High cost of drugs worsens healthcare situation with rising mortality

The costs of drugs in the country have hit the rooftops such that the prayer of many Nigerians is not to fall sick which will require a purchase of drugs.

The high cost has had concomitant effects on the entire basic medical care beginning from obtaining a hospital card and consultations, to getting routine tests, such as malaria and urine tests.

On the whole, the cost of drugs has gone up even 10 times higher in some instances, leaving sick Nigerians stranded. It has become so serious that many opt for alternative

healers instead of purchasing drugs prescribed in the hospital.

The pharmaceutical industry is facing its biggest challenge ever as forex has made importation of highly sought-after pharmaceutical drugs a difficult, even if herculean, task given the exorbitant prices influenced by fluctuating foreign exchange.

The reason for this is that many pharmaceutical companies have left the country in recent years due to an inclement business environment and unfavorable government policies.

Last year, the  Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN) lamented the paucity of foreign exchange in the country, saying it had negatively affected the local pharmaceutical industry.

They attributed fluctuations in forex as a major reason for the exit of some pharmaceutical multinationals from Nigeria.

The group raised concerns at a news conference in Lagos last year on the  7th edition of the Nigeria Pharma Manufacturers Expo (NPME), which took place on September 4 and 5., 2023.

Recall that some multinational pharmaceutical companies, including GlaxoSmithKline and Sanofi Nigeria Ltd, exited the country within the past year. GlaxoSmithKline (GSK) discontinued operations in Nigeria in August 2023, ending its 51-year existence in the country, while French pharmaceutical manufacturing company, Sanofi, exited Nigeria in November.

The Chairman, of the Local Organizing Committee (LOC), NPME 2024, Mr. Patrick Ajah, averred that for the domestic pharmaceutical industry to achieve needed progress, a stable exchange rate was a sine qua non.

Ajah, a pharmacist and the Managing Director of May & Baker said that many companies are also on standby for the implementation and takeoff of the recently announced Executive Order.

To reverse the dwindling fortunes of pharmaceutical companies, on June 29, 2024, President Bola Tinubu signed an Executive Order removing tariffs and Value-Added Tax (VAT) on pharma imports.

The order introduces zero tariffs, excise duties, and VAT on specialized machinery, equipment, and pharmaceutical raw materials to bolster local production of essential healthcare products.

Business Hallmark learned that the order has yet to take effect.

Ajah said: “Unless the value of the naira is fixed, achieving the country’s target of 70 percent in local drug manufacturing will remain a mirage.

“The government will need to do certain things to achieve 70 percent local drug production”.

Citing India as an example, he said that the country supported its domestic pharmaceutical industry, and today, India is notable for drug manufacturing.

“The Indian government has provided financial and technical assistance to local manufacturers and has even intervened to secure technology from other countries,” he said.

However, a crucial issue, often overlooked by the government, is the staggering surge in the cost of essential medicine in Nigeria. A World Bank report, “Healthcare Costs in Nigeria: Trends and Impact”, reveals a startling fact-the cost of essential drugs in Nigeria has skyrocketed by nearly 50% from 2020 to 2023.

The pandemic worsened this situation, with some medicines witnessing price hikes of over 100% during its peak due to supply chain disruptions and increased demand. This price increase seems to be getting worse post Covid 19. Common antibiotics like Amoxicillin have experienced price increases of up to 60% over the past three years. Medications for chronic conditions, such as antihypertensive drugs, diabetes, cancer, etc. have surged by an average of 70% between 2020 and 2024. Insulin and other diabetes medications have seen price hikes ranging from 30% to 80% since 2020. Antimalarial drugs, crucial in Nigeria, have had 50% or more price increases over the past few years.

Findings by Business Hallmark showed that the prices of some antimalarial drugs had increased from 11 percent to around 23 percent between November 2023 and April 2024. In November, an Artesunate injection of 120mg was sold for N2,500, while the 60mg injection was sold for N1,800.

However, in April, market surveys showed that Artesunate 120mg now sells for N2,800 (12 percent increase), while 60mg of the injection now sells for N2,000 (11 percent increase). The cost of Coartem 80/480mg was around N3,300, while Amatem Soft Gel was sold for N2,500 and Lonart 80/480mg for N2,850. In April, Coartem 80/480mg is now sold for N4,000 (a 20 percent increase). Amatem soft gel increased by over 20 percent, selling for around N3,000. Lonart 80/480mg sells for N3,500, a 22 percent increase.

These circumstances are, however, forcing many patients to skip their life-saving medications and, instead, turn to unapproved alternatives and counterfeit drugs. Reports suggest that due to high costs, the availability of essential medicines in public health facilities has decreased, with up to 40% of commonly used drugs often being out of stock. The prices of branded medicines have risen sharply, but even generic drugs have not been spared, with average increases of 30-40% across various drug categories.1

Analysts have attributed the surge in drug prices to factors such as the devaluation of the national currency, unstable foreign exchange rates, reliance on imported active pharmaceutical ingredients, and heavy dependence on drug imports, among many other micro and macroeconomic factors.

The impact of this rise in price is significant and affects Nigerian consumers, pharmaceutical companies, and the healthcare ecosystem. The consumers have affordability issues, accessibility issues, and health impact crises. According to a report by BMC Health Services Research titled “affordability of essential medicines in Nigeria”, over 60% of Nigerians now struggle to afford essential medicines, with many having to forgo treatment or seek alternative therapies due to high costs. The rising costs have led to a 20-30% reduction in medication adherence rates, particularly among patients with chronic diseases who require ongoing treatment.

In the past three years, more than six pharmaceutical companies have left the country, according to Dr. Anthony Ekanem, a reader in pharmacology, the implication is that “we no longer have the advantage of getting their drugs cheap because they are no longer in the country. We have to import them and this involves forex. The drug we normally got for N2000 before now costs N30000 because the company producing it has left the country.

Importing drugs, Pharmacist Labinjo Phillip told Business Hallmark is difficult because of forex which has led to skyrocketing prices of drugs, so importers, who are also pharmacists build into the final cost to consumers, the forex margin and still add their own margin, making the final cost to consumers beyond what they can afford but since they are sick they must buy.”

Business Hallmark’s findings revealed that many Nigerians have devised a devious scheme, which in the final analysis, does not help them. If a drug is meant to be taken in three doses a day, many of the patients skip one or two doses, thus rendering treatment abortive and without efficacy.

Ola Areola, a mechanic, said when he was down with typhoid two months ago, he had to skip one dose, saying though he is now okay, he sometimes feels worn out and weak. “I had to run to a traditional herb seller, who promised to give me the Agbo (traditional concoctions) that could flush out the remnants of the typhoid. I took it, and it worked.”

Many Nigerians are gradually slipping into the habit of avoiding orthodox drugs to cure their ailments, preferring to consult herbal doctors.

Dr. Friday Emeni, a consultant told Business Hallmark that the ” danger of herbal drug is that it is not passed through any scientific, laboratory test to determine its health implications and efficacy and it’s impossible to determine its dosage. I’m not discountenancing its efficacy, after all, before Western medicine came out forefathers and ancestors used the same herbal formulas to cure various diseases and ailments, including mental disturbances, which we call psychiatric.”