Profits Over Patients

In 1982, Bangladesh set a powerful precedent in public health governance with the Drug (Control) Ordinance. At the time, the country faced intense pressure from global pharmaceutical multi-nationals. 

Yet the non-elected military government refused to yield. It took a clear position: Human health was not negotiable. 

The policy restricted non-essential imports, tightly controlled retail prices, and required domestic manufacturing. Over time, it helped build a local industry that now meets around 95-98% of national demand.

Fast forward to 2026, and the contrast is hard to ignore. An unelected regime once resisted global corporate pressure to protect citizens. Today, a democratically elected government appears to be doing the opposite -- yielding to domestic industry interests, often at the public’s expense.

The consequences are already visible. Bangladesh continues to rely heavily on out-of-pocket payments, with households financing more than 70% of total health expenditure -- one of the highest rates globally, according to WHO and national health accounts. More than half of that burden is spent directly on medicines, making illness not just a health risk but a financial one.

A more recent attempt at reform came during the interim government earlier this year. Through two separate gazette notifications, authorities moved to modernize drug pricing under the Drugs and Cosmetics Act, 2023.

The scale of that reform is often understated because two different numbers are frequently confused. The National Essential Medicines List, last updated in 2016, already contained around 285 medicines. But the government fixed the retail price of only 117 of them -- a ceiling inherited from a 1994 circular. 

Prices for everything else were effectively set by manufacturers and merely approved by the regulator. The 2026 reform expanded the essential list to 295 medicines and, more importantly, brought all of them under government-determined pricing. It also introduced a standardized pricing mechanism, based on a cost-plus formula, intended to cover most commonly prescribed medicines.

Crucially, the revised list reflected today’s health realities. It included treatments for type-2 diabetes, hypertension, and cardiovascular diseases -- conditions that now affect millions of Bangladeshis. These are not short-term illnesses; they require lifelong medication. Without price regulation, patients are left exposed to market pricing, often leading to long-term financial stress or debt.

However, this reform effort did not last. On August 3, during a Cabinet meeting chaired by the Prime Minister, the government scrapped both the Essential Medicines List 2026 and the Drug Pricing Mechanism 2026.

The justification was procedural -- the failure to formally consult the National Drug Advisory Council, as required under the law. Industry representatives quickly welcomed the move, describing it as a restoration of “stability” to the market.

The Cabinet did state that it would update the essential medicines list and formulate a revised pricing mechanism. But that commitment came without a timeline, without a draft, and without any interim arrangement.

A procedural defect was answered not by curing the defect but by removing the entire framework first and promising a replacement later. In the meantime, the country reverts to a price-control regime built on a 1994 order.

The decision also echoes earlier signals from within the same political camp. During the interim period, the politician who now serves as Finance Minister -- then speaking as a senior BNP leader -- publicly emphasized the need to deregulate sectors, including pharmaceuticals, to reduce the cost of doing business.

The remarks drew criticism from public health experts, who warned against treating medicines as ordinary market commodities. That position has since carried into government, where deregulation has been framed as a central economic priority.

To its credit, the government has proposed a significant increase in the health budget. In the revised budget for FY2025-26, health spending stood at around 0.58% of GDP. In the proposed FY2026-27 budget, this has risen to just over 1.0% of GDP -- the first time it has crossed that threshold.

While this increase is substantial, it still remains far below the levels required to ensure financial protection for patients.

This creates a clear policy gap. Increasing budget allocations can improve infrastructure and service delivery. But without effective control over medicine prices, much of that benefit risks being absorbed at the retail level. Better hospitals alone do not reduce the cost of treatment if essential drugs remain unaffordable.

What is equally striking is how quietly this happened. A decision that directly affects the medicine bill of nearly every household was reported as a routine line item in Cabinet coverage.

There was no sustained reporting, no parliamentary debate, no public consultation, and no visible response from professional bodies or consumer groups.

Price regulation is not a technical footnote; it is one of the few instruments the state holds to protect households from catastrophic health spending. Its removal deserved far more scrutiny than it received.

The 1982 Drug Ordinance showed that the state can act decisively to protect public health, even under pressure. That lesson still holds. The real question now is whether there is the political will to apply it again.

If essential medicines remain outside effective price control, public health will depend less on policy -- and more on what patients can afford. For many Bangladeshis, that is not a sustainable equation.