It has taken a long time coming. But the promise to reduce the price of medicinal drugs while ensuring their quality finally seems to be nearing fulfillment.
For nearly six decades Lankan patients have waited patiently for affordable quality drugs dished out on a regular basis and constantly monitored and reviewed by experts in the field. That process towards realizing the elusive dream began when the Sri Lanka Essential Medicines List (SL-EML) was created for both, state and private sector hospitals. In addition, the Ceylon Hospitals Formulary was published by the late Prof Senaka Bibile to provide information for the use of these medicines.
Prof. Bibile also set up an International Procurement System which decreased costs and at the same time increased the availability of these medicines. The same process gained further mileage when in 1985, Sri Lanka made its first publication of an Essential Drug List on the recommendation of the World Health Organisation. Since then the List has been revised periodically on the advice of several expert committees. Director, Medical Technology and Supplies Dr B.V.S.H. Beneragama in a foreword to the SL-AML stated the following objectives: ensure availability of efficacious, safe and good quality medicines regarding health care to the people of Sri Lanka in a sustainable and equitable manner; promote rational use of medicines by health care professionals and consumers; promote local manufacture of essential medicines.
In 2009, the Committee of experts, set up for the fourth revision of the list, attempted to follow the WHO recommended process in selecting essential medicines and used the WHO model list as a template. But, it ran into problems. The difficulties were mainly related to actually implementing the WHO list of Essential Medicines. These included; difficulty to make a decision on some medicines due to lack of adequate local data, lack of data on disease burden for the country as a whole as most annual data even from the state sector were not currently update or forthcoming; unavailability of some medicines in the required strengths and dosage forms as they were not registered.
Seven years on, the question on everyone’s lips is “How long more do we have to wait for that overdue promise to realize?”
Announcement
Not very long - if the Health Minister’s recent announcement reported in all media, is to be taken at its word.
On September 23, this year, Healthcare, Nutrition & Indigenous Medicine Minister Dr Rajitha Senaratne declared, that within the year or at least by early next year, he would personally ensure that drug prices would be reduced.
It would be done in different stages; prices of 47 essential drugs including heart and diabetes drugs would be reduced under the first phase of the National Drug Policy (NDP) and prices of more drugs at a later stage.
That the announcement of the formula to reduce drug prices came during the 39th Prof. Senaka Bibile commemoration at the Sri Lanka Foundation Institute (SLFI) Auditorium, organized by the State Pharmaceutical Corporation, at which the Minister was a distinguished invitee, was all the more significant, with the Minister reportedly making it a point to say the NDP introduced by the late Professor was now being implemented.
That announcement won him the collective praise of Lankans whose lives are dependent on essential life saving drugs which for more than 90 percent of the population, still remain beyond their limited budget. Prior to that Sri Lanka’s National Drug Regulation Authority (NDRA) had agreed to issue the Gazette notification announcing the reduced prices of pharmaceuticals by August 31.
Registered drugs
Once the Gazette on reduced prices of medicine is issued, pharmaceutical companies will not be allowed to revise the CIF prices and arbitrarily increase the prices of medicines and other additional expenses, health sources said.
While there is a conflict of opinions over the so called essential drugs that have found their way into the list of registered drugs in the country, a pharmacologist said over 70 percent of 3,436 pharmaceutical product registrations were found to be drugs named in the country’s essential drug list. While the exact amount by which they will be reduced is still a matter of conjecture and being worked out, the Sunday Observer learns, they could be anywhere from 60 to 85% for the cheaper and most common drugs and about ten percent for the more expensive and less used drugs such as cancer drugs.
Asked if he could give us a date when the drugs would be reduced under the first stage, Director Medical Supplies Division Dr Kamal Jayasinghe said, it was not possible to give an exact date as the prices had not yet been gazetted. “Once the gazette notice is released we will reduce the prices immediately. But the Minister is the only one who will be in a position to take this decision”. Questioned on the proposed revised prices of the 47 drugs under the first stage , he said, it was difficult to say by how much a particular drug could be priced due to there being so many different brands for a single drug, such as, paracetamol for example.
Free stents
Asked when, and if cancer drugs would also be reduced soon, considering the number of patients in need of them, he said, these drugs would fall into the next phase. He also assured that all patients in need of an essential drug, whatever the disease, would be provided those drugs free of charge from any state hospital. “We have enough stocks to go round and the hospitals only need to call us when they want a drug. If it is a hard to get drug and we know in advance, we will import it”, he promised.
The Health Minister has also reportedly promised to provide free stents to needy heart patients, after learning that several patients postponed surgery due to the expenses involved in purchasing stents as the prices now ranged from Rs 60,000 rupees to Rs 100,000 per stent.
With hundreds of patients in the waiting list for heart surgery, we asked if these free stents could be provided in the near future.
“As they are costly and imported, we will be first calling for global tenders. Once an item is selected technically, and we have several bidders, whoever the supplier is, they will have to face strict lab testing according to our medical system before registering with us. Our maxim is assurance of a good product at a reasonable price which should be acceptable in quality and fair pricing.”
Since a stent is a life investment, we wondered how long a stent normally lasts. A heart specialist we contacted said, “It could be 10 or15 years, or more. But it depends on the quality of the stent. However, being inexpensive does not necessarily mean it is an inferior product”, he added. He said, free stents have been distributed to needy patients for sometime in state hospitals.
GMOA
Meanwhile, the Government Medical Officers Association (GMOA), which has welcomed the Health Minister’s recent announcement, has urged the Health Ministry to gazette the generic names of the 47 essential drugs whose prices are to be regulated according to the Senaka Bibile Drug Policy. Assistant Secretary, GMOA, Dr Haritha Aluthge told the Sunday Observer that under the National Medicinal Regulatory Authority (NMRA) a Pricing Committee had to be appointed to review the market situation before regulating drug prices. He charged, the 47 medicinal drugs which were being regulated were not commonly used drugs. “We don’t know what the drugs are and we need to know if the prices match the present scenario. That is why we have asked the Health Ministry to gazette the generic names.” Asked if the GMOA had held any talks with the Minister of this subject, he said, “We have held several rounds of discussions on this very subject but so far we have received only verbal responses. We want more than a verbal response. It should be in writing.”
Why is it so important?
Because, for a sustainable price revision, there should be a Pricing Commission and pricing formula.”
Hasn’t the NMRAS proposed that?
“Yes, but there has been no definite decision on it. We have told them, if a drug is imported there should be a maximum price and the highest price should be no more than 80 percent.
We have also pointed out that we don’t need to import so many brands in generic names, as it is a waste of our foreign exchange.”
The GMOA spokesman also emphasized the need for a Quality assurance lab.
When we asked if the lab already existing under the Cosmetics Devices Regulatory Act was not up to mark, his reply was, “It is not equipped to test all the drugs that come into this list or those later on. Some drugs now have to be sent to Singapore and Thailand for testing.
The Minister said, he would set up a hi-tech lab with Chinese assistance. We hope this will become a reality soon”. And as the battle of drugs soldiers on, we invite readers to send us their views.