Nigerians battle high cost of drugs

As the country battles with the escalating cost of medications, VINCENT KURAUN re-examines the implications of switching to generic or less expensive drugs.

TODAY, the issue of high costs of medications remains a pressing concern that has continued to impact their accessibility and affordability for many Nigerians. Though rooted in several factors, including economic conditions, healthcare infrastructure limitations, and the structure of the pharmaceutical industry, the challenge has had damning repercussions for many sick patients who are already overburdened by economic policies that have overstretched resources thin nationwide.

With millions of Nigerians suffering from diabetes, high blood pressure, depression, fever, cancer and many others, many of them depend on these medications, whose prices have gone over the roof, to survive.

As a result, a significant portion of the population struggles to obtain essential medications, highlighting a critical need for sustainable solutions to ensure equitable healthcare access nationwide.

Some Nigerians who spoke with Sunday Tribune said the escalating cost of drugs is becoming unbearable and this left them with no other choice than to abandon their daily medications.

One of them who chose to remain anonymous said, “I have stopped taking my medications for a while now because I can’t afford to buy them. I know this will definitely have a negative effect on my health but what choice do I have?

“Before now, the branded type I was taking was out of reach in terms of price and I ended up with other generic or less expensive ones, but one begins to wonder about the effectiveness of these ones after taking them.”

Meanwhile, a Senior Matron in an oncology department in one of the private hospitals in Lagos named Evelyn, while speaking with Sunday Tribune fumed at this ugly situation, particularly because of the negative impact it will have on the health of the people who need them.

According to her, “the rate at which drug prices are going up is alarming. Series of complaints are flying around from clients, patients and relatives. Some directed their complaints to the government because since the present government took over leadership, everything has turned upside down. From subsidy removal which resulted in the increase in the price of fuel and general inflation). It has not been easy for them to procure their drugs.”

Evelyn said some of the patients hinged this blame on the drug manufacturing companies who took advantage of the situation to increase the cost of their products in triple folds while some blamed the retailers (pharmacy, chemist, and all drug dealers). Others lay it on politicians who see it as an opportunity to overthrow their opponent as a failed party.”

She explained further that, “many are no longer taking their drugs as prescribed. For the alternatives, some are now turning to orthodox medicine, some to churches while a great majority have decided to stop taking drugs again and patiently wait for death.

“And the effects of this are an increase in morbidity and mortality rates in our nation if nothing is done urgently. Our leaders have a big role to play here, they know what to do if they really care and hear the cries of the masses.”

Speaking also to Sunday Tribune, a Media presenter in Port Harcourt, Catherine, said, “the high cost of drugs in Nigeria is very discouraging. I can only call on the government to intervene in this deadly situation.

“I would suggest that the government should do all that they can to revamp/revive our economy, so that more companies and even the foreign companies who produce more of all these drugs, especially cardiovascular drugs, which we do not produce here in the country come in or try to reduce the import duties on such drugs, so that when brought into the country, it will not be too expensive.

“I know the reason is not just the exchange rate, but also the fact that most of these foreign companies that produce them here in the country have folded up. We rely solely on importation for these drugs.

“I’m usually interested in supplements but when I saw the price recently, I decided not to buy them because the difference in terms of price was so high. Some are triple and some quadruple of what we used to get them for before now.”

How do we get here

Consultant family physician and certified global health project manager, Dr Adokiye Berepiki, told Sunday Tribune that, “The main reason is the current value of the naira against the dollar because, the majority of the drugs in use are imported and most of them are paid for in dollars. So, this current value is a huge contributing factor.

“For example, before this present administration came in, the dollar was about 700 against the naira but now, it has doubled that amount. So, it implies that all the cost of drugs will also be doubled. So, the rising cost of the dollar is implicated.”

A chief pharmacist at one of the prestigious hospitals in Lagos, who also chose to remain anonymous, attributed the high cost of drugs to the unsuitable state of the country for drugs production.

