The pharmaceutical market of the America

The pharmaceutical market of the America : 작성자, 카테고리, 작성일, 조회수, 원문,출처, 정보 제공
작성자	임이슬	카테고리	전문가 인사이트
작성일	2017-08-29	조회수	3,945
원문
출처

글 Esteban Ortiz-Prado: GPKOL위원

세부 전문분야 및 컨설팅 내용

OneResearch Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador; Department of Medicine and Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, NY, USA, Global Pharma Key Opinion Leader) position at the KHIDI (Korea Health Industry Development Institute).

ABSTRACT

The international pharmaceutical market is in constant development and growth. In the last 30 years, the drug market has increased significantly worldwide. This dynamic responds to greater access to medications and greater development of new products. Mostly of this increment depends on emerging economies such as those located in Asia or South America. According to some recent data, the size of the pharmaceutical market worldwide exceeds USD 2.5 trillion, an extremely higher figure than the 179 million reported in the early 1970s. The world’s economic and political context directly influences the dynamics of pharmaceutical activity, considering that the drug industry is one of the five most profitable industries on the planet. Understanding the relationship between pharmaceutical production, commercialization, consumption, regulation and drug development its mandatory in order to determine investment feasibility. In this sense, this manuscript tries to summarize the dynamic of the pharmaceutical market within the countries of the American continent, from the United Stated in the north to Argentina in the far south pole. Keywords: pharmaceutical market, generics, social investment, drugs, America, Latin America, Caribbean

INTRODUCTION

The pharmaceutical market is a complex sector that involves diverse actors, from the process of investigation, development and production of pharmaceuticals, to its consumptions. According to data from the World Health Organization, while 14% of the population consumes 80% of the pharmaceutical production, the 86% consumes the remaining 20% (WHO, 2000) This demonstrates a breach of one third of the world’s population that has no access to essential drugs causing public health problems, specially in developing countries. Access to drugs is an indicator commonly used to measure the standard of living of a country due to its social and economic impact, as well as a good indicator for the expenses destined to the health sector. Such inequality is repeated on a global level with marked differences between countries, many of which have taken measures to exercise active participation and regulation by the state in order to obtain a more proper distribution for the population generating substantial savings for the countries’ arcs (Association & others, 2016). The pharmaceutical industry, regardless of the country, is the most important in the economic, administrative and health field. Not only can generate GDP growth rates, but if it is well managed, it can generate good health care administration and a variety of new treatments. At the level of the American continent, the region is divided into countries that have a strong pharmaceutical industry in which the rate of imports of these products and local manufacturing is balanced and other countries such as Ecuador, where local production Reaches levels of concern in terms of the size of the local market and exports (Figure 1).

Figure 1 Percentage of local production (blue) versus exportations (orange) among countries, Source BAIN, 2014

The objective of this present review is to analyze the pharmaceutical market in the region, the tendency of its commercialization with or without medical prescription, the population preferences surrounding the use of brand drugs versus generic ones, the demand from the State, as well as its strategic role referring to the economic future of the country.

PHARMACEUTICAL MARKET IN THE REGION

Pharmaceutical market in north America
The pharmaceutical industry per se has always been one of the main sources of income among producing countries. North America has spearheaded this list of countries for a long time, with the advantage of technology, knowledge and in-process studies has come to be positioned as one of the top industries(Arora & Gambardella, 2010).

Pharmaceutical industry in United States of America
Nowadays, the United States health system is considered one of the most effective health systems in the world and this is reflected in the attempt to reproduce this system by other countries. The health system of the United States is formed by two subsystems that are Medicare and Medicaid. These two types of insurance, previously mentioned, are those that the state grants to the population, as well as private insurance or private health care. The Health Systems in the United States permit the patients to access pharmaceutical products through one of these systems or the pay for medical services through private insurances(Starfield, 2000).

