The Sustainable Development Goal- SDG 3 presented by the UN emphasizes that there is an urgent need to ensure that everyone has access to quality treatment at affordable costs. Therefore, among several interventions, one method to control health-care costs is to make sure that medicines are reasonably priced and affordable to the general population. Pakistan ratified this SDG’s after getting failed in implementing MDG’s.
However, affordability of medicines seems to be of low importance to policy makers in Pakistan and from 2018 this newly elected government is not giving much time to this serious issue. In recent months, prices of hundreds of essential and life-saving medicines have increased greatly in Pakistan, making them unaffordable to residents with low and middle incomes. For some of these medicines, a price increase of over 100% has been observed. For example, the price of the frequently prescribed antispasmodic drotaverine has increased by 218%, while that of commonly used cough syrup dextromethorphan hydrobromide, chlorpheniramine, and pseudoephedrine increased by 105%. Additionally, the price of an injection of vitamins B1, B6, and B12 increased by 85%.
Numerous medicines have recently increased in price over 2-3 months, making them unaffordable for patients. The situation is getting out of hand for the people of Pakistan because there is no national health insurance, and most of the health-associated expenditure is an out-of-pocket expense. We all are aware that for the first time in history of Pakistan, this PTI government has allowed the pharmaceutical companies to increase the prices of 45,000 medicines upto 15 percent, whereas the prices of 463 hardship medicines have been increased up to 200 – 300 percent the highest increase in the last 40 years.
The sudden rise in drug prices caused great distress and drew a lot of flak especially from low- and middle-class patients that were on regular medication. People with budgets set for weekly/monthly medicine supplies are now distraught over being unable to afford a basic necessity and human right ever since the exorbitant rise in drug prices.
Just to highlight for my readers that present federal government had issued a notification (SRO- Statutory Regulatory Order1610) in December 2018 and second in January 2019 by Drug Regulatory Authority of Pakistan (DRAP) through which they increased the prices of medicines by 15% to 24%. However, due to governance issues of DRAP, Pharmaceutical companies suddenly increased the prices from 24% to 500% which was illegal as government approved increase in prices till 24%. It created burden on poor for paying extra money or comprised on health conditions.
The inadvertent across-the-board increase in prices of medicines might endanger the lives of poor patients due to either unavailability or availability of drugs at exorbitant rates beyond their buying capacity
To make it easy for my readers, let me explain how this Drug regulatory authority of Pakistan works? Drugs are regulated in Pakistan under the Drug Act 1976 and DRAP Act, 2012, under which the sales, storage, and distribution of drugs are regulated at provincial level while the manufacturing(licensing), registration, pricing, import, export, and monitoring of controlled drugs comes under the domain of federal government. The Drug Regulatory Authority of Pakistan (DRAP) established under the DRAP Act 2012 works under the federal government to regulate the aforementioned matters including ?xation of prices. Prices are ?xed by the Federal government under Section 12of Drugs Act, 1976 after a recommendation of the Drug Pricing Committee (DPC) constituted the Statutory Regulatory Orders (SRO) on 6th August 2013 under the Cost and Pricing Division, DRAP.DPC is comprised of representatives from provincial health departments, Ministry of Finance and consumer bodies along with stakeholders as observers to proceedings of committee.
Within this context, surely pharmaceutical companies in Pakistan are using various tactics to avoid scrutiny from the regulatory authorities. At the same time, the leniency of the regulatory authorities is also evident. It is time for health authorities in Pakistan to start learning from past experiences. An amendment in the relevant schedule appended to the Drug and Pricing Act is needed that will allow the government to place stern policies on price control, and actions to be taken in case of illegitimate price hikes. Instead of listening to the demands of the pharmaceutical industry, the Pakistani Government should start listening to the people, who are now faced with unaffordable medicines.
I believe that the inadvertent across-the-board increase in prices of medicines might endanger the lives of poor patients due to either unavailability or availability of drugs at exorbitant rates beyond their buying capacity. The patients with cardiac diseases and diabetes are at risk due to unavailability of lifesaving drugs, which are now beyond the reach of a common man.
Recently I had chance to meet with few community people in District Khairpur, Deeba Solangia community mobilizer said, “his husband was prescribed Tegral for the treatment but when she went looking for the tablet, she found that she could only buy it at a handful of pharmacies in Khairpurat double the price. Deeba couldn’t afford the prices quoted and went home empty-handed”.
Through this write up I want to acknowledge Marvi Rural Development Organization-MRDO under the umbrella of “Tax Justice Coalition Pakistan” organized a public forum on the issues of price hike in medicine and generation of discourse around it. This event was organized in Shah Abdul Latif University, Khairpur. The basic purpose of this event was to discuss issues regarding the price hike in medicines and also urge the government to reverse back SRO 1610, so that people can afford the medicines.
While talking with Saira Ahmed socio-political activist said, “the government’s tall claims to make healthcare affordable for the poor stood exposed. She was on the view that the pharmaceutical industry’s greed, which is killing citizens, needs to be controlled on a war footing.
She further said, “these companies offer a drug for Rs50 in hospitals, while the retail price of the same drug is Rs300 for the patient. Such is the extent of their heartless exploitation”. The federal government should reverse its decision on immediate basis and make the price of medicines low.
My advice to the government and DRAP is to control the prices of medicines and immediately reverse SRO 1610 and make these medicines available in markets with actual prices. Moreover, impact of medicine price regulation on the availability and affordability of essential medicines should be monitored regularly.
The writer is a social and political activist based in Lahore