Prices of almost all medicines have increased manifold silently to the misery of commoners some of whom skip lifesaving recipe to manage rising cost of living, latest market surveys show.
Prices of some drugs, which are used for communicable and non-communicable diseases both, are found to have swelled by up to 120 per cent in local markets.
Exorbitant out-of-pocket expenditure or OOPE for healthcare leaves fixed-and low-income groups of people in a quandary.
Elderly people and patients suffering from chronic diseases are worse off in the wake of spiraling prices of medicines, as they mostly have to keep on regular courses of medicine.
In Bangladesh, OOPE on purchase of medicines is 69 per cent now, which, according to economists, has jumped several steps ahead following recent price escalation of medicines.
Save 117 price-controlled primary-category medicines under government supervision, all other medicines saw prices rise in recent months, in lockstep with consumer price spirals.
All of a sudden, many said, consumers found higher prices of medicines when they visited pharmacies to buy those as no public declaration was made after jacking up the prices of medicines.
Following price hike of medicines, many of the middle-and low-income groups of people, suffering from non-communicable diseases, are skipping regular medicine schedules to cope with higher cost of living amid steep inflation.
Health experts said careless and irregular medicines schedules for NCD patients such as of high blood pressure may be “life-threatening”.
Sadia Chowdhury, a housewife in city’s Kalabagan area, found cost of medicines that she used to buy for her mother-in-law every month go up by 20 to 100 per cent on the basis of brand and category.
Her family has to cut budget for kitchen market, compromising nutrition to her two school-going kids, to manage additional expenditures for medicines.
“Even price of saline (Orsaline N and Tasty saline) went up by Tk 1.0 per piece,” the middle-aged woman laments.
Consumers usually come to know when prices of essential commodities, including rice, edible oils, sugar, and onions, increase as the hike is declared publicly, she says.
“I wonder why prices of medicines increased silently without public declaration. It is also considered most essential product,” she adds.
Pharmaceutical industry-insiders said they had no alternative but to increase the prices of all medicines as prices of raw materials on the international market and import costs increased exorbitantly.
Health economics researcher at Bangladesh Institute of Development Studies (BIDS) Dr Abdur Razzaque said out-of-pocket expenditure on purchase of medicines would be escalating significantly following price hike of medicines.
Overhead costs of pharmaceutical companies and lack of regulations are among the major reasons for “irrational” price hike of medicines, he said.
“Medicine is essential goods. The government should monitor its prices cautiously,” he says, opposing arbitrary escalation of prices.
He notes that prices of only 117 medicines are controlled by the government, which is much higher in other countries.
Of the price-controlled drugs, only 70 are essential while the rest are vaccines and other types of drugs, he says, suggesting increase in the generic numbers.
Market competition in the pharmaceutical sector is not that much challenging as only 20 companies are dominating the market, he mentioned.
Price escalation of medicine has long socio-economic consequences, he said.
Most senior citizens suffering from NCD are the worse sufferers as prices of NCD drugs are comparatively higher than that of other medicines, he added.
High prices of antibiotics may discourage low-income people from completing full course antibiotics, resulting in health complications owing to antibiotics resistance, the researcher cautions.
General Secretary of the Consumers Association of Bangladesh (CAB) Humayun Kabir Bhuiyan, who is on the price-fixation committee of DGDA, said the CAB opposed increase in prices of saline but its opinion was not reflected in the meeting resolution.
“On the price-fixation committee for drugs, CAB representative is the only person who raised objection on price hike of drugs,” he added.
As the majority agreed to increase the prices, CAB’s opinion remained “ignored”.
He alleged that pharmaceutical companies set prices of medicines counting costs of promotional expenditures for doctors and health professionals.
Consumers are shouldering the cost of expenditures that the companies spend on health professionals, he said.
He cited a 1994 order of the DGDA that the number of price-controlled medicines should be raised to 219 from 117 but it remained unimplemented.
The Directorate-General of Drug Administration (DGDA) fixes prices of around 117 primary drugs while prices of 1700 drugs are fixed by pharmaceutical companies on their own with approval from the authority. In India, 800 drugs are under the National List of Essential Medicines (NLEM), which are under price control by the government.
“We sent a letter to the DGDA to hold a meeting on medicine-price- hike issue in March last but yet to get any reply,” Mr Bhuiyan said.
Before initiating any legal proceedings on price hike of medicines, CAB would require to take opinion of the DGDA, he added.
Salesmen in city’s different pharmacies said pharmaceutical companies had increased the prices of their respective brands of medicines in phases and separately.
