THE astronomical rise in the price of medicines domestically has been in the news lately. The issue is not specific to Pakistan, where the problem of unaffordable medicines has been a long-running concern and the rise in drug prices has figured on electoral and policy agendas.

In the US, with the election of President Donald Trump, the same issue surfaced there. The Democrats made rising drug prices an electoral issue and reaped huge rewards in the midterm elections. By contrast, political parties in Pakistan are curiously tight-lipped about a major increase in drug prices over the last two months. Prices have increased by up to 100 per cent in some case, surging past the officially allowed increase of 15pc. The Drug Regulatory Authority of Pakistan appears toothless.

According to one report, the price of erythromycin under a certain brand name has increased from Rs500 to over Rs900. A TV report has revealed that the price of another drug has gone up from Rs79 to Rs426. My own inquiries at the local pharmacy have revealed the price of another drug related to reproductive health has gone up from Rs500 to more than Rs800.

Such price increases have now become part of a well-established pattern whereby drug prices are increased way beyond the officially allowed increase. Over and above the Drap-allowed increases every few years, there have also been regular price hikes without authorisation. This happens even as courts challenge the practice. But as the matter winds its way through the legal corridors, the higher prices stay high, with no regulatory action in view. In neighbouring countries, the increase is reversed and excess charges recovered.

Increase in drug prices is now part of a pattern.

Pakistan’s condition reflects poorly not only on the regulatory function of Drap but also on pharma’s professed commitment to affordable medicine. This country has amongst the highest drug prices in the region. The impact of the recent increase on poverty-stricken and chronically ill patients is catastrophic. There have been reports of patients switching to some other treatment or forced to skip daily doses.

The irony is that the recent increase in drug prices has occurred under the watch of Prime Minister Imran Khan, who has built his career and reputation on enhancing the access of the poor to drugs and treatment. He must act to reverse this increase. This would be in line with his stellar record on access to and affordability of medicines and treatment as evidenced in his Shaukat Khanum Memorial Hospital.

Beyond this, an honest, well-rounded and transparent debate should begin on reforming Drap and all other institutions involved in price setting. The best place to start would be Drap, which has failed abysmally in its regulatory and oversight roles; controversies over its shoddy performance keep surfacing in the press.

To overcome this, Drap should be overseen by a board composed of representatives of probity from civil society, patient and consumer groups, public-interest lawyers, doctors, pharmacists and media persons. This board should appoint the CEO of Drap after ensuring that no conflict of interest is involved. Moreover, the reformed body should open the price-setting mechanism to the public gaze, with all price hikes rationalised and advertised on its website and a quick complaint-resolution mechanism instituted where a higher than permitted increase has occurred.

As for parliamentary committees on health and health-allied areas, they should invite outside expertise and civil society representatives in the widely advertised price-setting hearings to generate transparency and accountability in the process. As a necessary part of the transparency exercise, the members should declare their outside business interests before registering, in order to prevent any appearance of a conflict of interest. This is standard practice in the British House of Commons.

The superior courts have intervened in the matter of drug prices in recent years. Yet, it takes such a long time to fix and hear price-related public interest cases that there is virtually no effect where the reversal of price hikes is concerned. Here, the courts also need to play their overdue role in introducing transparency and fairness in the price-determination mechanism, while protecting the right to health and affordable treatment and medicines.

As for civil society, public citizens, patient groups and health advocates, they must fine-tune and coordinate their actions to play an ever-vigilant role in how prices are determined and how Drap’s regulatory bite and heft is sharpened in the public interest. Together, all stakeholders should make sure that the progress towards the goal of universal and affordable healthcare can be maintained and accelerated.

The writer is the author of Patient Pakistan: Reforming and Fixing Healthcare for All in the 21st Century.

drarifazad@gmail.com

Twitter: @arifazad5

Published in Dawn, March 7th, 2019