A bill backed by Peru’s health ministry would make clinics calculate drug copayments from Digemid market prices, not the Kairos catalogue. If it passes, expect clinics to seek the margin in bed-day fees.
POLICY & MARKETS · DRUG PRICING · OCTOBER 7, 2026 · PERU
Peru’s lower-house health committee is debating a bill that would bar private clinics from using the Kairos catalogue, a private drug-price publication, as the main or sole base for calculating insured patients’ medicine charges. Minsa (Ministerio de Salud), the health ministry, backs it; the clinics’ association opposes it. The target is the pricing base that drives insurers’ bills and patients’ copayments.
Bill PL 00184-2026-2031-CD, filed by Diethell Columbus, a Fuerza Popular deputy, would add an article 28-B to Law 29459, Peru’s law on pharmaceuticals, medical devices and health products, according to Infobae. Discounts, coverage, copayments and coinsurance at clinic pharmacies would have to be calculated from the market reference price published by Digemid (Dirección General de Medicamentos, Insumos y Drogas), the drug regulator, for the same product, manufacturer, strength, dosage form and presentation. The bill does not cap prices. It changes the number everyone else’s percentage is applied to.
14.7x
The Kairos reference price for 1g injectable ceftriaxone, S/158.88 (Peruvian soles), against a market price of S/10.83, the widest gap cited from the bill’s 2026 analysis.
A discount on an inflated base is not a discount
The bill’s explanatory memorandum, as reported by RPP and Infobae, analysed 100 medicines in 2026 and kept 93 valid comparisons. In 87 of them (93.5%), the average market price was more than 5% below the median Kairos suggested retail price; the median gap was 57.1%. Ondansetron 8mg/4ml injection showed S/71.40 against S/4.95 (14.4x); ipratropium S/272.65 against S/21.24 (12.8x).
Mr Columbus’s clearest example was esomeprazole 40mg. Kairos listed it at S/295; pharmacies sold it for S/17.40–19. An insured patient with an 80% discount paid about S/60 (S/59 by our calculation), roughly three times the upper street price of S/19. The memorandum itself concedes that the gaps do not prove every clinic charges those prices, and that clinics carry costs for round-the-clock availability, storage, cold chain and traceability, according to Infobae.
The problem is old. A 2021 report by Indecopi (Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual), the competition authority, found the Kairos suggested public price was the reference for valuing medicines in at least 88.3% of the clinic-insurer contracts it analysed. It linked that to medicines making up about 50% of the value EPS (entidades prestadoras de salud), the private health-plan operators, paid to clinics, against about 10% internationally.
The clinics’ defence points to cross-subsidies
Hernán Ramos Romero, general manager of the Asociación de Clínicas Particulares del Perú (ACP), the private clinics’ association, acknowledged a distortion in medicine prices but told the committee that they sit within a wider structure of tariffs negotiated with insurers. “There are tariffs below cost that are offset by other services. It is a cross-subsidy scheme that currently exists in the private sector,” he said, according to RPP (translated from Spanish). The association also argued that pharmacy-chain prices are a poor benchmark because of differences in purchasing volume and cost structure, and proposed that Minsa lead a working group on private-sector tariffs.
That defence tells payers what comes next. When some clinics and insurers changed their reference prices, in changes Indecopi said may have originated in a 2014 pilot by Susalud (Superintendencia Nacional de Salud), the health insurance supervisor, Indecopi, citing figures reported by the clinics it interviewed, recorded average medicine price reductions of 41% to 72%, while fixed intensive-care payments rose 69% on average and the hospital-day rate 52%. Indecopi’s figures suggest that margin taken out of the pharmacy can reappear in the room rate.
Government backing, with a caveat on price control
María Sofía Cuba Fuentes, the vice-minister of public health, said the ministry viewed the bill favourably because it could strengthen transparency and reduce information asymmetry in private-sector drug pricing, according to RPP. She noted that Digemid already runs a public medicines price observatory, and said the bill should not be read as direct price-setting. The Colegio Médico del Perú, the medical association, also backed it, with amendments.