“We would not be able to continue production of essential drugs unless the prices are revised upward,” said Md Halimuzzaman, Chief Executive Officer of Healthcare Pharmaceuticals Ltd and Treasurer of the Bangladesh Association of Pharmaceuticals Industries (BAPI).
The country would be compelled to depend on imported medicines if the local companies could not continue production, he added.
In last July, more than 60 medicines in Pakistan, mostly psychiatric, categorised by the World Health Organisation (WHO) as essential medicines, disappeared from Pakistan’s market as local manufacturers could not produce those due to high cost of production.
“No companies would do business incurring losses,” the BAPI treasurer said.
With the increase in energy prices, dollar price hike and global financial turmoil due to the Ukraine war, manufacturing costs of all products increased exorbitantly.
An FE analysis has found the neighbouring countries like India, Pakistan, Sri Lanka and Nepal have increased prices of medicines since April 2022.
In February 2023, the Pakistan government increased prices of 18 lifesaving medicines following year-long shortages.
In April 2022, Sri Lanka increased a dozens of commonly used medicines’ prices by 40 per cent amid its grueling economic crisis.
India has revised prices of essential medicines, including pain killers and antibiotics, upward by 10.7 per cent since April last.
As per the recent National Pharmaceutical Pricing Authority (NPPA) notice, the ceiling price of all essential drugs has increased by about 10.8 per cent in Nepal since April 01, 2022 due to the rise in the Wholesale Price Index (WPI).
Pharmaceutical industry-insiders said they also faced problems on opening letter of credit (LC) for importing Active Pharmaceutical Ingredients, resulting in some disruption to producing few drugs in time.
Most of the pharmaceutical firms have increased prices of their medicines obtaining approval from the DGDA.
Ashraf Hossain, Director of DGDA, said they disposed of some 80 applications of pharmaceutical companies requesting price hike.
He said the price-fixation committee scrutinizes the price-hike proposal of the pharmaceutical companies and suggests keeping prices as low as possible considering importance of the products.
On allegation of CAB, Mr Hossain said, the DGDA gave approval for increasing prices of medicines on the basis of majority opinion.
Last November, the CAB demanded suspension of the process of increasing the price of medicines again as prices of all kinds of daily commodities have gone up along with those of medicines in the country in recent times.
It had warned of launching legal proceedings if prices of medicines increased further.
Data compiled from different pharmacies in the city show that prices of per-piece Doxiva-200, used for Asthma treatment, increased to Tk 6.50 in the first phase and Tk 8.0 in second phase from Tk 6.0.
Price of Fexo-120, the medicine for cold and allergy, increased by Tk 1.0 per piece followed by prices of antibiotics Cef-3 50 ml rising by Tk 20 per piece, cefotil-70 ml by Tk 40, Zimax-500 by Tk 5.0.
Prices of Rivotril .5 and Coralcal-D has increased by Tk 1.0 per piece each.
Prices of Cildip-5 increased in three phases to Tk 8.0 from Tk 6.0, Cildip-10 to Tk 11 in three phases.
Prices of Provair-10mg increased in two phases from Tk 15 to Tk 17.5 per piece, Montene-10 mg by Tk 1.0 per piece.
Last Thursday, prices of insulin for diabetic patients increased by up to Tk 129 on the basis of category.
Prices of Actrapid Flexipen and Mixtard Flexipen increased to Tk 550 from Tk 421 while Mixtard Penfil to Tk 460 from Tk 415.
On December 4, 2022, the DGDA issued a gazette increasing prices of 24 types of medicines in generic names, strength and dose form, effective November 20, 2022.
In July 2022, DGDA increased prices of 53 essential drug brands of 20 generics used in primary healthcare.
The prices were last revised in 2015.
According to the new price list of 117 drugs, one piece of Paracetamol costs Tk 1.20 against the previous price of Tk 0.70.
The price of one piece of Metronidazole 200mg tablet which was Tk 0.60 will cost Tk1 now.
Of the 53 drug brands, the prices of 10 Paracetamol generics have been increased while the prices of six Metronidazole generics have been increased.
Md Golam Rahman, president of CAB, says the prices of medicine are increasing without following a transparent method.
“If the DGDA has to increase the prices of medicine, it should hold meetings with the stakeholders to take their opinion explaining reasons,” he says.
The pharmaceutical businesses should not make hefty profit selling essential drugs in view of its sensitivity, he adds.
He termed the current price hike of medicines ‘arbitrary’.
“We understand prices of raw materials and manufacturing cost have increased significantly but the prices of medicines should be revised through the decision of a committee of DGDA,” he suggests.
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