Market Size
The US pharma market represents 30% of the world pharmaceutical market, which generates a profit that exceeds the 430 billion USD annually. Most of this money came from recently patented drugs, imported generic products and expensive medication such as oncologic and biosimilar products. According to a study by the NACDS in the United States in 2003, the number of prescriptions for that year was 3.22 billion dollars. According to this same study, it has been determined that the pharmaceutical market has had a great increase since 2001(Berndt & Newhouse, 2010).
The United States leads the lists of the top ten world pharmaceutical companies due to the number of patented and commercialized products.
The US pharmaceutical’s consumption represents more than 14.1% of the country's GDP, the third most important economic sector by volume. Historically this sector has been one of the fastest growing in the USA. It is worth noting the between 1998 and 2002, the US market experimented an average growth of 40% and although the speed of growing has decreased significantly, the US market moves billions of dollars annually(Association & others, 2016).
Approximately US $ 38.3 billion is the annual sales volume of pharmaceuticals in the United States, these values refer to national production and consumption. In the last year, the sales volume of medicines reached 900 billions of USD for 2015, which was an increase of 9.5% in relationship with previous years(Aitken, Kleinrock, Lyle, Nass, & Caskey, 2015).
Interestingly, the US is one of the bigger generic drug consumer in the world. According to recently published data, more than 3.8 billions USD from the overall 4, 3 billion USD are attributed to generic drugs. That means that most of the prescriptions drugs are generics, representing more than 8 out of 10 prescriptions or 88% of patients are receiving generic drugs(Association & others, 2016; CGPA, 2016). Generic drugs in fact are very important because of the savings they represent, in 2014 this was evidenced with a savings of 254 billion dollars in savings from the health system(Aitken et al., 2015).

Pharmaceutical industry in Canada
With annual growth of 8%, Canada is the fourth fastest growing market in the world compared to the pharmaceutical industry. The industry benefits from Canada's booming biotech industry, which also favors the growth of pharmaceutical companies(ICEX, 2014).
The pharmaceutical market in Canada handles billions of dollars per year, including imports and exports. Big generic pharmaceutical producers such as Apotex have put Canada among the countries with better pharmaceutical development worldwide. The Canadian pharmaceutical market, another very important source of drugs, medicines, vaccines and generic products for the world, is one of the most important partner with the biggest consumer of pharmaceutical products, the US health system. The numbers demonstrate that for 2015, the Canadian market reached more than 34 billions of USD(ICEX, 2014).

Market Size
The Canadian pharma market from 2000-2010 experimented a significant increment, doubling up the size of the market up to 23 billion dollars. Canada has hundreds of pharmaceutical companies, either producers, developers or importers.
In this case the two companies that are on top, are the main in both areas, Pfizer and Apotex are the companies with more incomes in the country. On one hand, Pfizer is a company that produces branded drugs, instead Apotex is one of the major generic producers.
In Canada, the consumption of Generic corresponds to more than 34% of branded products versus 66% of generic drugs. Although this figure is not completely accurate, the Canadian Chamber of Commerce (CAPDM Driving / Healthcare) corroborates this distribution(Industry Canada, 2013).
Canada, a well-developed country with an extensive pharmaceutical industry exports more than a half of their products. In the period from 2001 to 2015 there was an increment of 345% of exportations and a140% of importations(Industry Canada, 2013).

Table 1 Producing and commercial companies in Canada, Source IMS 2014
Company	Total sales (million)	Market share (%)
Pfizer	2940	13,4
Apotex	1550	7
AzatraZeneca	1440	6,6
Schering-Plough	1330	6
Johnson&Johnson	1160	5,3
Novopharm	920	4,2
Novartis	890	4
GlaxoSmithKline	880	4
Abbott	850	3,9
Roche	680	3,1

Pharmaceutical market of Mexico
At the level of Latin America, Mexico is a country that has been characterized by having one of the largest and better developed industries among Latin-American countries. The Mexican market has an important participation of the public system as one of the main source or consumption in Mexico. The pharmaceutical market in Mexico was estimated to grow in 4.4% between 2011 and 2015 according to data published by Deloitte (Molina-Salazar, González-Marín, & Carbajal-de Nova, 2008; Torres Guerra & Gutiérrez, 2009).
Although in Mexico the North American Free Trade Agreement (NAFTA agreement) reduced local production and increased exportations, the local producers have great participation in has a great development in the production of high technology drugs such as antibiotics, anti-inflammatories, cancer treatments and medical equipment(Guerrero Castro & Gutiérrez Rodríguez, 2011)

