Unaffordable Medication for Life

Cardiovascular and Diabetic drugs are to be taken for lifetime, for a patient to live a productive and happy life. The irony is that due to the current tough economical situation, the prices of such medicines have become an important factor, which restrains the patient from taking his medication regularly in the long run. This leads to a poor quality of life and low productivity for the low income segments, even though economical alternatives are available which can play a major role in improving a person’s quality of life.

Rising cost of medicines in Pakistan has rendered it less affordable for the common man. Our country needs to realign it’s national pharmaceutical policy urgently, to enable the poor man to buy his prescribed daily dosage of medicines.

In many cases, medication expenditure may demand up to 80 percent of a poor family’s household budget. Many of the lone bread-earners of the family are seen, selflessly skipping several doses of their daily medicines, every week, to make ends meet. This causes a harsh decline in the access to health-care, which is already a rare privilege for billions of families in Pakistan, due to the weak healthcare infrastructure in the country.

To resolve this issue, we need to compassionately evaluate the fairness of medicine prices in the country, while condemning the unfair prescription practices among some corrupt doctors, who suggest expensive drugs to poor patients, for personal benefits.

In case of a minimum daily wage earner in Pakistan, who earns Rs.500 daily; if he is prescribed to take an expensive Atrovastatin 20 mg, or a costly Clopidogrel 75 mg, cardiovascular tablet every day. This one tablet will cost him almost Rs.100 per day. This poor man will be spending 20% of his income on his medication, depending on his cardiac ailment whereas the same medication can cost him around a maximum of Rs.15- 20 per day dosage from a reputed national Pharmaceutical concern since there are other effective brands of the same formulations that are available for as low as One Rupee per day to 5 Rupees per day, but for “obvious” reasons many doctors are reluctant to prescribe these low cost yet effective products.

The Doctors do admit that sometimes the cost of medication that they are prescribing are on the higher side but surprisingly, they see the patient to be one of the main obstacle in prescription of Economical Quality Products. Many prescribers admit that due to absence of the practice of Family Physicians in Pakistan, the patients directly go to the specialist, instead of getting routed through the family doctors as is the practice in the West and all other countries.

These specialist due to their experiences and qualifications do charge high fees, which is understandable, however when the same patients are prescribed with economical medicines they are not sure whether the doctor has treated them correctly. This

mindset needs to change, the entire community and the media needs to work together for the same.

The Doctors also admit that there are some of them in their community who are involved in “activities” with companies however they feel that every doctor must consider the patient’s financial condition and prescribe the more affordable medicines, which must have a proven efficacy. This calls for some extra research and exploration on part of the doctor, but it surely is a noble task.

There is a sharp variation in the prices of medicines in Pakistan, although we are indigenously producing almost 90 percent of our country’s basic pharmaceutical needs. We must appreciate the vision of our policy makers back in the 1960’s and 1970’s. It is common knowledge, in Iraq during the crisis the majority of deaths were related to absence of medicines since Iraq did not have a strong local Pharmaceutical industry. The increased cost of pharmaceutical production has definitely increased the pressure on the Pharma sector, but the government must support fair-pricing practices and severely punish the companies that are clearly fleecing the poor patients.

Additionally, we also need to understand that the total cost of medicines comes to under 40% of the total bills for patients. Therefore, the government should also focus on the costs charged by various testing laboratories and Hospitals which increases the total cost of health care for a patient.

The regulators should simplify the complicated pricing mechanism and only fix the ceiling prices for each formulation, which will surely reduce the variation in prices. Variation in retail mark ups, taxes and wholesale prices are all increasing the price variability for the consumer. The prices of medicine in Pakistan may be lower than the other countries, however, if seen in relation with the purchasing power of the common man, the prices of several brands are still high and unfair.

Currently, in Pakistan, the prices of high-efficacy Amlodipine 5 mg ranges from Zamlo @ Rs 1.02 per tablet to Norvasc @ Rs. 10.14 per tablet. Amlod is a mid-priced option @ Rs. 5.54 per tablet. Similarly the price variation in the renowned Atrovastatin 20 mg ranges from Colezaf @ Rs 8.50 per tablet, while Lipitor is @ Rs. 95.93 per tablet. A medium priced option is Lipiget @ Rs. 21.25 per tablet.

The prices of effective Clopidogrel 75 mg ranges from Clotnil and Lowpat @ Rs.11.00 per tablet to Plavix @ Rs. 102 per tablet. When we analyze the Pioglitazone 15 mg + Metformin 500 mg prices, we find that Diglyta Plus is priced @ Rs 2.79 per tablet, while other brands are all priced at almost Rs 6 per tablet.

In the medicine industry the options for the doctor and the consumer are decreased due to; Price-based market segmentation, excessive branding differentiation (without much variation in the chemical ingredients), aggressive advertising, unfair sales-promotion and vague information on pricing. Inconsistency and bias in the pharmaceutical policy and health policy can be a main cause of variable and high medicine prices.