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Patients are fast losing access to medicines

28 Aug 2022

By Maheesha Mudugamuwa   Anoma Fernando, a 45-year-old Malabe resident suffering from type 2 diabetes, said she had stopped her prescribed medication since April this year as she could no longer afford it. “I decided to stop taking my medicine so that I can afford treatment for my mother and husband, whose conditions are more severe than mine,” she told The Sunday Morning last week, while she was purchasing medicine from one of the private pharmacies in Athurugiriya.    Anoma has come to Athurugiriya in search of several prescribed medicines that were out of stock in most of the pharmacies around Malabe. “This is, I think, the 10th pharmacy I went to today,” she stressed. “My mother is 75 years old and her health is a bit complicated. She is a kidney patient suffering from high blood pressure, diabetes, cholesterol, and anxiety disorders. My husband has asthma and he is suffering from diabetes and cholesterol, so I have no option but to prioritise them. I know once I stop I will have to deal with my condition, but as of now, I’m not feeling so bad,” Anoma said.   She went on to say that the total monthly medicine cost for all three of them was now somewhere around Rs. 50,000 per month. “We can’t afford this anymore with all other necessary expenses of the family,” she stressed, adding that her husband, who decided to go to a Government hospital clinic to get medicine free of charge, had returned home empty-handed after waiting in a long queue for nearly five hours. According to Anoma, many have suggested that her husband should visit a Government hospital to obtain free medicine, but now they have lost hope for free health access, for which Sri Lanka is well-known. “Only the rich can access private medicine now, and we, the middle-class, are suffering,” she said with a sad smile on her face.   Price revisions affect millions    Anoma is one among thousands of patients who are now gradually stopping their prescribed medicines due to high prices following the most recent price revision in April. The recent price revisions have affected millions of Sri Lankans as they go through one of the worst economic crises in the country’s history. The ongoing crisis has caused a dramatic increase in the prices of almost all essential commodities and services, adding an extra burden on the shoulders of taxpayers. Piyal Weerakoon, a retired State employee from Nugegoda, charged that the burden of the economic crisis had now been put on the taxpayers as the Government and other businesses passed the additional costs to citizens without finding a way out. “It always comes to us. Even if there is a fuel price increase or an increase in electricity prices, every business puts that burden on our shoulders,” he lamented. Unlike other industries, there should be some control in the pharmaceutical industry because it dealt with the lives of the people, Weerakoon stressed, questioning: “What would you feel if you can’t save a loved one because you can’t afford medicine? We are gradually reaching that level as the pharmaceutical companies keep asking for high prices while the Government hospitals too have failed to meet the growing demand,” he stressed. “I barely meet my expenses. I have only my wife and myself since my three children are now grown up and live abroad, but what about the millions of low-income and middle-income families? Can they afford it?” Weerakoon questioned.   Pharmaceutical industry under pressure   The current economic crisis directly affects the medicine prices too as the country’s pharmaceutical industry mainly depends on imports. Despite several pharmaceutical items being manufactured locally, Sri Lanka mainly relies on imports to meet its domestic demand for medicines. Currently around 85% of the country’s pharmaceutical needs are imported. According to the Board of Investment (BOI), the medical and pharmaceutical expenditure of the country in 2020 was recorded at $ 599.5 million. By 2022, this is expected to reach $ 750 million, posting a five-year Compound Annual Growth Rate (CAGR) of 4.1%.  In 2019, medical and pharmaceutical product imports reached a value of $ 553 million which accounts for 2.8% of total imports and this is expected to reach $ 700 million by 2025, with a CAGR of 4%. Currently, 85% of pharmaceutical needs are imported and about 15 local manufacturing plants including the State Pharmaceuticals Manufacturing Corporation (SPMC) provide the balance 15% of the requirement with an estimated value of Rs. 18 billion annually.  It is evident that the depreciation of the rupee against the dollar has severely affected the country’s pharmaceutical industry and as a result, the local pharmaceutical prices have been revised twice this year to meet the gap caused by the drastic devaluation of the rupee last year. In March, prices of 60 essential drugs were raised by 29% by an Extraordinary Gazette notification. The Gazette notification stated that every manufacturer, importer, trader, distributor, pharmacist, medical practitioner, dentist, veterinary surgeon, as well as medical institutions, including private medical institutions, pharmacies, or persons in possession of the relevant drugs for the purpose of sale, should display their Maximum Retail Prices (MRPs). Following this revision, a total of 60 essential medicines have prescribed MRPs. Again, in April, former Minister of Health Prof. Channa Jayasumana issued a special gazette notification allowing a 40% increase in the prices of 60 pharmaceutical drugs. According to the extraordinary gazette notification issued by the Minister of Health on 28 April 2022, every trader, distributor, pharmacist, medical practitioner, dentist, veterinary surgeon, medical institution, including a private medical institution, pharmacy, or person who or which is in possession of the scheduled medicines for the purpose of sale, shall maintain the price of the scheduled medicines at the maximum retail price or revised retail price, whichever is less. Last year, the 9% price hike on drugs led to an increase in the prices of several essential medicines including azithromycin (oral antibiotic), albendazole (used to treat parasitic worm infections), amoxicillin (antibiotic), paracetamol (used to treat fever and mild to moderate pain), and cefuroxime (antibiotic).   