Market size
In the continent, Mexico is the fourth most important market after the US, Canada and Brazil. In 2014 the medication and drug consumption surpasses 17 Billion USD. On average, the pharmaceutical industry in Mexico represents more than the 3% of the national GDP(Du Tilly & Consultores, 2016).
In Mexico, there has been great competition in the manufacture of drugs that are generic and so-called OTC or commonly known as the main products of self-medication. As well as gradually growing said problem, it is encouraged another little by little and this refers to patenting medicines and growing quickly the sales of that medicines. But the generic medicines generated in Mexico by laboratories under strict rules or strictly necessary safety standards do not present greater difference compared to the rest of the world which are essential to combat major pathologies. The only notable difference can be the mode of presentation of these medicines, also recognized by economic prices and accessible to the population(Gómez-Dantés, Garrido-Latorre, Tirado-Gómez, Ramírez, & Macías, 2001; Leyva, Erviti, Kageyama, & Arredondo, 1998).
To increase sales of generic drugs, many laboratories are focusing directly on patients through messages that are transmitted by television or radio, causing an interesting dynamic when Mexican buys medicines.

Relationship between generic and brand drugs
Currently, the Mexican pharmaceutical industry is facing a government action to control the price of medicines, this generates a constant competition between the industries of generic medicines and those of branded drugs. Despite these actions, generics remain at the top of national revenues given the volume of sales in self-medication products (KPMG, 2010).

pharmaceutical market in central America

Pharmaceutical industry and market in Guatemala
In Guatemala, the pharmaceutical market represents more than 400 Millions $ USD for 2010(Flood, Mathieu, Chary, García, & Rohloff, 2017). The consumption of drugs by the private sector is the majority, reaching 70% versus 30% of the public sector. This market is supplied by more than 70 producing laboratories, the same ones that have a distribution of the production that or marketers of final products.
Regarding drug consumption, data from the Inter-American Development Bank (BID) show that in Guatemala the consumption of brand-name drugs reaches 46.5% versus brand-generic drugs, which reach 48.0%, leaving a very modest 5.5% for purely generic drugs(BID, 2011).

Market size
The pharmaceutical market in Guatemala has recovered since 2001 and was sustained mainly by the regional attention of recurrent pathologies and by the weight and importance that large global laboratories of products produced in the region. In Guatemala, the Total Annual Health Expenditure in 2010 was 1,214.9 million dollars and the Annual Total spent in Health represented more than 2.95% of GDP, averaging 82.57 dollars per capita.
The Guatemalan Ministry of Health allocates about 45% of these resources for importations of pharmaceutical products, most of them medicines. Drug programs in prevention and in recent years with outbreaks of zika, chikunkunya and dengue, public health programs have prioritized resources in the prevention or reduction of these endemic diseases in the region.
In Guatemala more than 75 pharmaceutical laboratories are entitled to produce medicines to meet the national demand, however, only 4 of these 75 laboratories guarantee the quality of the product to be offered and distributed due to the fact that those 4 are the with BPM’s. The rest of products to be sold in Guatemala depends on the other percentage produced by the local industry which makes most solid generics drugs and still does not fulfil the local demand leaving the people in vulnerable situation due to the fact that thousands of products enter the country through illegal activities from its borders(ProChile, 2011).

Pharmaceutical industry in Panama
In Panama, a country with the US Dollar as a currency, the size of the market for 2010 reached more than 186,561,494 $US dollars. In the following years, Panama increased the size of the pharmaceutical industry in general, reaching more than 307 million dollars annually by the year 2014.
The health system in Panama, a country with more than 4 million inhabitants, the public system covers 35% of the population, the social security 65% and the other 20% have no access to health care(Conte, Gómez, & Barahona, 2015; Lee, 1991).

