A/HRC/23/42 adequately reflected in the policies and activities under the national plan of action on medicines. 70. With regard to long-term security and affordability of medicines, the Special Rapporteur recommends that States: (a) Develop a policy framework on local production of medicines to ensure long-term accessibility and affordability of medicines; (b) Strengthen the regulatory framework to increase the competitiveness of the local industry and provide administrative and financial support, subsidies and guaranteed purchases; (c) Use flexibilities under the TRIPS Agreement to promote regional collaboration to pool resources and facilitate competitiveness of local production. 71. With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States: (a) Adopt price control measures in pricing and reimbursement policies with a view to ensuring access of the population, and vulnerable groups particularly, to affordable medicines; (b) Select countries with a similar level of economic development to that of the State concerned as reference countries in order to secure the lowest price medicines through external reference pricing; (c) Monitor and regulate, if necessary, manufacturers’ selling prices as well as distribution mark-ups in the supply chain, while ensuring incentives for wholesalers and retailers for sustainable distribution; (d) Resist trade policies that undermine the ability of States to reimburse the price of essential medicines to local pharmaceutical companies; (e) Eliminate import tariffs on medicines, except when considered to be strategic to the promotion of local production of essential medicines; (f) Remove taxes on all medicines, especially essential medicines, and consider other revenue options for health, such as excise taxes on socially harmful goods such as tobacco, alcohol and junk foods; (g) Adopt competition laws and policies to prevent pharmaceutical companies from indulging in anti-competitive practices and promote competitive pricing of medicines together with strong enforcement. 72. Promote competitive policies across therapeutic markets to secure reductions in prices of medicines over tiered pricing to secure a greater government role in decisionmaking related to prices of medicines. 73. With regard to ensuring availability of essential medicines, the Special Rapporteur recommends that States: (a) Adopt a national essential medicines list and regularly update it by selecting essential medicines that are evidence-based and adequately reflect the national burden of disease, irrespective of cost or patent status, including through a transparent and participatory determination process; (b) Ensure that access to essential medicines for treating mental health, drug dependence, sexual and reproductive health and palliative care is based purely on health needs and evidence and not restricted on account of extraneous non-health considerations; 21