Govt for lower drug prices, against aggressive marketing

Patients in Bangladesh are grappling with one of the highest out-of-pocket (OOP) expenditures in the South Asian region, and the latest Bangladesh National Health Accounts (BNHA) report firmly establishes medicine costs as the leading cause for this predicament.

Medicines are being sold in the country at a significantly higher markup, and industry insiders say the aggressive marketing tactics used by pharmaceuticals is the reason behind high drug prices.

For instance, doctors get gifts, even expensive ones such as household appliances, cars and apartments to prescribe a particular brand of medicine, thereby allowing pharma companies to drive up prices and corner the market unfairly.

To break this vicious cycle, officials from the health ministry and its directorates are working on reducing medicine costs effectively by bringing positive changes in the pharma marketing policy that had been continuing since Bangladesh inception.

Making the disclosure at a dissemination programme for a report titled “Bangladesh National Health Accounts 2020” held in the capital on Wednesday, officials added that they will also bring positive behavioral changes to doctors in this regard.

They are planning to develop a unified treatment protocol for private healthcare institutions so that the OOP expenditure can be brought down significantly.

Additional Director General (ADG) of Directorate General of Health Services (DGHS) Prof Dr Ahmadul Kabir said, “If prescriptions are made based on evidence only, the medicine costs will drop by 50 per cent, this in turn would help drop the OOP by 30 per cent to 35 per cent.

“We are trying to introduce a health protection scheme and bring the private healthcare sector under a regulatory framework. If possible, we will move forward through a public-private partnership, so that we can ensure more effective monitoring and supervision.”

He added, “We are launching more one-stop emergency services at government hospitals, so that fewer patients feel the need to get admitted.”

Secretary of the Health Services Division Dr Md Anwar Hossain Howlader admitted that there is pressure on them to increase medicine prices.

“We do not want to add woes to our people, and so we are looking into the aggressive unethical drug marketing policies to curb OOP expenditures,” he added.

Director General of Directorate General of Drug Administration (DGDA) Maj Gen Mohammad Yousuf said, “We have already written to the Bangladesh Association of Pharmaceutical Industries (BAPI), and will soon meet them to discuss possible changes.

“Doctors need to be convinced to change their habits as well. Such changes cannot be made overnight as these habits have persisted for over 50 years.”

Shahan Ara Banu, DG of Directorate General of Family Planning, said “To decrease the out of pocket expenditure of patients at private hospitals, we need to bring such institutions under a unified treatment policy or protocol. This will help us decrease OOPs significantly.

Report’s findings

Subrata Paul, focal person of BNHA Cell at the ministry’s Health Economics Unit said during his presentation, “Around 69% of total health expenditure in 2020 are out-of-pocket (OPP), which is around 3 per cent higher compared to 2019.

Medicines are big expenses, as drug purchases occupy around 64 per cent of the OPP. The high share of OOPs in healthcare is driven by the rich segment of the population.

A breakdown of the household OOPs showed that in 2020, the richest 20 per cent population in the country spent around Tk 22,310 crore of the total OOPs, around 42 per cent of it.

The overall household expenditure under OOP is Tk 34,400 crore for medicine purchases, followed by ambulatory medical services (from private practitioners) where they spent Tk 7,200 crore.

Other OOP segments are medical and diagnostic facilities at Tk 6,243.3 crore or 11.7 per cent, and hospital costs are Tk 5,364.9 crore or 10.1 per cent.

The government expenditure for healthcare has gone up $37 in 2017 to $54 in 2020 per capita, still the lowest in South Asia.

Speaking as Chief Guest at the event, Health Minister Zahid Maleque said, “While calculating the overall healthcare expenditure, the government’s passive investment is never considered.

“If such factors are taken under consideration, the government’s share would have gone up to $100 or $150.”