Market size
The pharmaceutical market in Panama reached more than 185 million $US dollars a relatively small amount if you consider that Panama is also a very good importer of pharmaceutical products within the region. In the last decade or so, Panama increased the size of consumption of pharmaceutical products, increasing its in more than 300 million since year 2014.
The key to analyzing this sector is the enormous difficulties involved in the marketing of the product. The sanitary registration of a product takes up to 6 months and the costs resulting from it become so high that, paradoxically in a country where 95% of the drugs are imported and 80% of the total expenditure comes from the Social Security Fund, Entry to the market becomes only accessible to large laboratories(BID, 2011).
In Panama, a country with high degree on international investment, more than 300 international pharmaceutical companies handle more than 95% of the local consumption. The Regulatory Agency in Panama declared that more than 5000 products with more than 9000 presentations create the local market.

Pharmaceutical market in Honduras
In Honduras, a small country with a little more than 8 million inhabitants, the pharmaceutical market is one of the smallest in the region. The pharmaceutical sector in Honduras reached an apparent size of US $ 350 million per year in 2011 however as in other parts of the region information is scarce (Pro Exports, 2014).
Honduras as the majority of central American countries import more than 80% of their products, especially those produced by international companies based in Central America, Panama or Mexico(Pro Exports, 2014).

Market size
The pharmaceutical market in Honduras behaves in similar way as the other countries in the region. the pharmaceutical industry and the pharma market represented more than 152 million US$ for the year 2009, although data its scarce information from un scientific sources demonstrates that the market experienced a very important expansion of more than 300% in the last 10 - 15 years, condition attributed to the fact that more international investment was received by the country, positive injection of capital which permitted that new local pharmaceutical companies take off(Acuña et al., 2014; Ravinetto & Villa, 2006).

Relationship between generic and brand drugs
The access to medicines as well as the right to obtaining good quality generic products in Central America including Honduras have the same dynamic. The international companies have created a very poor reputation about the generic drugs, causing that most of the prescriptions and medicines are commercialized as “brand generics” with no added value and higher price than regular generics. This relationship has shifted the equilibrium in more than 90% versus the generics, accounting the “brand generics” for more than 54% of the total sales, followed by 39% of original brand names and just a very small percentage is left behind for true generics, either locally produced or imported.

Pharmaceutical market in El Salvador
El Salvador a country with a little more than 6 million people behaves similarly to neighboring countries like Honduras or Guatemala. In El Salvador, for 2010, the State invested more than $ 1.45 billion US in Health, exceeding 6.9% of GDP for that year and over $ 238 per capita(MSP de El Salvador, 2011).
The local industry is confirmed by 52 local pharmaceutical companies and two large multinationals, all of which dedicate all their efforts to supply the private health network and self-demand more than the public health system in El Salvador.

Market size
The pharmaceutical market in El Salvador its small due to economic situation and the fact that they also use US dollars as the local currency. The last available data demonstrates that El Salvador has a market of about(Tobar, Drake, & Martich, 2012).

Relationship between generic and brand drugs
The consumption of drugs, as in other countries in the region, is mainly due to the private system, accounting for 64% of the total market versus 36% of the public sector(MSP de El Salvador, 2011). In terms of drug demand, the consumption of branded drugs and "branded" generic products is the rule, leaving a very small percentage for the use of true generics, representing this amount less than 8% leaving more than 90% of the market for branded generics and brand name products(BID, 2011; MSP de El Salvador, 2011).

