Chronicles of the ‘Black Market’ – Essential life-saving drugs go missing


LAHORE – Federal and provincial health department’s failure to monitor pharmaceutical companies and their distributors to ensure the supply of life saving drugs (LSDs) has created a “black market” for the crucial drugs, leaving thousands of critical patients at the mercy of profiteers, Pakistan Today has learnt.
According to details, Angised (for blood pressure and heart attack patients), Ventolin and Ventiline inhalers, Thyroxin (thyroid problems), Digoxin (heart enlargement), Neomercazole (thyroid problems), Migril (migraine) and Zyloric (uric acid) have all “disappeared” from the market. A local pharmacist said that all the aforementioned drugs are life saving and very crucial for patients.
“Angised is prescribed for heart patients and patients come to us begging for it but we do not have it and the patients have to run from pillar to post searching for all these medicines. The situation is very bad and we are helpless. If we place an order worth Rs 1 million, we get only ten packets of Zyloric and the distributors just claim that they do not have it in stock,” he added.
The procurement manger of a renowned pharmacy chain in Lahore said the pharmaceutical companies are bound to ensure the supply of medicine. “We have brought the issue to the notice of drug inspectors, distributors and the government but in vain. All the LSDs are very cheap and their prices are controlled by the government but the pharmaceutical companies claim that the retail price is less than the cost of even the basic salts used in the manufacturing of drugs.
They have also submitted a requisition with the federal government to increase the prices and the government has also increased the price of some of the drugs, such as Thyroxin, the retail price of which has been recently increased from Rs 30 to Rs 50 per packet. Even then the drug is not available,” he concluded.
Interestingly, however, all of these crucial LSDs are available at a few drug stores at highly inflated prices. Per a survey conducted by Pakistan Today in Lohari, the hub of wholesalers, the retail price of a packet of Angised (30 tablets) is Rs 50 but is sold between Rs 80 and Rs 120, Ventolin inhaler is Rs 100 but is sold at Rs 150, Rs 50 pack of Thyroxin is available at between Rs 90 to Rs 250, Digoxin is Rs 25 but is sold at Rs 100, Neomarcazole Rs 45 but available between Rs 300 to Rs 800, a Rs 20 pack of 10 tablets of Migril is sold at Rs 40, while the retail price of Zyloric is Rs 120, in the “black market” it costs Rs 150.
The Drug Act 1976 authorizes the federal and provincial governments to monitor the manufacturing, quality standards and sales of medicines. An entire hierarchy has been defined to monitor the whole process right from the manufacturing unit to the retail points in both the federation and the provinces. Every pharmaceutical company has a chain of registered distributors for different areas and categories such as government supplies, commercial retailers and special institutions.
The Act also clearly states that “The manufacturer will maintain the adequate supply of the products, registered in the name of concerned firm.” However, despite having a detailed hierarchy of government functionaries in the centre and Punjab, crucial life saving drugs are not available for patients. A major distributor in Lahore, seeking anonymity, told Pakistan Today that the root of the problem goes to districts in the periphery where the media is not strong enough and the government functionaries heedless. He said the problem is multilayered, with not just one individual responsible for the shortage.
“Distributors from other districts who have low cost of distribution charge commission and inject stock into the wholesale market in Lahore. Of 146 items, Angised, Thyroxin, Lyroxin (Digoxin), Migril and Ventolin inhalers are quota items. Distributors offer a 4 percent discount on general drugs and black the quota items out of their areas of distribution and distribute very little quantity in their respective area of distribution assigned in the agreement signed with the company,” he said, adding, “this is why the LSDs are not easily available in the open market and available in Lohari at inflated rates at the same time.”
To a question he said, the shortage can be easily addressed if the pharmaceutical manufacturers ensures “adequate” supply of drugs in the market and the government plays its role. Lahore Health EDO Umar Farooq Baloch said a comprehensive strategy has been devised to crack down on the drug mafia. He said the government plans to initiate action from the retailer and take it to the pharmaceutical companies.
He said the city district government has held meetings with the distributors to check their input and output record. “The distributors are legally bound to show their record of purchase and sale of medicines to the government. We have asked them to show us the receipts of medicines sold to wholesalers and pharmacies to point out where the fault actually lies. The government will cancel the license of the retailer and distributor found involved in creating an artificial shortage of important LSDs,” Baloch said.
To a question, he said the CDGL will further formulate recommendations after completing the process and will submit it to the federal government and the media for further action, as the authority to monitor pharmaceutical companies rests with the federal government. However, Federal Health Secretary Khushnud Lashari said per rules, the provincial governments are supposed to monitor sales through their drug inspectors. He said the ministry of health had directed provincial health departments to post drug inspectors down to the Tehsil level.
He said the federal government will initiate action only after receiving a complaint from one of the stakeholders, be it a distributor, a retailer or the provincial government. He said there are only 11 federal drug inspectors to monitor all pharmaceutical companies. “Basically the federal government has to ensure the quality of drugs manufactured, while the provincial chapters have to monitor sales as per the Drugs Act 1976,” Lashari said.
To a question that pharmaceutical companies are outside the ambit of provincial governments, he said the provincial government can always intimate the federal ministry of health to initiate action or address any issue. He further said the federal government will “definitely” initiate action after the provincial government points the problems out.