Why do medicine prices anger Bangladesh?

Is it because most medicines are paid for out of pocket? Yet almost everything, from food, clothing, rent and education to retirement, is paid for out of pocket. So why does the price of a pill get singled out for the firing squad?

Two explanations stand out.

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First, the bien-pensant cling to a comfortable myth: that local pharmaceutical companies put profit before human lives and therefore must be reined in by policy. Second, and more honestly, medical bills can wreck a household and drive it into poverty.

The price-gouging story is not just wrong. It is verifiably false. Public data show Bangladeshi medicines are among the cheapest in the world. And their prices have barely moved since 2023, even as costs have risen sharply across the economy.

The poverty argument, though, is built on rock. Falling seriously ill in Bangladesh can be hell. Monthly per capita income is Tk 30,739. One routine operation at a private clinic can swallow a month’s wages. A disease such as cancer does not just ravage the body. It can liquidate a lifetime’s savings.

Sometimes, no policy can fix the bill. Pemetrexed 500mg/20ml, used for non-small-cell lung cancer, costs Tk 76,000 per vial from the leading foreign brand. Local alternatives sell for less than Tk 25,000, a third of the price, but still 81 percent of monthly per capita income. A patient can beat cancer and still lose everything to the cost of surviving it.

In such cases, the only humane answer is targeted financial help for those who need it most.

Elsewhere, the picture is better. The country’s biggest-selling drug, esomeprazole for heartburn, costs Tk 7 per capsule, or Tk 210 to Tk 420 a month.

Chronic triple threats such as diabetes, hypertension and hyperlipidaemia cost about Tk 3,000 a month, or as much as 10 percent of average income. Yet what happens when this problem is “fixed” with price controls? Shaving 20 percent off the market price reduces the monthly bill by Tk 600. Meanwhile, drug makers’ margins are squeezed, supply is threatened, and the cheap medicines everyone relies on start disappearing from shelves.

Here again, the solution is targeted financial assistance for those who need it most.

Bangladeshis spend just Tk 235 a month on medicines, or 0.76 percent of income. Even the poor can cover that.

But averages lie. The real story lives in the tail, not the mean. It lives in the cancer ward, where one vial costs 81 percent of a month’s income, and in the household bankrupted by a single diagnosis. Yet blanket price controls only starve the very supply chain that keeps medicines affordable for everyone else.

So, the solution is not to make cheap drugs even cheaper. It is far better to build a safety net instead. The honest policy is not a war on the market, but a cushion beneath the few it fails: free or heavily subsidised medicines for those who cannot pay. That is how we save lives without breaking the system that saves them.

The writer is the CEO of Renata PLC