Pharmaceutical market in Cuba
The information about the pharmaceutical market in Cuba is not totally clear neither available due to political reasons, however in this section we are going to explore the data that is available regarding health access and the drug market in the island of Cuba.
According to data coming from the national pharmaceutical bureau, Biocubafarma and collected during 2008 to 2013, the Cuban pharmaceutical industry generated more than 2.7 billion dollars in pharmaceutical products, a very interesting amount considering that Cuban exports their products to many countries not only in the region but in the world (Armayor, Lantigua, Alen, & Batista, 2013).
Cuba has created one of the strongest pharmaceutical industry in the region, especially regarding the creation of new products with high added value like biosimilar products and vaccines(Fernández-Montequín et al., 2009; Herrera, 2004). The international blockage of all the trade imposed by the United Stated of America makes importing drugs a difficult process for Cubans, they have to carry out a number of special procedures or regimes to be able to sell to the island, thus, brand name drugs are very hard to find and their presence is almost null (Torres Domínguez, 2010).
One of the priorities of the Cuban regime is to supply its population with the necessary medicines by promoting their own production or acquisition with countries friendly to the Cuban government and not following the blocking policies of the United States. It is because of these circumstances that generic drugs are either produced or imported(Fors López & Peña Amador, 2001).

Market size
The Cuban pharmaceutical market its estimated to be somewhere around 2 billion US$ including exportations and importations. In the last decade, Cuba has experienced significant political changes, expanding their capabilities to export drugs and enhance their pharmaceutical production(García Milián et al., 2009).

Relationship between generic and brand drugs
The consumption of drugs, in Cuba depends from the government. The public health system is one of the most efficient in the world, giving a lot of effort to prevent diseases rather than having super specialized physicians. It is estimated that more than 90% of the products are generics and most of them are locally produced.

Pharmaceutical market Suriname
The Republic of Suriname, a small country located in the Atlantic Ocean of South America with an estimated population of 542.975 habitants has a pharmaceutical market that is very small in relationship with other countries. As this country import pretty much everything including medicines, the pharmaceutical market is driven by the private investment. The total market represents less than 20 Million US dollars a year(Thorndike, 1988; WHO, 2010).

Market size
In Suriname, data about the pharmaceutical market reach a total annual expenditure on health services including drug access and medications to about US$ 221.3 million for the year 2006(WHO, 2010). For this Caribbean country, the expenditure un health went to more than 7.73 % of the GDP for the same year.
The country imports 90% of the drugs and they produce the remaining 10%. All medicines must be approved by a Government Committee on Drug Registration and the Pharmaceutical Inspection Body is responsible for supervising the inspection of the manufacture of medicines and pharmacies. In Suriname, there are three pharmaceutical companies authorized to manufacture drugs and 26 companies authorized to import them.

Relationship between generic and brand drugs
According to the data provided by the Ministry of Health of Suriname, in the country are consumed more quantity of generic drugs than the brand ones, approximately 68% to 70% of drugs consumed are generic and 32% to 35% are brand name.

Pharmaceutical market French Guiana
French Guiana is a country that depends entirely on France and therefore the import and export of medicines or drugs is done mostly with the European continent as the Asian and American continent.

Market size
Annually, French Guiana spends about US $ 268,499 US$ on drug imports while it exports mainly to countries like Costa Rica and South Africa earning a sum of USD $ 11,402 USD.
The population consume consists on an 80% of branded drugs and 20% of generic medicines, the main exporting countries that supply medicines to French Guiana are the pharmaceutical houses of France and the United States. Local production is very scarce, and for this reason the country is forced to import the main medicines for the population's demand.
French Guiana is considered an underdeveloped country, so the pharmaceutical market is not a strong point in the country's economy(Sillero-Arenas, 2005).

pharmaceutical market in south America

Pharmaceutical industry in Venezuela
Like all Latin American countries Venezuela has a public and private pharmaceutical market, which depend on the demand generated by patients and private health care centers. Currently, more than USD 6.3 trillion is invested in public health in that country, exceeding the threshold of 7% in relation to GDP. Although the current situation in Venezuela is not the best, historically Venezuelans have had problems with the production of medical supplies(BMI research, 2016; Fraser & Willer, 2016).

