Disease Management is an intellectual exercise which needs inputs from Social, Economics, Logistics, Clinical expertise, psychology. Medicine plays an important role as they are to be purchased or reimbursed. If the medicines are expensive, where patients have not been covered by Insurance and are purchasing in out of pocket. The poor accessibility, affordability and patient compliance are the outcome due to medicine s. Especially in Chronic conditions, when patients are buying medicines out of pocket when they are having meager income. In this article, we discussed how the medicines impact the disease management.

INTRODUCTION

Medicines play a vital role in patient compliance and adherence to treatment especially in developing and non-develop economize. The price of the medicine is the cause of concern for various stack holders apart from patient and health consumers [1]. The regulation of the s has become vital even in develop the economics like USA, Canada and Australia each country have their own rules and regulation to have a control over some of medicine. Looking their advancement in technologies the affordable medicines should not be impossible task however geopolitical conditions and pharmaceutical industries make the situation worst leading to high of medicines for patients along with stake holder like insurance providers, government and other intermediate stake older comparing the medicines are similar in lines of consumers goods like foods items as simply complicated the issues the major differences between the food items and medicine. Markets work well in the interest of the society when there is price competition, comprehensive, accurate, unbiased medicine information and on adequate supply of drugs, where consumers are able to make informed unpressured choices between competing products and when there are few barriers for entry to the market [2]. Food items are not regulatory astringent lost because food items form safe and consume to anybody of any amount. Medicines are to be used under the recommendation of prescribers and may pose serious health issues if and health used in irrational manner it is to understand every medicine has its own protocol for storage, uses and comes with date of expiry, these conditions make medicine special products to be stored and dispense to the patients and health consumers against the prescription by the registered medical practitioners. The pharmacist is being designated as the custodians of medicines, in this back draw the role of pharmaceuticals industries, pharmaceutical sales professional, distributers, doctors, pharmacist, patient and health consumers form the basic supply chain. The medicines being sensitive to environmental factors need to be preserved under suitable conditions which also add to be cost of the medicines [3]. The complex nature of pricing of medicines as lead to blurring of the showoff pricing the medicine manufactures claimed that they are not charging heavily the patient and heath consumers and it is always a balancing act foreign industries between profit and loss they also enjoyed trust and goodwill of the public and other stack holders that their services to humanity is very noble like that of doctors and many a time their mistake are simply ignored and over looked [4]. In reality, pharmaceutical industries have an immersed profitable industries and evergreen industries. The medicine price discrimination plays role in increment of medicine prices, for example the price discrimination by health practitioners by scaling fees to the income of patients [5]. The pharma industry is in famous for following double standard and is showing a false image to the public but practicing unethical marketing leading to corruption of in the field of medicine. This differs from most other countries, where drug prices are regulated either directly through price control (e.g. France and Italy) or indirectly  through  limits  on  reimbursement  under  social insurance schemes (e.g. Germany and Japan) or indirectly through profit controls, e.g. United Kingdom [6]. Careful selection of a limited range of essential medicines results in a good quality of care, better management of medicines and more cost-effective use of health resources [7]. Medicine Prices Availability and Affordability measures patient affordability by estimating the number of daily wages – using the salary of the lowest-paid unskilled government worker – required to purchase a course of treatment. Such measurements provide a precise snapshot of a medicine’s affordability in any given context, helping to quantify the impoverishing effect of purchasing medicines [8,9].

In India health insurance ease in preliminary stage the patient and the health consumers are purchasing medicines by out of the pocket expenses although the government of India has made an initiative like Jan Aushadhi Kendra where the medicine and related disease management and diagnostic are made available at 50% s compare to branded medicines are available in the open market. However, the effort of government of India closed to be very marginal in the total market very few people are able to make use of Jan Aushadhi Medicine. Government of India has also brought several rules and regulations to check the s of the medicines throughout post independent era. The first of its kinds ease drug price control order of India and several amendments further government of India also form the body called as drug price control orders and BPPI [10].

CONCLUSION

It is very much evident that pricing of medicines involves various steps and considerations which need to be included in the finals of medicines for examples the medicines should have consideration of pricing of active pharmaceutical ingredients, pharmaceutical cost industrial overhead marketing cost which include margin on sells for C&F agents, distributers and retail sells. If the API is under patent should also include the royalty expenses for the patent holders. In over all the entrepreneurs who take the responsibility of manufacturing and providing medicines should and up with sustainable profit for this the government have made a suitable framework and given enough space of operation for pharmaceutical. Despite of the provision the industries is behaving in a greedy manner leading to escalating the medicine s it is also mandatory to have control and check over the industries by monitoring their ethical marketing practices and identifying the wrong practices prosecuting the offenders which can ensures the pricing the control of medicine in a sustainable manner. 

1.       (2007) Essential drugs for hospitals under government of NCT of Delhi. EML for Hospitals.

2.       Bigdeli M, Peters DH, Wagner AK (2014) Medicines in health systems: Advancing access, affordability and appropriate use. World Health Organization.

3.       Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R (2009) Medicines, availability and affordability in 36 developing and middle-income countries: A secondary analysis. Lancet 373: 240-249.

4.       Jain NK (2015) Pharmaceutical jurisprudence. Vallabh Prakashan, 4^th revised (Edn.). Drug Control, pp: 107-122.

5.       (1995) Drugs (Control) Order.

6.       http://www.indianmedicine.nic.in/writereaddata/mainlinkFile/File222.pdf

7.       The M/o Health and Family Welfare and Ministry of AYUSH also govern various aspects relating to pharmaceutical companies.

8.       http://nrhm.gov.in/images/pdf/in-focus/Shimla/Guidelines/Free_Drugs_Service_Intitiative.pdf

9.       (2018) Bureau of Pharma PSUs of India (BPPI) (Under Department of Pharmaceuticals, Govt of India).

10.    http://nrhm.gov.in/images/pdf/in-focus/Shimla/Guidelines/Free_Drugs_Service_Intitiative.pdf