LAHORE: The countrywide persistent shortage of several life-saving drugs has opened floodgates of smuggled drugs in the market and the patients are forced to pay three to five times higher prices to buy the essential medicines than their actual rates.

The drugs crisis hit most parts of the country hard after Federal Health Minister Dr Nadeem Jan and the Pakistan Pharmaceutical Manufacturers Association (PPMA) locked horns over the review of the prices of 262 drugs of hardship cases.

According to the documents (a copy available with Dawn), the proposed prices of 262 drugs were reviewed and approved by the Drug Regulatory Authority of Pakistan (DRAP) under its policy in November 2022. It had sent the same to the ministry of health to consider them in the cabinet meeting to issue a notification but the matter had been pending since then.

The situation aggravated when the caretaker health minister opposed DRAP’s decision and left the matter of 262 hardship cases to be decided by ‘upcoming government’ while the manufacturers’ association declared the decision disastrous, saying it could jeopardise the health and safety of individuals battling severe diseases besides the drug industry.

Delay in drug prices review caused shortage while businesses make hay as crisis deepens; medicines being sold in black at five times higher rates

The crisis has deepened to the extent that it has led to the growth of the grey market, particularly in Punjab and Sindh where the black market of the imported life-saving and essential drugs is at its peak.

There are also reports that many smuggled life-saving medicines are not carrying any warranty while the genuine drugs are being replaced by spurious and counterfeits.

It is evident from a report presented by the PPMA in the last high-level meeting of the Strategic Investment Facilitation Council (SIFC) held in Islamabad.

However, the higher authorities in the federal health minister have reportedly turned a deaf ear to the grave situation and the PPMA puts entire blame to the caretaker health minister’s incompetence for seriousness of the issue.

The report (a copy also available with Dawn) pointed out some anomalies and loopholes in the federal government’s system of fixing the drugs prices. It has produced, as evidence, some imported drugs which are being sold at rates many times higher as compared to those proposed by the firms in the 262 hardship cases.

Like, it says, the hardship price of heparin injections pending approval by the caretaker health minister and the other cabinet members was Rs1,341 per injection but patients are forced to buy the imported Heparin from Turkey at Rs3,000 from pharmacies. Yet, the health minister has actively opposed the proposed hardship price despite clear evidence that patients are hostage to black market and counterfeit medicines in the increasing absence of legitimate ones.

DRAP had approved a new price of another drug Retalin (Methylphenidate) 10m (pack of 30 tablets) at Rs567.

This imported drug (made in Spain) has been made available in the local market at price Rs5,950, many times higher than the proposed price.

Similarly, the new price of another drug, Tegral (Carbamazipine) 200mg, was approved at Rs578 by DRAP. However, this drug is being sold at price Rs3,000 in the market, compelling the patients to buy it at the same price mentioned on the pack.

Insulin is another drug that’s short in the market and its price has increased from Rs1,200 to Rs1,500 during a short period of the last three months.

Giving a comparison of the neighboring countries, the report further highlights that the National Pharmaceutical Pricing Authority (NPPA) in India has limited the price control to a scheduled list of 302 essential drugs while in Bangladesh, price controls extend to a list of 117 essential drugs.

“Whereas, in Pakistan, all the drugs are subject to price fixation by the federal government,” reads the report.

PPMA chairman Mian Khalid Misbahur Rehman told Dawn the ECC met in November to review the hardship cases under orders of the Islamabad High Court. He said a committee of health ministry officials was formed to review the veracity of these hardship cases, most of which are pending for over two years.

In its report to the Economic Coordination Committee, the health ministry stated that it had carried out a “detailed analysis” of all cases, and found them to be “in line with the government’s [pricing] policy”.

The committee further reported that a meeting of the provincial health ministers was convened by Dr Nadeem Jan on Nov 16, 2023.

“All provincial health ministers were of the view that most of the common-use medicines were not available in the market,” quoting the minutes of the meeting, he said.

All the health ministers agreed to the proposed increase in prices of 262 drugs as calculated under the hardship category.

The PPMA chairman said the committee also carried out a market survey in five major cities and found that many drugs were not freely available in the market and some drugs were being sold in black market at prices much higher than approved ones.

“Yet, the caretaker health minister opposed his own ministry’s findings and went against the recommendations of all provinces, again opposing any approval of hardship prices,” Mr Rehman lamented.

As a result, the drugs’ shortage crisis hit the country hard, inevitably leading to worsening health statistics and leaving the patients exposed to smuggled, spurious and potentially counterfeit drugs and price gouging in the black market, the PPMA chairman said.

Federal caretaker health minister Nadeem Jan attributed the inordinate delay to the procedural matters because of involvement of many stakeholders concerned, including the ministry of health’s cabinet.

“We wanted to incentivise the hardship cases, keeping in view the stakes of both public as well as pharmaceutical firms,” he said.

To a question, he replied that it was the responsibility of DRAP to conduct raids and stop the sale of imported medicines in the country’s black market.

The drug inspectors should take action against spurious and substandard drugs, he said and added that he would try his best to take a final decision on the 262 hardship cases pending approval with the cabinet during caretaker setup.

DRAP CEO Asim Rauf refused to comment on the issue when this reporter called him and sent WhatsApp messages to ask for his version.

Published in Dawn, January 27th, 2024