Expert explains causes of ongoing ‘medicine shortage’ problem in Bahrain

TDT | Manama

The Daily Tribune - www.newsofbahrain.com   

Report by Mohammed Darwish

Dr Khalid Al Awadhi, Head of the Pharmacies Owners & Importers Society, has pointed to several factors behind Bahrain’s ongoing medicine shortages. In a conversation with The Daily Tribune, he drew attention to the intricacies of the market: when a drug’s patent lapses, cheaper generic alternatives flood in, sometimes up to eight times less expensive than the original.

While this influx brings down prices, it also leaves Bahrain wrestling with shortages as companies scuttle off to more profitable shores.

The National Health Regulatory Authority (NHRA) maintains stringent price negotiations, which can deter profit-driven generics from entering Bahrain’s market. “This leaves the country teetering on the edge of shortages as companies shift their focus to more financially rewarding markets,” according to Dr Al Awadhi.

Yet, Dr Al Awadhi is cautiously optimistic that the forthcoming national health insurance programme might ease the situation. He thinks it could pave the way for private companies to play a bigger role in supporting public health while also boosting their revenue. Dr Al Awadhi also criticised the outdated profit margin formula, unchanged since 1976.

Price adjustments

“The lack of price adjustments over the past quarter-century has made the market untenable for some pharmaceutical firms, forcing them to either close or struggle.

Additionally, Bahrain’s medicine prices lag behind those of its Gulf neighbours, making it difficult for companies to justify their presence in the country,” he noted. “This profit margin formula, frozen in time as it is, needs a serious rethink if Bahrain’s pharmacy sector is to stand a chance,” Dr Al Awadhi said.

Dr Al Awadhi also took issue with the stringent requirements, particularly the costly international certifications needed for market entry. “These certifications are hurdles for generic companies aiming to enter the Bahraini market.”

He acknowledged that while import regulations have relaxed, profitability remains a major hurdle. Companies often face rejection if their prices exceed the acceptable margin, largely due to inflationary pressures from the global economy.

Financial strain

“The requirement of 500 dinars to register each Stock Keeping Unit (SKU), applicable to every drug size, adds further financial strain on pharmaceutical companies,” he remarked.

Regarding the rationale behind some of these stringent standards, Dr Al Awadhi said, “The authorities aim to provide the highest possible level of protection, sometimes exceeding what is necessary for the average person.

We must balance ensuring the availability of essential medicines with their safety.” “Urgent medicines are still available,” he assured, “but many old but necessary standbys such as Agarol, Anusol, Glyvenol, Milk of Magnesia, and hydrogen peroxide have nearly disappeared.”

“Even one instance of a drug shortage is unacceptable, especially for medicines crucial to specific patient groups, such as those with hearing disorders,” Dr Al Awadhi added.

Baseless

Regarding rumours that private hospitals nudge patients towards their in-house pharmacies, Dr Al Awadhi dismissed these as baseless.

“Current laws protect consumer choice, allowing patients to choose their preferred pharmacy,” he said.

“While in-ward medication practices may differ, patients are not compelled to purchase medicines at inflated prices from hospital pharmacies.”

He acknowledged that quasi-medicines like vitamins follow a different set of rules, with pricing largely set by individual pharmacies. To tackle the medicine shortage, Dr Al Awadhi proposed measures such as greater pricing flexibility and reducing the pressure on manufacturers to register medicines at high costs.

Bargaining power

He stressed the need to consider Bahrain’s small market size and limited bargaining power compared to larger markets like Saudi Arabia. Nonetheless, he observed that recent efforts to align medicine prices with those in Saudi Arabia have shown some challenges.

Contrary to popular belief, Dr Al Awadhi contended that market saturation isn’t the core issue. Despite Bahrain’s over 400 pharmacies, many generic drug makers find the slim profit margins unappealing. Intense competition This has ignited intense competition between local and foreign firms, with net profit margins squeezed to as low as 2–4%, while operational costs have soared to 19%. As a result, many pharmacies face difficulty surviving.

In conclusion, Dr Al Awadhi called on the Labour Fund (Tamkeen) to support Bahraini pharmacy owners. He said, “As more Bahraini graduates eye pharmacy ownership as a stable career, it’s crucial to create a fairer playing field for local entrepreneurs. Supporting Bahraini pharmacy owners could help balance the scales against foreign firms and nurture home-grown talent.”