Market size
In a 2016 study conducted by BMI found that a total of 88.7 billion of EBV or 3.0 billion US dollars was spent on drugs in 2015, however for 2016 it was found that more was spent on the country's currency 259.6 billion VEB this means a 192.6% more but due to the constant devaluation of the currency was spent less a total of 950 million US dollars or 68.6% less than what was spent the previous year(BMI research, 2016).
Imports of medicines have fallen 62% between 2014 and 2015 and even 6% more in 2016 these figures will continue to rise if the economy continues with this crisis. Generic medicines in the country are approximately 30% of the total of drugs consumed (950 million USD) while 665 million dollars are destined for foreign or non-generic medicines.

pharmaceutical market in Uruguay
Uruguay, one of the most developed countries in South America and is one of the biggest consumer per capita. It is observed that the national industry has been built within the framework of a strong dependence on both its production and the destination of the products.

Market size
In 2010, Uruguay spent more than US $ 331 million US dollars in drugs, an increase of 23% over 2009 sales (US $ 273 million), explained by the 5% growth in units sold and 17 % Due to the increase in prices in dollars. In the period 2004-2010, sales increased by 80% in current dollars(Brunini, 2011; Constenla, 2008). Within the pharmaceutical laboratories for human products, mostly are international corporations, manufacturing patented products on a regional scale, commercializing generic and branded products.

Relationship between generic and brand drugs
Data from the Minister of Public Health of Uruguay establish that in the local market 89% of the units are generic and only 11% corresponds to patent products, However, in value the ratio of this dynamic is 70/30%, respectively(Brunini, 2011).
In Uruguay there are currently about 83 laboratories covering both domestic demand and pharmaceutical exports. These laboratories are grouped under two associations. On the one hand, there is the Association of National Laboratories (A.L.N), which represents the national and binational laboratories and the Chamber of Pharmaceutical and Allied Specialties (C.E.F.A), in which the multinationals are associated (Deloitte, 2010).

Pharmaceutical industry in Brazil
The pharmaceutical market in Brazil is the eighth largest in the world, and is growing at a faster rate than many of the markets in developed countries. Between 2005 and 2013 there were double-digit growth rates, and market value tripled. The pharmaceutical industry in Brazil has shown significant progress, benefiting mainly from the growth of health care expenditures as a whole, and in particular by the increase in revenues(Areda, Bonizio, & Freitas, 2011; Pharma Intelligence, 2016).

Market size
Brazil is one of the countries on South America with more information available about the pharmaceutical market. Some reports from 2007 to 2011, sales of retail drugs increased 82.2%, from $ 23.6 billion to 43 million. According to a study by Scrip Insights, out of total pharmaceutical sales of $ 25.8 billion in 2011, $ 18.3 billion represented prescription drugs and $ 7.5 billion were OTC medication. In the group of prescription drugs, 25.2% of the prescriptions were generic products, an increase of 42.5% over the previous year. Similar drugs reached 18.3% of the total prescriptions, which meant an increase of 33.8%. Despite leading the prescription market with 40.8% of sales, branded drugs showed a lower growth rate, 7.6% in 2011, compared to the previous year. Nearly 80% of drug costs are for low-cost products, a phenomenon related to the low purchasing power of the local population compared to developed markets(Flax, 2016; Giaccaglia, 2010; Pharma Intelligence, 2016).
Since the beginning of the 1990s, Brazil has implemented measures that have resulted in its growth in the production of medicines, which has been reflected in its economic growth, and is currently one of the main sources of national income. In addition, Brazil leads the list of drug producing countries and is also one of the main exporters. Its main production covers the drugs used in tropical diseases.
On the other hand, the production of medicines was consolidated a few years ago and goes through a relative phase of prosperity, which makes it less white important policy on the part of the government. Meanwhile, there are some difficulties to be faced, such as the control of market power, internalize the support of drug production and the increase in the supply of these inputs, which would attenuate the problem of imports of more expensive finished drugs, to collect foreign companies, as soon as they rise in the internal ranking of their corporations, greater participation in investments in R & D(Areda et al., 2011; Pharma Intelligence, 2016; Sillero-Arenas, 2005).

Pharmaceutical Market in Peru.
The economy in Peru has shown that it has been strengthened in many sectors, especially in the health sector. According to data, in 2009 the total annual expenditure on health was approximately 5.856 million US dollars. In addition, the general annual public expenditure on health in 2009 was approximately 3,431.2 million US dollars(The World Bank, 2014). The Peruvian government is responsible for health expenditures, where the annual public health expenditure is 58.6% of the government's budget. It should be noted that the private sector covers the remaining 41.4% of total health expenditure.

