Medical associations boycott meeting with minister

The Sri Lanka Medical Association (SLMA) and the main Colleges this week turned down a meeting chaired by Health Minister Keheliya Rambukwella to discuss lowering drug prices, saying the priority was to solve dire medicine shortages and to stop the purchase of unevaluated drugs.

The influential medical community has been fighting for weeks against Health Ministry (MoH) moves to import drugs from locally-unregistered Indian suppliers—and to seek sweeping waivers of registration (WoR) from the National Medicines Regulatory Authority (NMRA) for hundreds of them.

This was one reason why the SLMA and the Colleges that had taken a “principled position” on the matter avoided the meeting with Minister Rambukwella, health sector sources said. However, it has now been resolved to hold regular discussions on all urgent medical matters and there is an indication of better participation by sector representatives.

Health Secretary S. J. S. Chandraguptha had invited the SLMA, the Sri Lanka Association of Clinical Pharmacology and Therapeutics and eleven Colleges to the February 1 meeting “to discuss matters on identifying list of commonly used Medicines where concession to be given [sic] to patients by way of a price control”. It had been summoned on the initiative of the Government Medical Officers’ Association (GMOA).

Consequently, the SLMA in collaboration with the SLMA InterCollegiate Committee called a virtual meeting at which “the subject matter of price reduction of medical supplies was thoroughly considered and discussed”.

“The participants held the view that the root cause of escalating prices of medical supplies are the shortage of essential drugs in hospitals and the unacceptable process of obtaining authorisation from the National Medicines Regulatory Authority (NMRA) to purchase unevaluated drugs,” SLMA President Vinya Ariyaratne wrote in a letter to Mr. Chandraguptha.

“Additionally, the participants expressed their cautiousness that their involvement in the meeting could be interpreted by the public as deviating from addressing the more urgent core issues related to shortages of medicines in the country,” Dr. Ariyaratne continued.

The establishment of a “core group” comprising representatives from all Colleges was imperative to address the crisis and “should not solely focus on controlling the prices of drugs involving only a selected number of Colleges”, the letter said. The SLMA and Inter-Collegiate Committee were willing to attend future meetings if the agenda incorporated their key points.

The Ceylon College of Physicians, the College of Surgeons of Sri Lanka, the Sri Lanka College of Obstetricians & Gynaecologists and the Sri Lanka College of Paediatricians also wrote to the Health Secretary.

“The very short notice given on the meeting, lack of any proposal outlining its implementation and expected contribution from us, would prevent us from giving a positive contribution to the meeting,” their letter said, adding that they would not attend.

“While the above measure [reducing the prices of drugs] will help to some extent the patients in the private sector, we would like to bring to your notice that our main concerns of public health care is the shortages of many medications as well as other consumables and the quality and safety of unregistered, non-evaluated medications to be brought into the country in the future,” they stressed.

The four Colleges recently conveyed to President Ranil Wickremesinghe “concerns and reservations” on the MoH’s request to the NMRA Board and its Medicinal Evaluation Committee (MEC) to bypass registration of around 300 varieties of medicines to be bought from India’s Savorite Pharmaceuticals (Pvt) Ltd and other companies through the Indian Credit Line “under a cover of a Cabinet decision”.

The SLMA had also previously opposed the move to the President. The College of Physicians (CCP), the SLCP, CCP and the Sri Lanka Association of Clinical Pharmacology (SLACP) separately sent letters of protest to the NMRA Chairman. The Sri Lanka Chamber of Pharmaceutical Industry (SLCPI) was the first to raise objections with the regulator.

The Patients’ Movement for the Rights of Patients (PMRP), too, has written to President Wickremesinghe saying it was “extremely disturbed by the news reported in the mainstream and social media with regard to the medicines purchased by the Health Ministry from India [sic]”.

“It appears these purchases are being made without following the stipulated regulations in the NMRA Act of 2015,” Christine Perera, PMRP Joint Secretary, pointed out. “Also, according to reliable information received, we are made to understand that appointments to the NMRA have been made without following the specific guidelines/regulations in the NMRA Act.”

“The regulations in the Act were stipulated to ensure the safety of patients, avert conflict of interest and minimize corruption,” Ms. Perera points out, requesting the President to take immediate action to “stop this controversial purchase till such time as an inquiry is made of the above serious allegations as these are life-threatening issues for all citizens”.

It appears these purchases are being made without following the stipulated regulations in the NMRA Act of 2015