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KARACHI, Sept 29: Sindh has urged the federal government to ensure a downward revision of at least 45 essential and life-saving drugs, including those meant for hypertension and diabetes patients, at the earliest as the lower and middle income groups of the population are unable to afford them due to their arbitrarily fixed high prices.
Speaking at a press conference at his office on Saturday, Sindh Health Minister Syed Sardar Ahmad said that the soaring prices of medicines had become a source of concern for the provincial government, which felt that it was high time prices of branded medicines were re-fixed.
“A number of medicines are prohibitively expensive even for patients belonging to the higher income group,” he observed.
Greed, lack of ethics to blame
He said the causes of rocketing prices of medicines manufactured in the country by local or multinational companies or imported from abroad included the greed of the companies, a faulty system of drug and medicine pricing and unethical practices by doctors.
“Physicians should be persuaded not to prescribe high-cost brand-name medicines and go for prescribing the medicines by their generic names,” he suggested.
“The federal health ministry, I am sure, is fully aware of the fact that the remarkable difference of the prices of the same generic products persists not only between the multi-national manufacturers and national manufacturers, but there is also widespread difference between the processes of production of different local manufacturers. Similarly, the prices of the same product imported by different importers -- whether multinational or national -- also varies substantially,” he noted.
Mr Ahmad, who is also a senior minister in the Sindh cabinet, said that the Sindh health department had recently examined various aspects of brand-name medicines and indiscriminate determination of prices and furnished a detailed set of observations and recommendations to the federal health ministry with a request that all the prices fixed for 45 to 75 essential drugs be reviewed and re-fixed within three months. The new prices should be enforced from January 1, 2008, while a notice about the proposed review exercise should be given to the manufacturers and importers immediately, he added.
While assisted by Special Secretary Health Dr Abdul Majid, Deputy Secretary Quality Control, Sindh, Mohammad Sualeh and Chief Drug Inspector Salahuddin Tunio, the minister talked elaborately on the medicine price mechanism and said that there was a great variation in the prices of the raw materials imported from different countries, which indicated that manufacturers did not care for the undertakings they gave to import raw materials at competitive prices, which was contributing to the exorbitantly high prices of medicines.
He said that the fixation of maximum retail price (MRP) of the finished products by the ministry of health was also unrealistic sometimes. “One can see a widespread difference between the landed cost and the MRP of the finished products, which was unjustified,” he observed.
The prices of both manufactured and imported medicines are fixed under the Provision of Drugs Act, 1976, by the federal health ministry on the recommendations of a Price Recommendation Committee (PRC) headed by the director general health, which includes federal government members. There is no representation of any province in the committee.
The minister demanded of the federal government to establish an independent drug regulatory authority under Section 5 of the Drug Act, 1976, by ensuring participation by provincial health ministers and health secretaries a well. “The authority may appoint committees at the federal and provincial levels to deal with the subject under Sections 4, 6, 7, 8 and 9 of the act, under its control and superintendence,” he pointed out.
The minister informed the newsmen that he had quoted the prices of 20 brand-name products, out of 45 major generic drug molecules, which covered 60 per cent of the total market, to the federal ministry.
Huge price difference
“A study of the highest and lowest prices of the generic products in question will give the understanding of how indiscriminately and irrationally the health ministry has accepted the recommendations of the PRC,” said the provincial health minister.
He quoted the high and low-end prices of brands based on Amlopidine (generic), as Rs467.10 and Rs35.30 respectively and said that the ratio of 1:13 in the prices of the same generic drug was beyond any explanation.
Coming to the wide difference between the prices of the raw materials imported by multinationals and national manufacturers, Mr Ahmad said that almost all raw materials for these branded medicines were imported either from India or China, which were least expensive.
“My field officers have collected the commercial invoices of the raw material imported from India and some European countries. For example, Lisinopril is imported from India at the rate of $525 per kg, while some of the firms imported it from Ireland at the cost of $7,200 per kg,” the minister noted.
“At the time of registration and issuance of licence, the manufacturer undertakes to import raw materials at the most competitive price. How and why such high-priced raw materials were adopted as the basis for determination of the price when much less expensive raw materials were available in the neighbouring country remains an enigma,” the health minister said.
He further observed that prescribing high-cost, brand-name medicines to the patient was against professional ethics.
He cited the prices pertaining to the brands meant for controlling cholesterol and said that it was due to the doctors that poor patients had to beg or borrow to purchase the medicine that cost about Rs662 per box, without even knowing that low-cost medicine of the same variety was also available at the cost of Rs80 or Rs90 per box in the market.
The minister also referred to the prices of some drugs sold by the same company in India and Pakistan and said that many of the medicines were being sold at a much higher cost in Pakistan, disregarding the parity between the currencies of the two countries.