“The high cost of drugs is basically because Nigeria does very little drug production and that’s because the economy and other factors in Nigeria, are not suitable for drug manufacturing.

“Factors like power, taxes, insecurity, and of course, the power of the naira against the dollar, basically. This, therefore, makes whatever is being imported to be gotten at exorbitant prices,” she explained.

A paediatrician/paediatric cardiologist at the University of Benin Teaching Hospital, Dr Emmanuel Eyo-Ita, told Sunday Tribune that the Nigerian economy has taken quite a hit in recent times, more so in the last 12-14 months. Most industries (small and large) and other establishments produce their own electricity which means they rely greatly on petrol.

“Transportation of goods and services (human and otherwise) is by road and air which also depend on petroleum products. As such, a hike in petrol prices would usually result in a hike in the cost of such goods and services. Medicines and other pharmaceuticals are not exempted, hence the rising cost of these products.

“Secondly, a good number of pharmaceuticals have moved their operating base out of Nigeria. This means, the medications now have to be imported by independent marketers. This also would worsen import duties being paid which leads directly to higher market prices.

“The manufacturers would usually bring in huge quantities as they had special arrangements with the government hence they could sell at cheaper prices.

“Now, the few cartons available are sold to the highest bidder who in turn, in keeping with the law that fewer products equals higher demand which equals higher prices, would try to sell at the highest price possible. All of these have led to higher costs of these medications,” he explained.

Are generic, less-expensive drugs effective?

Though they expressed their misgivings, many medical experts who spoke with Sunday Tribune agreed that some of these generics, especially those from known brands, are good and efficacious, with one saying “they may not match the innovator brands but they give good results.”

The experts, however, advised the populace to be careful in choosing such brands because cheaper drugs could be effective but there are times they can’t give that desired result.

Sharing his thoughts on the generic drugs, Dr Adokiye said, “First we need to understand what the generic is. The generic drugs still have the same components as the branded, the only difference is that when a medicine with a new active ingredient is first developed, a patent or what we can call a legal right is given to a new or innovative product or process and this patent protects it for several years.

“Normally, those people who have the original are the ones who did the research, they spent money, they made the drug, they brought the molicle out.

“So, when they do that, they are the only ones who end up selling a particular product for a particular period of time until they feel okay, they have recouped their profits and their investment in research and everything spent on the molicle. After that, they now give out the components or these active ingredients to other drug companies who make the generic. These are known as generic medication where several different brand names may all have the same active ingredients as the original medicine.

“You know one company can not reach out to everybody; it will be difficult because the population of the world is large. So, the branded companies now end up giving these components or these active ingredients to other drug producing companies who can now make the molicle.

“For example, Augmentin is a brand by GSK; they did the research on Augmentin but what is inside Augmentin is amoxicillin and clavulanic acid. So, somebody goes ahead and makes co-amoxiclav which is the same thing, the same components.

“So, generic drugs can equally be as effective, there may be some slight differences. It is like when someone is not willing to give you his whole secret of ingredients. Now, in cooking, one will tell you to add pepper, tomatoes and so on but he will keep one special spice from you.

“So, in some cases when you give somebody a generic, sometimes you don’t get the desired outcome, not all the time but it happens in some instances, so you will end up using the branded drug.

“So, some molicle don’t give their entire secret to those generic producers but they give a significant amount. Like the Augmentin mentioned earlier, the main active ingredients are the amoxicillin and clavulanic acid. They will tell you this is the amount you need to mix together to get this.

“Maybe there are other things in the drug to make the absorption of the drug easier or faster to be absorbed into the blood system. Maybe, they may not include that part into the formula they are giving out to the generic companies. So, this can be effective but not as much as that original brand.

“The generic type can actually give that result. However, in some cases where we need to now get branded medication like Ceftriaxone, an antibiotic. The brand name is Rocephin. Sometimes, 48 hours after giving somebody a generic, we don’t see an effect, we now change to the branded Rocephin after which we see improvements.”

