Opaque pricing

Published July 31, 2019
The writer is the author of Patient Pakistan: Reforming and Fixing Healthcare for All in the 21st Century.
The writer is the author of Patient Pakistan: Reforming and Fixing Healthcare for All in the 21st Century.

THE World Health Assembly, the annual gathering of the member states of the World Health Organisation and health leaders, was held a few months ago. The assembly attracted global attention for the novelty and boldness of some of the items on its 2019 agenda. One of the items which attracted special attention was Italy’s resolution, sponsored by 20 other countries, calling for “improving the transparency of markets for medicines, vaccines and other health products”.

Coming on the heels of an outcry against exorbitantly priced drugs, the resolution was adopted by member states, with the UK, Germany and Hungary distancing themselves from the final resolution. The latter, though considerably watered down to accommodate the UK and its other nay-saying allies, asks governments to ensure greater public disclosure of drug prices, vaccines and other health products.

The resolution also seeks to strengthen governments’ hand in negotiating fair drug prices with the powerful pharma industry in the wider interest of public health. Govern­ments as well as consumer-oriented and health-rights civil society organisations have pledged to use the resolution to bring more transparency to the way drug prices are determined. For instance, French civil society has already set up a monitoring centre for the implementation of the resolution in France.

Drap has failed to play its role in regulating medicine rates.

Pakistan can look into this to reform its opaque drug-pricing mechanism and inject greater transparency into the way medicine prices are fixed and determined. In Pakistan, rising drug prices have been a serious concern for some decades now. This concern caught the attention of the mainstream media early this year when drug rates were arbitrarily increased well beyond the officially allowed price increase. The rationale offered was unclear.

Opposition parties have cried foul and hinted at possible price collusion between top officials of the government and the industry. In the public outcry that followed, the health minister, Amir Kiyani , was shown the door. His sacking was linked to his role in the alleged drug pricing scandal. The new special assistant to the prime minister on health, Dr Zafar Mirza, has an impressive background in public health advocacy at home and globally. He promised a rollback of the arbitrary price rise.

In so far as the price hike is concerned, there is a common misperception that there has been an effective price freeze for the last decade. Yet this does correspond with the experience of chronically ill patients. Ask any patient on long-term medication and he/she will tell you that small unannounced price rises have been a regular feature over the last many decades. If you couple this with the price hikes instituted and maintained through stay orders then the fiction of the decade-long price freeze falls apart.

The continuing unchecked price hikes show the abysmal failure of the Drug Regulatory Authority of Pakistan (Drap) which has been either wilfully negligent or thoroughly incompetent in ensuring stable and affordable prices in the interest of accessible and affordable healthcare for all. Despite the new special assistant’s good intentions, the expected price reduction has not materialised thus far. (Sounding out local pharmacies confirms this.)

Instead, the prices of some medicines have actually gone up where they should have decreased. Alongside this, the pledge voiced by many ministers to recover the excessive price charged and depositing the recovered money in Baitul Mal also remains unimplemented.

The prime minister’s special assistant on health has acted swiftly to mobilise the international and local response to the HIV outbreak in Sindh. The World Health Assembly’s resolution on drug-pricing transparency offers him an opportunity to push for greater openness in the way drug prices are determined, calculated and implemented. There has always existed a great deal of secrecy around drug-

pricing issues. This secrecy has been compounded by the incompetence of Drap which has come in for a great deal of criticism for its role in the price hike and its inability to introduce transparency and openness in the drug-pricing determination process and implementation.

The new health adviser’s claim to implement the price rise rollback decision and the failure of the regulatory body to implement the decision does not reflect well on the capacity and will of the regulatory and implementing agencies. This yet again underscores the need for wholesale reformation of Drap as well as ensuring transparency of drug-pricing deliberations and processes. The World Health Assembly’s resolution offers a fresh opportunity for a renewed push on the issue of affordable and accessible medicine.

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, July 31st, 2019

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