Market size
For 2009, total pharmaceutical expenditure was approximately 1,250 million dollars, which gives a per capita pharmaceutical cost of 41.97 US dollars(Oscanoa, 2012).

Relationship between generic and brand drugs
The share of branded and unbranded generic drugs is 26.47% and 46.75%, respectively(Crisante, 2013). In Peru 64% of the pharmaceutical supply is given through pharmacy chains, which is why large chains tend to develop strategic alliances with laboratories or distributors that maintain the flow of movement of pharmacological products(Calderón, 2010).
The main barriers of entry that cross the pharmaceutical industry are the local patents. Since 2004, there has been an increase in local production that has remained at present, however, it still remains below the production index. Until the year 2010 this situation generated an inclination of the consumer sector towards branded drugs (Calderón, 2010).

Pharmaceutical market in Paraguay
Paraguay, a country from South with a population of 6’755.756 inhabitants; has a health system that is divided in three providers: The public health sector, The social Security Service and the private sector. The pharmaceutical sector is in progressive growth and in 2015 it was positive in both the foreign and domestic markets.

Market size
The information about the pharmaceutical market in Paraguay is Scarce. Some reports suggest that exports during 2015 reached an amount that was superior to US $ 50 million, reaching a total market of about 1000 millions of USD in 2015.
The pharmaceutical industry in Paraguay, according to the results of the CEN in 2011, represents 0.3% of the growing industry, with a total of 64 economic units in the country. Generating a total of 1.8% of total national income(Embajada de España, 2008; Gimenez, 2012).

Relationship between generic and brand drugs
The market in Paraguay was reported in According Edgar Giménez 2014, 64% of global drug turnover corresponds to branded products; 27% to generic products and 9% to others (Embajada de España, 2008; Gimenez, 2012).

Pharmaceutical market in Argentina
The pharmaceutical industry is one of the most developed in South America, moving millions of US dollars a year. The structure of the national production and industry in particular, shows that the sector of the pharmaceutical production represents the 6% of the product in the industry and about 1% of the gross domestic product.
In Argentina near the 60% of the active laboratories are national capitals, while the remaining 40% are of foreign capital. Also dominate the non-innovative laboratories it is to say those who commercialize products of generic or similar type and do not dedicate resources to the research and development or there are dedicated to copying formulae of already defeated patents or to producing medicines from the acquisition of licenses.

Market size
In the year 2013 the turnover of the pharmaceutical market rose to 2 Billion USD, in 2016. In that year the pharmaceutical industry increased 44.7% in the first quarter of the year. This sector is one of those that is growing every year in the world The pharmaceutical industry includes the manufacture of drugs and active ingredients.
With regard to imports, it represents 23.2% of sales to the domestic market. The remaining 76.8% were products local manufactured, of which, the domestic market is supplied mainly with own production. It is also important to note that between 2007 and 2012, the percentage of resale of imported (on the full amount billed) has remained between 23% and 28%, after a period of substantial increases experienced during nearly the whole decade of the 1990s (Abrutzky, Bramuglia, & Godio, 2015)

Pharmaceutical industry in Colombia
Colombia is a Latin American country, located in South America. It has a general population of 47.12 million people. This is a country that has developed in all commercial fields, one of those is the pharmaceutical industry. The pharmaceutical market has a production of 4,480 billion dollars. In terms of business density, it has grown by 0.16% in the last decade.
The main source of growth has been of internal origin, mainly recovery of private investment. Likewise, the greatest dynamism in the consumption. The majority of the sectors presented growths above of what was foreseen last year, highlighting the mining, construction, financial sector, transportation, manufacturing and retail.in terms of prices, a trend has reduced of the CPI, closing last year at 6.49%, still above expectations initials (6%).
The Colombian market is divided in two parts; in a commercial market and an institutional market, both are equally necessary, however, the capital budget from which they come is different from commercial ones, it is made from sources outside the health system, While the institutional ones are made with own capital of the Health System, in both plays an important role the supply and the demand what makes that there are variations of prices between them(Guerrero, Gallego, Becerril-Montekio, & Vásquez, 2011).