Shortages loom   One of the main reasons for the recent price hikes is the severe shortage of essential medicines in local markets. Industry experts said the shortages had arisen because pharmaceutical importers were limiting their imports as a result of losses incurred due to the rupee depreciation. Whenever prices are revised the shortages ease, but return once again as they have in the past few weeks. The Sunday Morning learns that there is a shortage of a variety of essential and vital drugs in the local market as well as in the State sector. The main reasons, as highlighted by medical experts, are the delays in procurement of the drugs and delays in getting approval for necessary finances to bring down the medicines. Speaking to The Sunday Morning, Government Medical Officers’ Association (GMOA) Executive Committee Member Dr. Prasad Colombage said there was a looming shortage especially in rural areas, which was mainly due to the delay in processes. “There are shortages of several essential drugs,” he said, adding that the situation arose as a result of the delay in getting the processes completed on time. “We notice a delay in procurement as well as in getting down the already-approved funds,” he stressed, while urging the Government to expedite the process and bring down the necessary medication on time before the current situation worsened. With shortages mainly recorded in the State sector, many hospitals have been given permission to go ahead with local purchases when dealing with severe shortages. However, the GMOA said the process of local purchasing of medicines by hospitals was corrupt and therefore the Government should expedite the process and bring down the medicine as soon as possible. As per the mid-year fiscal position report of 2022 issued recently by the Ministry of Finance, the total Government expenditure on health including Western and indigenous medicine sectors has increased by 4.8% to Rs. 95,729 million during the first four months of 2022 compared to the same period of 2021 covering both Provincial and Central Government health expenditure. Out of the total health expenditure, the recurrent expenditure was Rs. 87,447 million and the capital investment was Rs. 8,281 million. Under medical supplies – one of the major categories under recurrent expenditure – Rs. 20,143 million had been spent on pharmaceuticals, surgical items, and laboratory equipment.   Risk of NCDs   Meanwhile, Academy of Health Professionals (AHP) President Ravi Kumudesh warned of a rise in Non-Communicable Diseases (NCDs) and related deaths in the near future as many patients were now delaying taking medication, mainly due to high costs. He stressed that this would be the next health disaster and the cost would have to be absorbed by the Government. Kumudesh also stressed that the previous medicine shortage was not as severe now as many patients were not taking their prescribed medication. “Due to the high costs and the ongoing situation in the country, patients are delaying their treatment and some are stopping treatments halfway,” he stressed. However, he warned that this would pose a major health threat as NCDs could cause serious health effects if not treated properly.   Industry seeks more   While people are overwhelmed with high costs, the pharmaceutical industry says it is barely surviving amid the current economic crisis due to high import costs. Speaking to The Sunday Morning, Sri Lanka Chamber of the Pharmaceutical Industry (SLCPI) President Sanjiva Wijesekera said the present price adjustments were based on exchange fluctuations and had omitted inflation, borrowing rates, fuel costs, and other important aspects. “The Sri Lankan Rupee has seen about 82% depreciation. For the money we borrow from banks, we have to pay an interest rate of 24-29%. Apart from that, other operational cost escalations like fuel and so on, are affecting the industry badly in the absence of pricing mechanisms,” he stressed. Wijesekera added: “The prices we got are in line with costs when the dollar was Rs. 350, but the prevailing rate is Rs. 370 as per the Central Bank. There is a difference of about Rs. 20 there. Apart from that, when our working capital income is not sufficient, obviously companies need to borrow from banks with interest rates of 24-29%. That badly affects the industry. The cost of fuel has also gone up. Whenever they give price adjustments, they don’t consider the cost of fuel adjustments. That’s why they say that there should be an index for inflation and cost of fuel. When a price is regulated and if there is a mechanism, that mechanism should be a holistic mechanism, not only based on the dollar.” Responding to industry claims, Health Minister Keheliya Rambukwella said there would be no more price adjustments for the pharmaceutical industry as the Ministry had approved adjustments recently. Highlighting that the current processes had been expedited to bring down essential medicines, the Minister told The Sunday Morning that the current shortages were under control and the experts were looking into the matter and exploring possibilities of managing the shortages using substitutes.  


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