Islamabad: Hundreds of thousands of patients with cancer, heart disease, glaucoma and other life-threatening illnesses are facing severe hardship as shortages of several essential medicines worsen across Pakistan.
The crisis follows the federal government’s failure to decide on recommended price increases for 105 hardship-category medicines for more than two and a half years, forcing many manufacturers to halt production.
Among the medicines that are either unavailable or in critically short supply are oral morphine capsules (10mg and 30mg) for severe cancer pain, streptokinase injections for heart attacks, chemotherapy medicines including cisplatin, carboplatin and doxorubicin, pediatric digoxin liquid, pilocarpine eye drops, yellow fever vaccine, folic acid tablets and several immunoglobulin products, according to pharmaceutical industry and DRAP officials.
Officials of the Drug Regulatory Authority of Pakistan (DRAP) confirmed that price revision cases for 105 hardship-category medicines have remained pending since February 2024 despite recommendations by the Drug Pricing Committee.
Officials familiar with the process said the committee found production of several essential medicines commercially unviable because of soaring manufacturing costs and recommended price adjustments under the Drug Pricing Policy. The cases were subsequently forwarded through the Ministry of National Health Services, Regulations and Coordination to the federal cabinet.
However, despite the passage of more than two and a half years, no final decision has been taken, leaving manufacturers unwilling or unable to continue producing many of these medicines.
A senior DRAP official, requesting anonymity because he was not authorised to speak publicly, acknowledged shortages of several hardship-category medicines but maintained that DRAP had completed its regulatory responsibility.
“The cases were processed under the policy and recommendations were forwarded to the government. The final decision rests with the federal cabinet and the government has to decide in what it considers the larger public interest,” the official said.
The prolonged delay has resulted in repeated shortages of critical medicines at hospitals and pharmacies, particularly injectable cancer drugs, morphine preparations and other specialised medicines with few or no therapeutic alternatives.
The shortage of morphine has been particularly devastating for cancer patients requiring palliative care, with oncologists warning that many patients are forced to endure unbearable pain or rely on less effective alternatives.
Ophthalmologists have also warned about shortages of pilocarpine eye drops used in glaucoma and emergency eye conditions, while cardiologists describe streptokinase as a life-saving clot-dissolving medicine for heart attack patients, particularly where more expensive alternatives are unavailable.
Industry representatives argue that the crisis reflects a contradiction in Pakistan’s drug pricing system, where prices of many non-essential medicines have increased, but hardship-category essential medicines remain frozen despite rising costs of imported raw materials, packaging, utilities, transportation, labour, exchange rates and financing.
Abdul Samad Buddani, Chairman of the Pakistan Chemists and Druggists Association (PCDA), warned that the prolonged failure to revise prices of essential medicines was creating a vacuum increasingly being filled by counterfeit and spurious drugs, including cancer medicines and other life-saving products.
Officials of the Pakistan Pharmaceutical Manufacturers’ Association (PPMA) said successive governments had repeatedly delayed decisions on hardship-category medicines, discouraging production of low-priced but essential medicines. They also warned that continued shortages were creating space for counterfeit, smuggled and unregistered medicines.
“When genuine medicines disappear from the market, desperate patients and their families look for any available source to save lives. That creates opportunities for counterfeiters and illegal smugglers,” a PPMA representative said.
The PPMA urged the federal government to immediately approve DRAP’s recommendations for all 105 medicines so manufacturers could resume production.
“If manufacturers cannot even recover their production costs, they simply cannot continue manufacturing these products. Essential medicines should remain available to patients, and that requires economically sustainable pricing under the policy,” the industry representative said.
The PPMA representative added that prolonged delays were increasingly forcing pharmaceutical companies to seek legal remedies.
“Many manufacturers are approaching the superior judiciary to obtain relief because their applications remain undecided for years. This is not a healthy situation for either the industry or the healthcare system,” he said.