As a diabetic patient, 54-year-old Mesbah Uddin (pseudonym) requires daily insulin injections. But it has been struggling with the rising price of the drug for the past six months or so. “I used to buy the [insulin] vials at Tk1,200-Tk1,300 and now cost around Tk1,500-Tk1,600.”
When the price of medicines increases, people with long-term diseases like diabetes, hypertension, cardiovascular diseases, etc. suffer more, because they need to take these medicines regularly.
Last April 29, the Superior Court of Justice ordered the General Directorate of Medicines Administration (DGDA) and the Secretary of Health to take effective measures against the increase in the price of medicines in the country, within 30 days
The order came after the Consumers Association of Bangladesh (CAB) submitted a brief attached to a newspaper report, which said “prices of medicines rose by between 7% and 140% in two weeks”.
The report stated that numerous companies have increased the price of medicines, especially antibiotic pills and insulin.
According to Article 30, subsection (4) of the Drugs and Cosmetics Act-2023 “No person or establishment shall supply and sell drugs or raw materials at a price higher than the price fixed in this section.”
Therefore, unless the DGDA the regulatory body that sets the prices of medicines approves, the price of the medicine cannot be changed.
Setting the price of a medicine is a long process, which requires the approval of the DGDA and the Ministry of Health, explained Dr. Rashid-e-Mahbub, public health expert and president of the Health Rights Movement of Bangladesh.
“In Bangladesh, the DGDA provides drug registrations and sets the price of all drugs produced in the country,” he said. The DGDA has a price-setting committee that evaluates all requests to raise prices from pharmaceutical companies.
Since a government body is actively employed to look after the interests of ordinary patients, drug prices in Bangladesh should, in theory, be moderate and stable. But as Mesbah Uddin’s experience proves, or for that matter anyone who’s ever walked into a pharmacy knows, it’s anything but stable.
The justification for the price increase
Pharmaceutical companies point to the devaluation of the taka against the US dollar, and the increase in the price of raw materials in the international market, for the recent price hike.
In January this year, during a meeting with Salman F Rahman, adviser on investment and private industry to the prime minister, leaders of the Bangladesh Association of Pharmaceutical Industries (BAPI) said that drug production costs have increased (up to 30% last year), but the DGDA did not increase the price.
They said failure to adjust prices will lead to losses and even possible shortage of supply in the market, as well as lower quality of medicines. However, it was not long ago (December 2022) that the DGDA increased the prices of 53 essential medicines in the country.
Kaiser Kabir, CEO of Renata PLC, said: “The law states that, except for 117 products, pharmaceutical companies are free to change prices at will. However, in practice, the DGDA has the final word on this matter. It is understandable that during a period of economic crisis, this authority hesitates to grant permission to increase prices.”
“Essentially, it is very difficult to raise the price of drugs. Because of the competitive nature of the pharmaceutical industry, there is a strong will to raise prices.”
However, he said that when it becomes clear that costs have gone up permanently, companies ask for permission to raise the price. “In other words, industry rarely reacts to short-term inflation or minor exchange rate devaluations.”
He also believes that “medicine prices in Bangladesh are the lowest in the world according to data published by IQVIA”.
The reality for ordinary patients
In Bangladesh, 69% of the total healthcare expenditure in the country is paid by patients out of pocket. A large part of this goes to pay for the drugs.
Dr. Be-Nazir, former Director of Disease Control at the General Directorate of Health Services, said that it is not true that drug prices in the country are within the reach of the people.
“May be [the pharma companies] they think that by looking at their profits and thinking that because people are buying the drugs, things must be going well,” he said.
“When I visit the villages, sometimes I go to the Gaibandha villages, I see many people who cannot buy medicine, those who need it regularly. Maybe they buy one pill instead of the two prescribed, or maybe they take the medicine regularly. All this increases the complications and even causes death.”
He said drug companies don’t have the tools to measure these changes, so they can’t say with certainty that people can afford the drugs. “There are no surveys or anything. Why else does Bangladesh have such a high OOP for buying medicine? Medicine is a lifesaver; it can’t be that expensive.”
According to Dr. Rashid-e-Mahbub, the Drugs (Control) Ordinance enacted in 1982 had academicians involved in the price fixing committee, which no longer exists. (The ordinance has long since been repealed).
“There are no academics, no representatives of the users or even those who prescribe the drugs”, he said, pointing out how people’s interests have been undermined.
Dr. Be-Nazir said that the price of drugs is much higher than the cost of production, which can easily be deduced from the discounts that pharmacies often offer.
“You’ll notice that pharmacies can offer drugs at deep discounts if they want to, which means their margin is so high that they can always take less than the retail price,” he said.
Dr. Rashid-e-Mahbub echoed similar sentiments saying that pharmaceutical companies spend a lot of money on marketing and promotion, and if they can reduce it, they will easily reduce the price.
“For the law to be enforced, the DGDA should play the main role, but their limitations are so great that they cannot do this, including the quality control of medicines. Now we see that unlabeled medicines have flooded the rural areas. The government must identify the flaws in the system and work on them, as the law is not being implemented anywhere,” he added.
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