Most of the 117 medicines declared essential by the government are now scarce in Bangladesh. The drugs are unavailable at pharmacies in government hospitals and in the private market. Companies are losing interest in producing them because prices on a list drawn up three decades ago have remained unchanged. Patients unable to find the medicines are paying more for extra formulations or third- and fourth-generation alternatives, increasing the risk of long-term health complications.
Paracetamol is among the most widely used medicines on the essential list.
The 500 mg drug is used for common fever, colds, flu and initial body pain. About 100 companies have licenses from the Directorate General of Drug Administration to produce and market it, but only a handful manufacture it throughout the year. Shortages therefore emerge during peak periods for dengue or other diseases. In recent years, companies have used the opportunity to sell higher-priced products with added formulations under names including Napa Extra, Napa One, Napa Rapid, Napadol, Napa Extend, Ace Plus and Tamen Turbo. Patients who could have used standard paracetamol are influenced by promotion to buy more expensive versions with additional formulations. Similar practices occur in other generic groups, and patients are developing health complications from some of the added formulations.
Amoxicillin 500 mg capsules are a low-cost, first-line antibiotic widely used to treat respiratory infections, ear and throat inflammation, urinary tract infections and bacterial skin diseases. DGDA data show that more than 50 pharmaceutical companies are licensed to produce the medicine, but only 8 to 10 do so. Because the commonly used and relatively inexpensive drug is not readily available, many doctors prescribe costlier fourth- and fifth-generation antibiotics. Patients face higher costs as well as long-term risks including antibiotic resistance.
Cefuroxime is used for many conditions that can also be treated with amoxicillin, doxycycline or flucloxacillin, all three of which are on the essential medicines list. A 500 mg dose of cefuroxime with clavulanic acid costs Tk 55 to Tk 85 depending on the company, while amoxicillin 500 mg costs only Tk 7.5, doxycycline 100 mg Tk 2.5 and flucloxacillin 500 mg Tk 14. A modest increase in the prices of these low-cost essential medicines could encourage companies to produce them and spare patients from buying more expensive antibiotics.
Health experts say patients could complete treatment at much lower cost if the essential antibiotics were readily available, while avoiding the risks associated with stronger antibiotics.
Ciprofloxacin is known as an effective antibiotic for respiratory and urinary tract infections. Visits to large pharmacies found products from at most 15 to 20 companies. Although the medicine is on the essential list, many companies have largely stopped making it because the government-set price is far below raw material import and production costs.
Another problem is the wide price difference among brands made by different companies. The disparity is alleged to be deceiving consumers and placing medium and small pharmaceutical companies at a severe disadvantage.
Market checks found that companies have been approved to sell azithromycin 500 mg tablets at prices ranging from Tk 27 to Tk 50 each. Different approved prices for the same generic medicine have drawn mixed reactions. Although DGDA authorizes companies to produce medicines using current good manufacturing practice standards, allegations persist that it approves unequal prices. Companies assigned lower prices say they have faced discrimination for years, while influential first-tier companies are accused of securing better rates.
Sheikh Zahir Raihan, a professor and former chairman of the Department of Clinical Pharmacy and Pharmacology at the University of Dhaka, said essential medicines should be readily available at every public and private hospital, but the country was seeing the opposite. Every licensed pharmaceutical company is legally required to produce a share of essential medicines, he said, but compliance is not being properly monitored. Considering higher international raw material prices, energy costs and other factors in recent years, policymakers and manufacturers urgently need to review prices so the medicines become accessible, he added.
Novatek Pharmaceuticals Managing Director Md Mostafizur Rahman said it was time to revise prices for many medicines, including those on the essential list. Fuel costs, severe global raw material shortages, currency fluctuations and other pressures had not been matched by a major or rational adjustment to the price structure in three decades, he said. Market costs now exceed prices fixed by the government years ago, causing losses for companies. A small, rational increase could encourage more companies to manufacture essential drugs and benefit patients. Rahman also said small and medium companies faced discrimination because different prices were approved for the same generic medicine despite identical raw materials and production processes.
People involved in medicine production said government policies also contribute to rising prices. Bangladesh has the highest medicine VAT and tax burden in South Asia, applying to essential and other drugs. Manufacturers pay 15% VAT and retailers up to about 2.5% more, for a combined burden of roughly 17.5%. By comparison, the total is only 5% in neighboring India and about 1% to 2% in Pakistan.
Bangladesh Association of Pharmaceutical Industries President and Incepta Pharmaceuticals Ltd Chairman Abdul Muktadir said the industry had repeatedly asked the government to revise medicine prices in light of global conditions and hoped officials would consider the request. Different prices for the same generic medicine also required a rational solution, he said.
DGDA Director Md Akhtar Hossain said discussions were under way to form a Health Ministry technical committee on the availability of essential medicines, updating the list and other issues. Once formed, the committee would submit recommendations to the government, which would guide action by the government and DGDA.
বাংলায় মূল প্রতিবেদন পড়ুন · Read the original Bengali report