To enhance access to healthcare services in less developed and developing nations, the World Health Organization (WHO) introduced a list of 200 essential medicines in 1977. The selection process for these medicines by WHO is based on three main criteria: addressing crucial public health needs, being relevant to population health, and ensuring the effectiveness, safety, and affordability of the medicines. Essential medicines, as per WHO guidelines, should be readily available in suitable forms, meet quality standards, and be affordable. This concept forms the basis for various aspects of medical procurement, insurance coverage, donations, and local production. The WHO updates the essential medicines list biennially to adapt to changing requirements, with the current list comprising around 500 medicines.
Recently, Bangladesh expanded its national essential medicines list to 296 items by incorporating 135 new medications to broaden healthcare access. While this expansion is laudable, two accompanying policy directives have raised concerns regarding the sustainability of the pharmaceutical sector. The first mandates that at least 25 percent of a pharmaceutical company’s sales must come from essential medicines, while the second enforces stringent price controls.
Bangladesh presently offers approximately 1,500 generic medicines, with roughly 20 percent falling under the essential category. Essential medicines are typically priced significantly lower than non-essential ones, often with market alternatives available. Expecting companies to derive a quarter of their sales from products that constitute only 20 percent of their inventory and are priced lower presents challenges for most manufacturers.
Operational limitations further complicate matters as not all companies can produce every dosage form. Those with restricted capabilities may struggle to comply with the government’s requirements, necessitating additional investments to meet the targets while operating in low-price sectors. Market dynamics further add complexity, with growth patterns not always aligning with the essential medicines list. Despite the overall pharmaceutical market in Bangladesh growing at 9.2 percent annually in 2025, certain segments, such as anti-ulcerants, expanded at a slower rate compared to cardiovascular and nervous system medications.
These discrepancies in growth rates among therapeutic classes not equally represented in the essential medicines list lead companies to prioritize higher-growth segments for sustainability. The market trend increasingly favors medium and small specialized therapies over established segments, with many of these specialized medicines commanding significantly higher prices than essential ones. Companies focusing on high-value, technologically advanced medicines may find it challenging to meet the 25 percent essential medicine sales quota.
An essential question arises: does Bangladesh truly require an annual essential medicine market nearing Tk 10,000 crore, equivalent to a quarter of total sales across all pharmaceutical companies? Addressing this issue necessitates a comprehensive survey-based evaluation. Price regulations also warrant careful examination, considering the varied costs of raw materials, operations, production, and transportation that influence final drug prices.
Therefore, a balanced and realistic pricing framework developed through inclusive stakeholder engagement may better safeguard consumer interests while fostering the long-term viability of Bangladesh’s pharmaceutical industry. Excessive price controls could lead to adverse effects such as diminished quality incentives, supply disruptions, distorted competition, and reduced investments. Instead, a flexible approach to pricing mechanisms could better serve the industry’s growth and sustainability.
(Note: The writer is a deputy general manager at UniMed UniHealth Pharmaceuticals and can be reached at [email protected])