The bill would also give outpatients the right to buy medicines at an outside pharmacy, with exceptions for hospitalisation, emergencies and procedures; Susalud would supervise clinics and insurers; and private entities would have 90 calendar days to adapt systems and contracts, according to Infobae.
What to Watch
- Whether the health committee approves a report (dictamen) on PL 00184, and whether the clinics’ working-group proposal is folded into it
- Whether Digemid’s observatory can publish a reference price by product, manufacturer, strength and presentation, as the bill requires
- Repricing of hospital-day, intensive-care and procedure tariffs in clinic-insurer contracts if the Kairos base is removed
- Manufacturers’ list-price strategy if a Kairos suggested price can no longer be the main or only reference
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The bill would make Peru’s private health system price medicines closer to their market value. Our expectation: if it passes, total clinic bills to insurers will fall less than the drug-price gaps suggest, because the cross-subsidy will migrate to bed-day and procedure fees, as clinics reported to Indecopi when some contracts changed their references. Insurers and employers that buy private health plans should negotiate those tariffs now, not after the 90-day adaptation window opens.
Key figures and how we calculated them
| Figure | Value | Source / calculation |
|---|---|---|
| Ceftriaxone 1g injection, Kairos vs market | 14.7x | 158.88 / 10.83 = 14.67 (bill’s memorandum, via RPP/Infobae) |
| Ondansetron 8mg/4ml injection | 14.4x | 71.40 / 4.95 = 14.42 |
| Ipratropium | 12.8x | 272.65 / 21.24 = 12.84 (our calculation) |
| Atenolol | 11.2x | 2.12 / 0.19 = 11.16 (our calculation) |
| Comparisons where market price was more than 5% below Kairos | 93.5% | 87 / 93 (our calculation) |
| Esomeprazole 40mg, insured copayment | ~S/59; 3.1x street price | 295 × (1 − 0.80) = 59; 59 / 19 = 3.1 (59 / 17.40 = 3.4) |
| Contracts using Kairos as the medicine reference (2021) | at least 88.3% | Indecopi market report |
| Medicines’ share of EPS payments to clinics | ~50% (vs ~10% internationally) | Indecopi market report |
| Effect of moving off Kairos (post-2014) | Medicines −41% to −72%; intensive care +69%; hospital day +52% | Indecopi market report, averages reported by clinics |
Sources: PL 00184-2026-2031-CD explanatory memorandum as reported by RPP and Infobae; Indecopi, Reporte del mercado de comercialización minorista de medicamentos en clínicas (2021)
Why this is relevant
Patients
Insured outpatients could pay copayments calculated on market prices and buy outside the clinic; in the bill’s esomeprazole example an 80% discount still left a bill about three times the street price.
Industry
Manufacturers that publish suggested prices in Kairos would lose their role as the main pricing base in clinic contracts; clinic pharmacy margins would come under pressure; Indecopi found medicines made up about half of the value EPS paid to clinics.
Payers
EPS and insurers would gain a public benchmark for drug claims but should expect clinics to seek higher bed-day, intensive-care and procedure tariffs, as clinics reported to Indecopi when some contracts changed their references.
Regulators
Digemid’s price observatory would become a reference for private billing, and Susalud would supervise clinic and insurer compliance within a 90-day adaptation window.
Sources: RPP: Minsa backs bill to cut clinic medicine prices (6 Oct 2026) · Infobae: Fuerza Popular bill on clinic medicine prices (7 Oct 2026) · Correo: clinic pharmacy prices in Congress’s focus (7 Oct 2026) · Indecopi: retail market for medicines in clinics (2021) · Indecopi: full market report (PDF) · Indecopi: press release on COVID-19 drug prices in clinics (21 Sep 2021)
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