??per tablet/CapsuleRamipril 5mg Tablet/Capsule??Originator brand??Tritace?Sanofi-Aventis20??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)20??per Tablet/CapsuleLowest-priced generic ???20??per Tablet/CapsuleSalbutamol 100mcg/DOS pressurized inhaler??Originator brand??Ventolin Glaxo Smithkline1 inhaler: 200 doses??per pressurized inhalation, suspensionNovartis Access Medicine???SandozOther (specify)1inhaler: 200 doses??per pressurized inhalation, suspensionLowest-priced generic ???1 inhaler: 200 doses??per pressurized inhalation, suspensionSimvastatin 20mg Tablet/Capsule??Originator brand??Zocor?Merck Sharp & Dohme30??per tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per tablet/CapsuleLowest-priced generic ???30??per tablet/CapsuleSimvastatin 40mg Tablet/Capsule??Originator brand??Zocor?AstraZeneca100??per tablet/CapsuleNovartis Access Medicine???SandozOther (specify)100??per tablet/CapsuleLowest-priced generic ???100??per tablet/CapsuleTamoxifen 20mg Tablet/Capsule??Originator brand??Novaldex DAstraZeneca?30??per Tablet/CapsuleNovartis Access Medicine???SandozOther (specify)30??per Tablet/CapsuleLowest-priced generic ???30??per Tablet/CapsuleValsartan 160mg Tablet/Capsule??Originator brand??Diovan?Novartis28??per tablet/CapsuleNovartis Access Medicine???NovartisOther (specify)28??per tablet/CapsuleLowest-priced generic ???28??per tablet/CapsuleValsartan 80mg Tablet/Capsule??Originator brand??Diovan?Novartis28??per tablet/CapsuleNovartis Access Medicine?? ?NovartisOther (specify)28??per tablet/CapsuleLowest-priced generic ???28??per tablet/CapsuleVildagliptin 50mg Tablet/Capsule ??Originator brand??Galvus?Novartis56??per Tablet/CapsuleNovartis Access Medicine?? ?NovartisOther (specify)56??per Tablet/CapsuleLowest-priced generic ???56??per Tablet/CapsuleSECTION CC1. How do you procure medicines at your facility? (select all that apply)Competitive tenderDirect procurementCompetitive negotiationGet medicines for free (donations and free government supplies)Borrows medicines from other facilities My facility also gets rebates back from suppliers My facility gets discounts on purchases madeOther (Please specify)C2. From which supplier(s) did you purchase your medicines from within the last six (6) months? Select all that applyCounty government officeHarley’s Kenya Medical Supplies Authority (KEMSA)Mission for Essential Drugs and Supplies (MEDS)PhillipsSurgipharmOther (Please specify)C3. From which supplier(s) did you purchase the Novartis Access medicines you have in stock (if any)? (Select all that apply)County government officeHarley’s Kenya Medical Supplies Authority (KEMSA)Mission for Essential Drugs and Supplies (MEDS)PhillipsSurgipharmOther (Please specify)C4. In addition to the sale or dispensing of drugs, which of the following services does your facility offer and how much does each cost?Service – Test Available? (Yes/No)Cost per test/service (KES)Blood pressure monitoringBlood glucose monitoring Checking body weightChecking patient’s height C5. If the cost of the services in C4 are bundled, what is the cost for each bundle? ................
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