State can make drugs available cheaply to poor people

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7388.553 (Published 08 March 2003) Cite this as: BMJ 2003;326:553
  1. Saroj Jayasinghe, associate professor (saroj{at}sri.lanka.net),
  2. Shyam Jayasinghe, student,
  3. Pubudu de Silva, research assistant
  1. Department of Clinical Medicine, Faculty of Medicine, PO Box 271, Colombo 8, Sri Lanka
  2. Ananda College, Colombo
  3. University of Colombo, Colombo

    EDITOR—Sri Lanka has shown that the state should try to bring down drug prices in ways other than by asking drug companies to make drugs available at cost price to the poor.1 The country's state sector (with its zero charge services) has successfully used the concept of an essential drug list for some time, thus curtailing total costs on drugs. Two other lessons from the country apply to retailing.

    Firstly, the private retail drug market is poorly controlled as there is no ceiling for prices or on the number of preparations (of the same drug) that can be imported. The government owned State Pharmaceutical Corporation has several retail pharmacies, which sell high quality generic drugs at cheap rates, thereby competing with the private sector. This model can be made more effective by widening the network of outlets nationally.

    Secondly, Sri Lankan data show that merely writing generic prescriptions would not suffice because private retail pharmacies dispense higher priced alternatives. We recently sampled 21 private pharmacies for the price of 14 common drugs whose prescriptions had been written using generic terms and compared them with the price from the outlets of the State Pharmaceutical Corporation. The mean cost for drugs from all pharmacies was Rs38.20 ($0.40; £0.24; €0.36) per day (95% confidence interval 32.90 to 43.50) compared with Rs14.97 per day at the State Pharmaceutical Corporation. One drug was sold at almost three times the cost at the State Pharmaceutical Corporation.


    • Competing interests None declared.


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