Timely increase in drug prices to greatly help patients

LAHORE: The increase in the rates of numerous drugs without approval from the Drug Regulatory Authority of Pakistan (DRAP) is being hotly debated, although many companies in the recent past have gotten away with similar unilateral increases.

The first increase in the rates of drugs was made by domestic pharmaceutical concerns and the latest was by multinational companies. The law prohibits increase in prices of drugs without prior approval of the DRAP.

Still for the first time in the history of Pakistan, the pharmaceutical companies defied the law and the domestic companies that increased the prices succeeded in getting those prices ratified by DRAP at slightly lower rates.

Perhaps DRAP’s slow response time on requests for price increase gave the companies courage to announce the unilateral increases and obtain stay order from the courts. In case of domestic firms, the courts after hearing the cases, asked the DRAP to fix the prices in line with the genuine increase in cost. 

The law allows the pharmaceutical companies to apply to DRAP for price increase in case they find it unviable to market the drugs at the prices notified. The response of the regulator on these requests has always been lopsided.

Some companies were allowed increase in price a few weeks after the request, whereas in many cases, the request for increase was not taken up by the regulatory authority for years. One multinational, GSK, in a letter to its dealers has said requests for increase in the rates for some drugs were made in 2012.

The companies would probably cite these extraordinary delays in acceding to the request for increase as the reason for making the unilateral increase in the best interests of the patients. This is because patients suffered when they stopped manufacturing the unviable drugs.

The regulator has the option to refuse increase in price but only after duly hearing the case of the company by its pricing committee. Unfortunately, the numbers of requests for price increase are in thousands, while the pricing committee hardly meets once a month and takes up cases of a few drugs.

There is no priority that those that applied first would be heard first. This is the reason that requests dating back to 2012 are pending and requests made in later years were entertained.

Drug regulation is essential, including the prices of the drugs, but discretion of giving priority to requests for price increase cannot be given to the regulator.

 If it lacks capacity to take up all requests for price increase then the government should either strengthen its capacity or for the time being adopt pricing mechanism suggested by World Health Organisation.

The precedence of unilateral price increase bypassing the regulator is dangerous and should have been avoided. However, we must keep in mind patients suffer when there are inordinate delays in taking up price increase requests by the regulator.

The DRAP would have to put its house in order as its decisions have far reaching impact on the health of the nation. Take for example the case of Hepatitis C medicine. Every third Pakistani is suffering from Hepatitis C and its treatment is very expensive and uncertain.

An American company introduced a drug in the United States that has a cure rate of 90 percent. A patient has to take 84 tablets in three months. Each tablet costs $100 (Rs10,700) in United States. Pakistani patients cannot afford this price.

The company lowered its price for Pakistan, making it possible for a Pakistani company to market it at Rs1,178 per tablet, which meant the entire treatment would be possible in Rs99,000. This meant the price of 84 tablets in Pakistan was less than the price of the same tablet in the United States.