Access to medicines

Drug pricing has always been a sensitive topic. If the government regulates the price too low, pharmaceutical companies might cease production of medicines due to low returns. Then again, if you allow the companies to price the products themselves, affordability can become an issue, particularly in a country such as Pakistan.

With this in mind, the issue of access to medicines was highlighted by Islamabad-based think tank PRIME last week. Shortages of even basic drugs are quite common in Pakistan, even in our developed metropolitans like Islamabad. It was noted that out of 70,000 registered drugs in the country, only 10,000 are currently in production, and within those even there is a shortage or unavailability. This gives rise to the counterfeits, spurious, and smuggled medicines.

A survey conducted by PRIME to gauge the availability of drugs in Islamabad and Rawalpindi revealed a shortage of 58 percent with various large and small retailers, dispensaries, and private hospitals in both cities. One shudders to think what the situation would be like in rural areas! Apart from the pricing problem, a number of reasons were highlighted for this high cost of production, failure to achieve economies of scale, seasonality, and artificial shortages created by distributors. Still, price regulation has to be the top reason; its why multinationals have withdrawn, its why theres no investment in research and development, its why production of so many drugs has stopped.

Where regulation is concerned, however, the conversation isnt what it should be. DRAPs role as a regulator should be more focused on quality rather than price. It should provide certifications, audit manufacturers, inspect facilities and ensure that medicines are not substandard. This column has highlighted how Pakistan does not have a single FDA-approved plant, which is also one of the reasons for muted pharmaceutical exports.

Moreover, it was highlighted at the event that a number of drug registrations are pending with DRAP for a number of years (through faulty policies and no fault of its own) which need to be cleared. Finally, DRAP has recently developed an essential medicines list to be regulated only, but the implementation remains weak.

The drug pricing debate has gone on for years and years. There could well be a middle ground for it. All said, government cannot shy away from its responsibility of improving health standards and facilities.