E-drug: Drug prices in Sri Lanka
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Dear e-druggers,
I always thought that asking drug companies to behave ethically or
even to forego their profits in favour of the world's poor should be
accompanied by more governments in developing countries taking
responsibility for the health of their populations. Here is the
testimony of a state that in my view is acting in an exemplary
fashion. Maybe Sri Lanka can afford not to ask for discounts from
the drug companies because of a particularly favourable economic
situation (I have no idea). However, there are many populations in
the developing world who suffer at the hands of their own
governments and whose lack of health care is at least partly due to
corrupt and inefficient political leaders (alas, many of them
supported by developed democratic countries). Denouncing these
governments to make them more accountable to their own people
or highlighting the example of states which, from the top (and not
only by isolated dedicated politicians) like Sri Lanka, seem to be
acting in favour of the health of their populations, might be as
important as trying to curb the greed of the drug giants.
Valeria Frighi
Diabetes Trials Unit
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Old Road
Oxford OX3 7LJ, UK
tel. -44-1865-857249
fax -44-1865-856286
e-mail valeria.frighi@dtu.ox.ac.uk
[Copied as fair use. HH]
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BMJ 2003;326:553 (8 March 2003)
Letters
State can make drugs available cheaply to poor people
EDITOR
Sri Lanka has shown that the state should try to bring down drug
prices in ways other than by asking drug companies to make drugs
available at cost price to the poor.1 The country's state sector
(with its zero charge services) has successfully used the concept of
an essential drug list for some time, thus curtailing total costs on
drugs. Two other lessons from the country apply to retailing.
Firstly, the private retail drug market is poorly controlled as there is
no ceiling for prices or on the number of preparations (of the same
drug) that can be imported. The government owned State
Pharmaceutical Corporation has several retail pharmacies, which sell
high quality generic drugs at cheap rates, thereby competing with
the private sector. This model can be made more effective by
widening the network of outlets nationally.
Secondly, Sri Lankan data show that merely writing generic
prescriptions would not suffice because private retail pharmacies
dispense higher priced alternatives. We recently sampled 21 private
pharmacies for the price of 14 common drugs whose prescriptions
had been written using generic terms and compared them with the
price from the outlets of the State Pharmaceutical Corporation. The
mean cost for drugs from all pharmacies was Rs38.20 ($0.40;
�0.24; �0.36) per day (95% confidence interval 32.90 to 43.50)
compared with Rs14.97 per day at the State Pharmaceutical
Corporation. One drug was sold at almost three times the cost at
the State Pharmaceutical Corporation.
Saroj Jayasinghe, associate professor.
Department of Clinical Medicine, Faculty of Medicine, PO Box 271,
Colombo 8, Sri Lanka saroj@sri.lanka.net
Shyam Jayasinghe, student.
Ananda College, Colombo
Pubudu de Silva, research assistant.
University of Colombo, Colombo
Competing interests: None declared.
1. Dyer O. Drug companies urged to make drugs available at cost
price to the poor. BMJ 2002; 325: 1320.
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