Therapeutic apartheid: a cross-sectional assessment of estimated cost, accessibility, affordability, and availability among psychotropic medications across 25 regions.

INTRODUCTION

Mental disorders affect approximately 20% of the global population and remain a leading cause of disability and premature mortality. Despite pharmacotherapy being central to treatment, access to psychotropic medicines is highly unequal, particularly in low- and middle-income countries. In South America, comprehensive national evaluations integrating availability, price, affordability, and geographic accessibility are scarce.

OBJECTIVE

To assess the availability, cost, affordability, and geographic accessibility of psychotropic medicines across public and private sectors in all regions of Peru.

DESIGN

A secondary cross-sectional analytical study.

METHODS

We use open-access data from the Peruvian Observatory of Pharmaceutical Products between May 20 and 25, 2025. A total of 54 psychotropic medicines were included based on the WHO and national essential medicine lists and expert consensus. Outcomes included median unit cost (interquartile range), availability (% of facilities), affordability (days of minimum wage for a 30-day treatment), and regional accessibility. Public-private cost differences were assessed using Wilcoxon rank-sum tests and Cliff's Delta.

RESULTS

Only 22.2% of psychotropics were classified as essential by both WHO and national criteria. Median costs were substantially higher in the private sector, with price differences ranging from 2- to 140-fold (e.g., risperidone 2 mg: $1.41 private vs $0.01 public; Cliff's Delta = 0.99). While essential medicines were generally affordable in the public sector (<1 day of minimum wage), newer and long-acting formulations required up to 276 days of labor. Public-sector availability was limited, and geographic accessibility showed marked centralization: several Amazonian and highland regions lacked access to key psychotropics, whereas private-sector availability was near-universal.

CONCLUSION

Psychotropic medication access in Peru is characterized by profound economic and geographic inequities.

TRIAL REGISTRATION: Not applicable.