Picture a senior citizen or a low-income family provider standing at a pharmacy counter early in the month, with a prescription in hand. The slight tremble in their hands is not just financial anxiety. It marks a breaking point in the unwritten social contract between the state and its citizens. When the price of rice, lentils, or fuel goes up, public outrage follows immediately. This is needed, as many are impacted. But when life-saving medicine prices climb silently, people have no choice but to pay up in silence.
Recently, Bangladesh has witnessed a troubling reversal in pharmaceutical policy. The updated 2026 Essential Drug List — which expanded price-controlled drugs to 295 — and its universal pricing framework were abruptly scrapped by the Bangladesh Cabinet in 2026. In their place, authorities reinstated a three-decade-old policy from 1994. While global health targets talk about Universal Health Coverage (UHC), this move leaves citizens exposed to unchecked corporate pricing and raises a number of questions. What is really happening here? Who benefits from this policy backtrack and surging medicine prices? Is this a genuine administrative hiccup, or a classic case of corporate closed-door lobbying behind the reversal of the drug policy?
Back in 1994, a controversial circular limited government price control to just 177 drugs, handing pricing power for everything else directly to manufacturers. Here is the core issue: the disease burden in Bangladesh has shifted dramatically over the last thirty years. While infectious diseases once dominated, non-communicable diseases (NCDs) like diabetes, hypertension, heart conditions, stroke, and cancer now account for the vast majority of health cases. The outdated 1994 list leaves modern, essential treatments for these chronic conditions almost entirely unregulated.
In response to a 2018 public interest writ petition, the High Court instructed the government to regulate and publish gazetted prices for all life-saving drugs. Following this directive, the essential list was expanded to 295 drugs. Yet, after an appeal by the Bangladesh Association of Pharmaceutical Industries (BAPI), the government backtracked under the pretext of an absent Drug Advisory Council.
What this means on the ground is simple and harsh for care, such as diabetes management, cardiovascular care, and oncology and chronic care. Prices for modern insulin and newer oral medications vary wildly without government price caps, everyday blood pressure and heart medications face unchecked price hikes — straining elderly citizens on fixed incomes — and cancer therapies and specialized drugs lack price ceilings, forcing families to liquidate assets just to stay alive.
There are systemic flaws in cost-plus pricing, which is a simple pricing method in which a company, pharmaceutical or any other, adds a fixed percentage markup to the total cost of making a product or running a service of it. Medicine prices in Bangladesh rely on a “cost-plus” formula. While that sounds fair on paper, it masks two major systemic flaws: raw material over-invoicing and aggressive marketing expenses.
Local pharmaceutical manufacturing relies heavily on imported raw materials — Active Pharmaceutical Ingredients (APIs) — for 80 to 90 percent of medicine production in Bangladesh. Over-invoicing these imported APIs artificially inflates baseline production costs before prices are calculated. Moreover, between 30 and 40 percent of the retail cost of a drug goes toward aggressive marketing, promotional schemes, and gifts aimed at prescribers. Under a cost-plus formula, manufacturers earn an approved profit margin on top of these inflated expenses. But in effect, the more a company spends on aggressive promotion, the higher its allowed price tag becomes. Consequently, the patient picks up the entire tab.
The Directorate General of Drug Administration (DGDA), the main drug regulatory authority in Bangladesh, is tasked with keeping the market fair and safe. But what is being seen at its Mohakhali headquarters is a textbook example of “regulatory capture” — a situation where a regulatory body ends up serving the commercial interests of the industry it is supposed to oversee. Public service guidelines require government regulatory bodies to hold public hearings at least twice a year to maintain transparency.
But the DGDA has not held a single public hearing in over two and a half years. Moreover, meetings of the Drug Control Committee (DCC) have stalled, and pricing decisions continue behind closed doors. This creates severe information asymmetry: the regulator and manufacturers hold all the data, while patients remain entirely in the dark.
International benchmarks, like generic pricing, external reference pricing (ERP), and public pricing dashboards, reveal clear strategies used worldwide to prevent artificial price inflation. Countries like India encourage generic prescribing and require doctors to write generic chemical names on prescriptions rather than brand names. This gives patients the freedom to choose affordable options and curbs unethical brand promotions. ERP benchmark pricing compares domestic prices with equivalent markets abroad to prevent single-market price gouging. Aligning with WHO’s Good Governance for Medicines framework and platforms like India’s NPPA, actual API import costs and price caps are published online for public verification.
Medicine is not a luxury item you can delay buying when prices spike. In economic terms, it is a completely inelastic good — when life depends on it, people buy it regardless of the cost. But Bangladesh’s failure to adopt these standard practices leaves its pharmaceutical market vulnerable to unchecked commercial interests. A 5-Point Policy Roadmap can help. Fixing this broken system requires five immediate policy steps:
The government needs to cancel the rollback to 1994 and reinstate and gazette the 2026 Essential List to legally enact the 2026 list of 295 essential drugs, along with its pricing framework. Moreover, enforcing mandatory public hearings every six months under the Drugs and Cosmetics Act 2023, involving patients, consumer rights groups (like the Consumers Association of Bangladesh), and independent health experts, and guaranteeing civil society representation through reserving permanent seats for independent public health researchers, economists, and consumer representatives on the Drug Control Committee (DCC) and Pricing Committee are vital.
The government needs to launch a Public API Cost Dashboard. Under Section 6 of the Right to Information Act 2009 (of Bangladesh), it is crucial to publish raw material import costs, duties, and factory production estimates on an open digital dashboard. Moreover, it is vital for Bangladesh to mandate generic prescribing to ensure that doctors write generic names on prescriptions, cap promotional budgets, and set a strict legal cap on pharmaceutical marketing expenses.
Pharmaceuticals cannot be treated like an ordinary profit-driven commodity; they are tied directly to the constitutional right to life. Reverting to an outdated 1994 list and allowing regulatory opacity to persist undermines public welfare. The Ministry of Health and Family Welfare, along with the broader administration, must decide whether to act as an enabler of corporate profits or as a guardian of the fundamental rights of its citizens.
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