In Bangladesh, the critical issues of essential medicine list and pricing are closely tied to people’s well-being, livelihoods, and financial stability. Given that a significant portion of healthcare expenses in the country is paid out of pocket, with medicines accounting for a substantial share, these matters carry immense importance. Determining which medications are essential, setting their prices, and ensuring their continued availability are not just administrative tasks but integral aspects of public health policy.
The recent scrapping of the Essential Medicines List 2026 and the Medicine Price Determination Method 2026 has brought renewed attention to these longstanding concerns. As these policies were never put into effect, their cancellation is not expected to have an immediate impact. However, it presents an opportunity to pause, learn from past challenges, and devise a more robust, practical, and evidence-based framework moving forward. In the interim, the existing legal framework will remain in force.
Since 1994, Bangladesh has predominantly utilized a cost-plus pricing model for 117 essential medicines, where a predetermined markup is added to the costs of raw materials and packaging. The issue arises from the infrequent adjustments in prices, with the last comprehensive revision taking place in 2022. Consequently, the production of many essential medicines has become financially unviable, leading several manufacturers to halt production of these unprofitable drugs.
It is crucial to acknowledge that medicines are commodities subject to commercial dynamics. Their pricing should reflect changes in production expenses, encompassing raw materials, labor, energy, packaging, transportation, and currency exchange rates. Failure to align prices with escalating costs could render the gap between regulated prices and actual production expenses unsustainable over time. This mismatch may discourage production and diminish market supply, posing risks to both patients and manufacturers.
A key hindrance to addressing this issue has been the political reality, as governments often hesitate to adjust medicine prices due to concerns about public backlash. However, disregarding economic realities does not make them disappear. If regulated prices fail to mirror actual production costs, manufacturers may gradually cease producing low-cost essential medicines. A pricing strategy that undermines the sustainability of the pharmaceutical sector ultimately compromises patient welfare in the long run.
The central policy objective should be clear: ensuring medicines remain affordable for patients while providing manufacturers with prices that support the production of quality drugs without incurring losses. Affordability and industry sustainability are not conflicting goals but rather essential components of effective public policy.
To achieve this balance, establishing a robust, multidisciplinary technical taskforce under the newly formed National Drug Advisory Council (NDAC) could be beneficial. This taskforce would primarily serve as a body for generating evidence and technical insights, while the NDAC and the government would be responsible for making final policy decisions within the legal framework. This collaboration would combine technical expertise with legal and institutional oversight.
When formulating a new essential drug list, the primary consideration should be what defines a medicine as essential. Merely being widely used or sold should not be the sole criteria. The evaluation should factor in disease prevalence, mortality rates, treatment indispensability, efficacy and safety evidence, availability of alternatives, cost-effectiveness, patient financial burden, alignment with clinical guidelines, and national health system significance. Such a comprehensive approach would ensure that the essential medicine list reflects public health priorities rather than market demand or historical norms.
Similarly, medicine pricing demands a realistic approach. While the cost-plus formula served its purpose in the past, the current market dynamics necessitate a more sophisticated strategy. Simply applying a fixed markup to raw material costs is no longer sufficient. Prices must be regularly reviewed to adapt to shifts in production expenses, exchange rates, raw material prices, and broader market conditions.
However, the bureaucratic landscape in Bangladesh poses challenges to timely price revisions. Since medicine prices are determined through government processes, necessary adjustments can be delayed due to bureaucratic and political factors. One potential solution could involve establishing an independent authority to regulate drug prices, drawing insights from successful models in other countries like India’s National Pharmaceutical Pricing Authority. This specialized body could conduct regular price reviews based on defined rules, production cost data, and market insights. If granted operational independence within a clear legal framework, such an authority could alleviate the government’s burden in adjusting medicine prices.
Nevertheless, there are valid concerns about creating another regulatory body, as it could increase administrative and compliance expenses for pharmaceutical companies, potentially exerting additional pressure on medicine prices. Thus, creating a new authority does not guarantee improved regulation.
The Bangladesh Association of Pharmaceutical Industries (BAPI) has argued that, akin to other goods, medicine prices could be primarily determined by manufacturers and moderated through market competition. In a competitive market environment, companies must consider consumer demand and purchasing power while covering production costs and ensuring business sustainability. This approach would also reduce direct governmental involvement in setting individual medicine prices.
However, medicines are not conventional products but essential, sometimes life-saving commodities. Relying solely on market forces for pricing could expose patients to exorbitant costs, while excessive price controls might hinder production and distribution.
Therefore