Drug Prices and the Perils of Policy Reversal
The decision to return to Bangladesh’s 1994 drug pricing policy, more than three decades after it was introduced, raises a question that goes beyond pharmaceutical regulation: when a country’s healthcare needs have changed so dramatically, can going back really be called reform?
For a family already struggling with inflation, the answer matters far more than it does in a policy file.
Consider a household where elderly parents need medicines for diabetes, arthritis or heart disease, while children require food, education and other essentials. Medical expenditure is not an occasional inconvenience for such families.
It is a permanent deduction from their income. When medicine prices rise, they do not simply consume less medicine. They often postpone treatment, skip tests, reduce doses or borrow money.
This is why the government’s decision to cancel the Essential Medicines List 2026 and the Drug Pricing System 2026 deserves scrutiny beyond the question of whether the previous interim government followed the correct legal procedure.
The legal argument may be valid. If the Drugs and Cosmetics Act, 2023 requires consultation with the National Drugs Advisory Council before an essential medicines list is formulated, that requirement should not be ignored.
A government cannot selectively respect laws simply because its policy objective appears desirable. Due process is not a technicality in public administration.
But there is a fundamental distinction between correcting an unlawful procedure and abandoning the policy objective altogether.
That distinction appears to have been blurred.
The interim government’s list may have procedural defects. It may even require substantial revision.
Yet the response to an improperly formulated policy does not necessarily have to be a return to a policy designed in 1994.
The more logical response would have been to correct the process, consult the relevant stakeholders, review the medicines and pricing mechanisms, and produce a legally sound and medically updated framework.
Returning to an old policy creates the uncomfortable impression that the easiest way to solve a complicated problem is to rewind the clock.
The problem is that healthcare does not move backwards simply because regulation does.
In 1994, Bangladesh’s disease burden, pharmaceutical market, technology, treatment protocols and demographic realities were different. According to public health experts, the essential medicines list contained 117 medicines at the time. It later expanded to 285 in 2016 and 295 in 2025.
That expansion was not merely bureaucratic inflation. It reflected the changing needs of a population whose life expectancy, disease patterns and access to modern treatment have evolved.
Many Bangladeshis today live with chronic diseases that require lifelong medication. Diabetes, hypertension, cardiovascular disease and other non-communicable illnesses have become central public health concerns.
A medicine policy created more than 30 years ago cannot automatically be expected to address a health system that looks fundamentally different.
The deeper concern, therefore, is not simply the number 117.
It is what happens when the state’s definition of an “essential” medicine becomes narrower than the population’s actual healthcare needs.
The essential medicines list is more than a catalogue. It is one of the instruments through which the state signals which medicines deserve special attention in terms of availability, affordability and public oversight.
Reducing the list may therefore have consequences beyond removing several names from a government document.
If fewer medicines remain within a regulated framework, the government’s ability to influence prices and ensure accessibility could also become weaker.
That matters in Bangladesh because patients already carry an extraordinary share of healthcare expenditure.
Research cited in the report indicates that the poorest households spend around 35 percent of their income on healthcare.
Government figures have also placed the share of out-of-pocket health expenditure at around 80 percent, dramatically higher than in countries such as Thailand and the Maldives.
These numbers should fundamentally change the way medicine policy is discussed.
For a wealthy household, a 20 percent increase in the price of a medicine may be irritating.
For a poor or lower-middle-income household, it can mean choosing between medicine and groceries. For someone with a chronic disease, there may not even be a choice.
This is where the government’s stated commitment to affordable medicines will ultimately be tested.
The government says it intends to update the essential medicines list and establish a pricing mechanism that protects consumers while maintaining healthy competition.
That objective is welcome. But good intentions will mean little unless the eventual policy produces measurable improvements in affordability and availability.
There is also a larger question about the relationship between the state and Bangladesh’s pharmaceutical industry.
Bangladesh’s pharmaceutical sector has developed considerably, particularly since the National Drug Policy of 1982.
The industry has become one of the country’s important manufacturing sectors and has expanded into international markets.
This success deserves recognition and protection. But a strong pharmaceutical industry and affordable medicine are not necessarily contradictory objectives.
In fact, a mature pharmaceutical industry should be capable of operating within a system that protects both commercial viability and public health.
The danger lies in allowing the debate to become a false choice between the interests of pharmaceutical companies and those of patients.
The real challenge is to design regulation that makes the industry competitive without allowing essential treatment to become inaccessible.
That requires transparency.
Who determines which medicines are essential? What evidence is used to determine their prices? How are production costs, research expenses, import costs and profit margins assessed? How frequently are prices reviewed? What role do patients and consumer organisations have in the process?
These questions are particularly important because the Drug Advisory Committee itself has been criticised for lacking adequate consumer representation.
A pricing system that directly affects millions of patients should not be designed primarily through conversations among regulators and industry representatives.
The patient, who ultimately pays the bill, should have a voice in determining how that bill is regulated.
There is another irony here.
The larger lesson from this controversy is that public policy should not be treated as a pendulum swinging between governments.
One government creates a framework, another cancels it, and the public is left to absorb the consequences.
Such reversals create uncertainty for manufacturers, regulators, doctors and, most importantly, patients.
A modern drug policy should instead be built on continuity, evidence and periodic revision.
The government therefore has an opportunity. Rather than defending the return to 1994 as an end in itself, it can use the present controversy to create a genuinely updated, legally sound and publicly accountable medicines policy.
It can consult doctors, pharmacists, pharmaceutical manufacturers, economists, consumer representatives and patients.
It can review the essential medicines list according to current disease patterns and international evidence.
It can establish transparent criteria for price determination and mechanisms for regular review.
Most importantly, it can recognise that the ultimate purpose of drug regulation is not to protect a document from legal challenge. It is to protect people from being priced out of healthcare.
For Mazharul Islam and thousands of families like his, the difference between a 1994 policy and a 2026 policy is not an academic debate.
It is measured in monthly medicine bills, postponed tests and difficult household decisions.
A government may legally go back 32 years. Patients, however, cannot afford to go backwards.
(The writer is an Academic, Jounalist, and Political Analyst based in Dhaka, Bangladesh. Currently he teaches at IUBAT. He can be reached at nazmulalam.rijohn@gmail.com)