Market size
In 2016 The national industry showed a change of trend and returned to register positive growth in the month of March, according to the last figures revealed by the National Administrative Department of Statistics(Bustamante & de Investigaciones Económicas, 2007).
After the decline in February, industrial production grew by almost 5% in March 2017 compared to the same month in 2016. Industrial sales also had a positive month of growth of more than 3%.
This behavior was due to several segments, including the subsector of the manufacture of pharmaceutical products and medicinal chemical substances. Sales and production in this segment grew above the industry average: 11% and 6.5%, respectively.

Pharmaceutical Market in Bolivia
Bolivia is one multi-cultural country located in south America. In Bolivia, public expenditure on drugs is US $ 41.21 million and total pharmaceutical expenditure is US $ 169.6 million, while private spending on drugs amounts to US $ 128.8 million, compared to a total health expenditure of US $ 728.23 Millions of US $, means that 41% of total health spending is spent on medicines(Gobierno de Bolivia, 2013).
In local production, Bolivia has 24 pharmaceutical manufacturers, supplying 80% of the country’s demand, the remaining 20% of medicines are imported, mostly for a lack of high technology not available in Bolivians manufacturers; oncological and retroviral drugs are an example of this group of drugs, because they have a complex composition(Gobierno de Bolivia, 2013).
Imports are influenced by the geographical proximity, Argentina and Chile are the main suppliers, followed by China and India due to the low cost.

Pharmaceutical Market in Ecuador.
Ecuador is relatively small country located in South America this country has a population of about 16 million people. The pharmaceutical market depends mainly in the private sector representing more than 70% of the total amount to spend in medication because her and market is bigger than all their markets in the region when we compare the per capita consumption(Ortiz-Prado, Galarza-Maldonado, Cornejo, L, & Ponce, 2014). In 2015 the market reached something around US$1.5 billion USD. In this small country as the majority of countries in South America most of the products are imported representing more than 70% of the total spent. In Ecuador generic drugs reach just the 10% when comparing to the 90% of Branded and Branded generic drugs. For the past 5 years, generic medicines in Ecuador have had a better reception by consumers, thanks to the low cost and campaigns aimed at educating people about the consumption of generic drugs, That is, to demonstrate to the population that the same results are obtained in the treatments. These campaigns by the Ministry of Health seek to give a better place to the national pharmaceutical industry(Durán, Lucio, & Rovira, 2017).
National pharmaceutical production is characterized by the use of generic drugs, most of the raw material required for these processes is imported from countries such as China and India, since Ecuador does not have pharmacological synthesis laboratories. In Ecuador, as well as in most Latin American countries, the main companies of the pharmaceutical industry with those large multinationals that satisfy the demand of the national population.

Pharmaceutical Market in Chile
Chile is one of the most advanced countries in South America. The health system works very well of the population had a very good access to it. The pharma market in Chile is very interesting they do have a very strong industry either as a producer or importer.
The pharmaceutical industry in Chile has undergone significant changes in the structure of the supply, the characteristics of the demand and the regulation that regulates the sector, all of which has generated transfers of power between the different players in the sector(Vasallo, 2010).
The drug market is regulated by the Institute of Public Health (ISP), in 2012 the three largest chains had revenues of 1.502 billion dollars, with an annual growth of 8% over 2011. This was due to a Growth of 34.1%, mainly in prescription drugs followed by over-the-counter drugs(CENAFAR, 2013).
On the other hand, sales in dollars of the ethical market in Chile were US $ 811 million in 2008, with a variation of 16.7% compared to 2007. The ethical medicines constitute 76% of the total pharmaceutical market. On the other hand, the popular or over-the-counter market reaches 24% of US $ 249 million, and its growth was lower than that registered by the ethical market during 2008, only 10.5% while in 2007 it had grown 16.5%(Vasallo, 2010).

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