KARACHI, Oct 29: Machinations in the informal sector and profiteering on the part of pharmaceutical companies have helped spawn several distortions in the medicines market.

For one, a drug which can be had at only a few hundred rupees from most retail stores is supplied for several times that amount by the registered suppliers. The pricing of drugs, therefore, is not uniform, inquiries made by Dawn have revealed.

One reason for the difference in prices charged at the retail stores and those demanded by registered suppliers is rampant smuggling of drugs, Dawn can reveal. The other reason is the over-pricing of drugs by pharmaceutical companies having exclusive rights over some brands.

The owner of one of the biggest medical stores in Karachi told this reporter that pharmaceutical companies wanted to recover their overhead costs (incurred on salaries and perks of sales managers and medical representatives and so on) as soon as possible. “If a company has an exclusive rights for a drug for, say, three years its owners and managers will try to make as much money as possible during this period.

“However, once a competitor moves into the market, the price gets stabilized in no time,” he said on condition of anonymity.

A manager at a drugs supply company said some drugs were smuggled into the country from neighbouring countries like Iran. These drugs are sold at very low prices in Pakistan.

“Take for instance a drug meant for the patients of Haemophilia — known as Hemophilic Factor or KOATE-DVI. Our retail price for this medicine is Rs3,968. On discount, we can sell this drug for Rs3,200 per vial.

“However, a smuggled version of this drug is being sold for anything between Rs600 and Rs1,500. When there’s an oversupply in the market, a vial of this injectable fetches Rs600. But when the market runs dry, a vial may fetch up to Rs1,500, may be more.”

He claimed that in Iran the price of the drug is very low. “You see, the Iranian authorities have a sympathetic attitude towards all kinds of patients. This is the reason why the medicine is smuggled into Pakistan from that country.”

In response to a question, he said the medicine was supposed to be kept at a temperature ranging from 2 to 8 degrees Centigrade. “This means that we have to maintain the temperature at all times — during transportation and also during storage at the drug stores.”

This was one reason why a vial of the injectable was sold at more than Rs3,000 by the registered suppliers, he claimed. Haemophilia drugs are not the only ones which are smuggled. “Some anti-depressants and anti-cancer and hypertension drugs are also smuggled.”

The owner of a large medical store which supplies medicines to a public hospital told Dawn that the smuggled drugs were always sold over the counter and on cash. “It’s a crime to sell smuggled medicine. That’s why they are sold for cash and proper receipts are not given even if demanded by the patient.”

Answering a question, the middle-aged man claimed that he did not deal in smuggled medicine. “How can I? I supply medicines to a large public sector hospital. In our dealings with this hospital, we have to produce receipts and other documents. We cannot give smuggled drugs to the patients even if we want to ... simply because doing so would be a disaster.”

He said drugs were smuggled not only from Iran but also India. “The Indian drugs can be acquired easily in the UAE. From there they are smuggled into Pakistan by professional smugglers, known commonly as khepias.

A middleman who supplies smuggled medicines to the retail stores told Dawn, on condition of anonymity, that khepias had become quite organized in their dealings. “This business has now become so organized that you can order an item to be smuggled on a notice of a couple of days.

“That is to say, if you tell a middleman to get a particular item smuggled into the country today, you will get delivery within the next two days.” Answering a question, he said he was in constant contact with at least 10 khepias.

He said one of the Khepias’ many jokes had it that goods could be smuggled even from Israel, the country which has no formal relations with Pakistan. “They often say: Hum to Israel say bhi cheezein laa sakte hain.

The short, balding man said the khepia business could not flourish without the support of certain unscrupulous airport officials. “By implication then you can say that the airport authorities are largely responsible for the problems you are talking about.”

Prof Mashoor A. Shah of the Jinnah Post-graduate Medical Centre said the smuggled medicine were of dubious quality. “You see these drugs are smuggled either through the airports by khepias or through some land routes.

“And during smuggling through these means it’s difficult to maintain the temperature, etc., of these drugs. That’s why I am certain that the smuggled medicine are of lesser quality than the ones that are imported in a proper fashion. Their efficacies are compromised.”

Elaborating, the professor said most injectables and vaccines must be maintained between 2 and 8 degrees Centigrade. “How can a khepia maintain temperature of the drugs he’s smuggling. And why should he?

“Nobody is going to demand the papers from him and no one is going to take samples from his consignment and test them. Similarly, why should a smuggler bringing in goods from Iran and Afghanistan via difficult land routes or spend money on maintaining the temperature of medicines under his charge.”

Prof Shah advised that people should use the medicine only that are supplied by registered suppliers.

A manager at a medicines supply company said that as a consequence of the increasing smuggling of medicine several suppliers had to close down their businesses. “I remember distinctly that not long ago a supply division of a multinational drug company was shut down because of the distortions in the market.”

He said the division specialized in medicine meant for cancers. “Can you imagine one company had to pull out of the market simply due to the competition from smugglers, paving the way for more smuggling of anti-cancer drugs of dubious quality, and yet nobody pauses and ponders?”

Dr Farzana Chaudhary, federal health ministry’s Chief Drug Controller, said the authorities had taken strict action against a number of outlets which dealt in smuggled medicines. Asked to give the total number of convictions in this regard, she said: “Off-hand how can I give you the exact number? But I reiterate that we have been serious in curbing smuggling of medicines.”

She said the government officials largely remained low-key and their efforts were often ignored by the print and electronic media of the country.

She urged people to use only the medicine supplied by the registered drug supplier. “These drugs are imported only after a thorough verification of the test reports and other import documents.”