Essential and orphan drugs in Panama: perception of competition and implications of pricing policy

We measured the perception of competition in the market for essential and orphan drugs. The inflation rate for original products was 0.002 annually, whereas that for generic drugs was 0.005. The province of Panama, containing 46.5 % of private pharmacies, has the lowest index in the perception of competition; 18 % of the respondents to the out-of-pocket expenditure survey did not have drugs available, and 55 % could not afford them. The Gini coefficients were 0.40 (2014) and 0.76 (2017). The increase in prices, the relative independence of retailers to establish prices, and low access to social/private insurance increase the out-of-pocket expenses.