Against this backdrop of switching to generic or less-expensive brands of drugs and its effectiveness, Dr Eyo-Ita dispelled insinuations that the generic drugs are less expensive and less effective.

“A less effective medication would not bring about the desired effect(s), may exacerbate potential adverse effects of the medication and ultimately present as clinical failure.

“This would worsen morbidity and mortality indices and fan the flames of the already existent lack of trust in the health sector and lead to more physician aparty and unfulfillment.

“The effects are negative all round. After all, people come to the doctor to get treated and if for any reason they do not feel better, then they see that as a waste of time and other resources.

“If, however, we see generics as what they are, the chemical name of the active ingredient in the medication, then the discussion might be different.

“As a medic, I ought to prescribe the name of the drug and not the name of the brand because it is expected that whatever brand is available on our shelves has been tested and passed quality assurance checks.

“Hence, 1 gram of paracetamol by company A is expected to be just as efficacious as 1 gram from company B. Such quality, for medicines, is expected to be tightly regulated. While anyone can opt to make their version of a drug, it must first be tested and found to meet certain minimum requirements before it is allowed into the market but this appears to be missing.

“Hence, the average Nigerian knows which brand of paracetamol they’d rather buy if they had a headache. Many Nigerians have bought certain medicines and could tell they were fake just by looking at the packaging.

“Allow me digress, the fellow down the road from where I live is allowed to make slippers and put them out for sale as slippers as long as they meet the minimum requirements. What he is not allowed to do is tell his customers that they are made by a top brand.

“The same applies with medicines but that clause must not be forgotten, it must meet the minimum requirement. An important question to ask at this point would be ‘who is supposed to ensure this minimum requirement is met?’

“Your top brand slippers might be more shiny but mine from down the road would also stop a nail from going through my foot and meet whatever other standard(s) there is/are.

“With medicines, we can expect that one might taste better, or pills might be smaller or come as capsules and be easier to swallow. One might come as chewable tabs while the other must be swallowed, but they must all have the same efficacy. Once this is achieved, we would be happy to prescribe generics without thinking twice about it.”

In summary, Dr Eyo-Ita said, “if all medications on our shelves have undergone proper quality checks and have been found to meet the minimum standard for efficacy, safety, then we would have no problems with the use of generics.

“I think it will be relevant to do a few things by verifying that we have a sizable number of generics which are not efficacious.

“Organisations responsible for such quality control pressure should do the right thing and keep Nigerians safe,” he advised.

Explaining the downside of switching to generic or less expensive brands of drugs, the pharmacist said, the first implication is that the cost of procuring drugs, especially for the lower class, is reduced.

“Secondly, if the generic brands are effective, it means one will get results at an affordable price. However, if the generic brands are of low quality, then the consumer will have to contend with losing even the little money he/she has spent, in addition to worsening health conditions.”

 

Any positive intervention?

Dr Eyo-Ita told Sunday Tribune that he was not aware of any specific intervention in Nigeria, whether by the government or WHO to directly address this concern.

“The government has assured us that plenty is being done to stabilise the economy, but to the best of my knowledge we are yet to see what exactly these efforts are and the much-needed positive results are also not yet palpable,” he said.

A pharmacist, who also spoke with Sunday Tribune also said she was not aware of any intervention.

“No, I’m not aware of any intervention. Though, I think after the Covid-19 period when we had a huge problem with drug availability because other drug manufacturing countries refused to export to us, President Buhari promised to inject more money into the drug manufacturing sector but I don’t know if anything has been done.”

Calling on the government to intervene in the unfortunate situation, Dr Adokiye, said: “If we have probably more indigenous producers and maybe government introduces waivers for material that are going to be used for production of these drugs as well as cutting other taxes, it will go a long way in reducing the cost of drugs, that is the key thing.”

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