Price control on 48 drugs: Hotlines kept busy

The Sunday Times checks the ground realities and finds more negatives than positives. Kumudini Hettiarachchi and Minushi Perera report

While pharmacies and drug importers scrambled to implement the recently-announced price control on 48 medicinal drugs, the Health Ministry set up two hotlines on Friday for public complaints.

On the first day alone there were around 60 calls on the hotlines handled by the ministry’s Disaster Preparedness & Response Division from 8 a.m. to 8 p.m., the Sunday Times learns.

“The complaints were about the Maximum Retail Price (MRP) not being followed by some pharmacies and also that some drugs on the MRP List were not available,” said Division Head, Dr. Hemantha Herath, explaining that his unit was facilitating the fielding of the calls.

Thereafter, the complaints are immediately sent for action to the National Medicines Regulatory Authority (NMRA) and the Director-General of Health Services, it is understood.

When the Sunday Times checked the ground realities, there were afew positives but more negative reactionswith regard to the MRP model. It was found that these 48 drugs are usually the fastest selling in the market.

The drugs which are caught up in the MRP model include oral suspensions, tablets, capsules, inhalations and an injection. The list covers drugs prescribed for bacterial and viral infections; diabetes, hypertension, high cholesterol, for heart attacks, thyroid issues, mental illness, seizures, asthma, gastritis, osteoporosis, to halt vomiting, prevent worm infestation and also non-steroidal anti-inflammatory drugs (NSAIDs).

“A few companies were able to react fast to the MRP(announced at midnight on October 21)and reduce the prices immediately but for others it is not such an easy task,” a source from one of the importers said, adding that they have to talk to their foreign principals. “We have to absorb the losses in the value-chain and as such need some kind of methodology. Even before that we need to take stock-checks which are time-consuming. It is only thereafter that we can negotiate with our principals, for the losses are huge.”

Another source pointed out that since Sri Lanka does not have an effective quality control mechanism, quality variations exist. This could impact the patients, for in case they switch brands there is a danger that the efficacy (effectiveness) may be impaired.

Citing the example of numerous brands of anti-diabetic drugs, a third source said that if the patients switch to a new brand as the one they are used to is unavailable because it has been taken off the shelf due to pricing problems, there may be parameter changes in his/her condition. However, his/her doctor may assume the changes are due to a progression in the disease – not because of the new drug – and increase the dosage.

Drug importers normally hold about 2-3 months’ stocks of a particular drug; the distributors about a month’s stocks and the pharmacies (retailers) about three weeks’ stocks.

There are about 3,500 pharmacies across the country and they will pass on the losses caused by the price-reduction to the importers, it is learnt.

Drug quality

A major issue brewing is whether importers of quality drugs (in the restricted list) would replenish existing stocks once they are sold. If they don’t, others who resort to unethical practices could flood the market with sub-standard drugs, many warn.

This could result in ‘informal and unregistered’ imports through ‘hand-carrying’ drugs into Sri Lanka while the flood gates will also open for such drugs to come in by post, said a source.

The Sunday Times was able to zero-in on some of the practical problems and confusion that have arisen in the implementation of the MRP:

(an antibiotic) – The MRP of the oral suspension with a strength of 156mg/5ml is Rs. 287.50 but what of the other

With quality of medicinal drugs and the need for testing being highlighted, the Sunday Times learns that under the National Medicines Regulatory Authority (NMRA) Act, the NMRA Chairman and top officials, under advice from the Technical Committee, have the power to restrict the import of drugs.

The old law looked only for ‘safety, efficacy, quality and affordability’ but the new Act has provision to consider ‘need and cost-effectiveness’.

Currently, the National Drug Quality Assurance Laboratory (NDQAL) under the NMRA tests about 20% of drugs, new samples and in post-marketing surveillance.

Plans are in the pipeline for a bigger laboratory, with Chinese support, for drug-testing. It is expected to be up and running and about two years. strength? Should the price be worked out through multiplication or should it be sold at the old price?

(an anti-hypertensive drug) – The 30mg tablet is Rs. 2.70; the 60mg is Rs. 8.90; and the 90mg is Rs. 21.40. How has this price structure been worked out? Usually, with the packaging etc., being the same should not the higher strength be of a lesser price? Will patients who need the higher strength, for example 90mg, be tempted to buy three 30mg tablets as it would cost less? Then what would be the impact on the disease?

Pharmacy reactions

Pharmacies, meanwhile, continued to grumble. It is good for patients but pharmacies should have been given time, was the view of many.

“Our life has become difficult because customers fuss about the prices of medicines that are not on the list,” said one pharmacist, concerned that patients were asking a lot of questions and the work in the pharmacy was being hindered.

He said that most medicines produced in Europe have pulled out because those companies cannot afford to sell them at the new price.

The Sunday Times found that smaller pharmacies have been able to adjust quickly because of lesser stocks, while bigger pharmacies are having a difficult time.

“Cutting prices are good for customers especially for those who cannot afford the brands. But pharmacies should have been given about a month’s time to adjust the prices,” he said.

Another pharmacist who sells medicines imported from Europe as well as those manufactured by the State Pharmaceutical Corporation (SPC) said that one or two companies have requested him not to sell their drugs. Sales have gone down but the expenses are still the same and the reality will come to light only after about