Pakistan’s healthcare debate has traditionally revolved around a seemingly straightforward question: how can medicines be kept affordable for ordinary citizens? The concern is entirely justified. With out-of-pocket healthcare spending remaining exceptionally high and millions of Pakistanis struggling to pay for even routine treatment, rising medicine prices can place an unbearable burden on households.
But affordability has little meaning when the medicine a patient needs cannot be found. The reported shortage of dozens of hardship-category medicines, following more than two years of delay in approving price revisions recommended by the Drug Regulatory Authority of Pakistan, has exposed a serious weakness in the country’s approach to pharmaceutical regulation. The problem is not simply an administrative delay. It highlights the consequences of treating medicine prices as an isolated political issue rather than as part of a broader system involving production costs, supply chains, regulation, and patient access.
The medicines reportedly affected include cancer treatments, cardiac drugs, oral morphine used in palliative care, paediatric formulations, vaccines, and ophthalmic medicines. These are not optional products that patients can simply choose to purchase later when prices become more favourable. For many patients, missing even a limited number of doses can have serious or irreversible consequences. This makes the current situation particularly troubling.
Successive governments have found themselves caught between two competing pressures. Approving higher prices for essential medicines can be politically difficult, especially when inflation has already reduced household purchasing power and families are struggling with rising costs across almost every area of daily life.
Delaying price adjustments, however, does not eliminate the underlying economic problem. It merely transfers the burden elsewhere. Pharmaceutical manufacturers face rising costs for imported raw materials, energy, transportation, packaging, labour, and regulatory compliance. If the cost of producing a medicine rises significantly while its regulated price remains unchanged for years, manufacturers eventually face a difficult commercial choice. They can continue production at a loss, reduce output, or stop manufacturing the product altogether.
The result is a shortage. This is precisely the danger Pakistan now appears to be confronting. A medicine may remain officially affordable, but if manufacturers can no longer produce it economically, patients cannot obtain it. A controlled price on an empty pharmacy shelf provides no protection to the patient who needs treatment. That reality should not, however, be interpreted as an argument for completely unrestricted pharmaceutical pricing. Medicines are fundamentally different from ordinary consumer goods. Patients often have no alternative to a particular treatment, while doctors and healthcare providers must make decisions based on clinical needs rather than market prices.
For that reason, government regulation of medicine prices remains necessary. The challenge is to design a system that protects patients from excessive prices without making the production and supply of essential medicines commercially impossible. The balance is difficult, but it is achievable.
Pakistan’s recent experience with non-essential medicines provides an important lesson. The deregulation of certain medicines was defended as a means of restoring supplies after years of recurring shortages. While the policy contributed to improved availability in some cases, it also resulted in higher retail prices. Essential medicines, meanwhile, remained subject to price controls because of their importance to public health. That principle is understandable. But when price revisions for controlled medicines are delayed for years despite recommendations from the regulator itself, the policy designed to protect patients can ultimately undermine their access to treatment.
The problem extends beyond shortages and prices. When legitimate medicines disappear from pharmacies, patients and families naturally begin searching for alternatives. This creates opportunities for counterfeit, smuggled, expired, and substandard medicines to enter the market. Industry representatives have warned that shortages can provide precisely the conditions in which such products thrive.
The consequences can be devastating. A counterfeit cancer medicine or cardiac drug is not simply an expensive substitute. It can directly endanger a patient’s life. A substandard medicine may delay effective treatment, worsen a medical condition, and undermine public confidence in the healthcare system. Once patients lose confidence in the authenticity and availability of medicines, the damage extends well beyond the pharmaceutical industry. The current crisis also exposes a broader problem in economic governance: regulatory uncertainty.
If hardship-category medicines are eligible for periodic price reviews under the existing regulatory framework, those reviews must lead to timely decisions. A recommendation that remains trapped in bureaucratic procedures for years is not an effective regulatory process.
Predictability matters as much as the final decision. Manufacturers can plan their production, imports, inventories, and investments around a transparent and predictable system. They cannot plan around indefinite uncertainty. Patients, similarly, cannot build their treatment plans around the possibility that a medicine may or may not be available in the future.
A functional pharmaceutical policy must therefore recognise that affordability has multiple dimensions. The retail price is one factor, but availability is another. A medicine that costs less but cannot be obtained is not genuinely affordable. Nor is a medicine affordable if patients are forced to purchase it from an unregulated market at several times the official price. The government should therefore pursue a balanced approach. Essential medicines should remain subject to regulatory oversight, but price reviews must take place at predictable intervals and be completed within defined timelines. Decisions should reflect changes in production costs, exchange rates, energy prices, raw materials, and other factors affecting supply.
Where price increases are unavoidable, targeted assistance can be provided to vulnerable patients rather than forcing manufacturers to bear unsustainable losses indefinitely. Public hospitals, insurance schemes, social protection programmes, and targeted subsidies can all play a role in protecting patients who cannot afford necessary treatment. The pharmaceutical industry, for its part, must also remain subject to strict quality controls and transparency requirements. Any adjustment in prices should not become a justification for compromising quality or exploiting patients. The essential point is that patient protection and sustainable pharmaceutical production are not opposing objectives. Both are necessary for a functioning healthcare system.
The greatest danger lies in policy paralysis. The irony of the current situation is that a policy intended to protect patients from high medicine prices may ultimately impose a far greater hardship on them. A cancer patient cannot benefit from a price cap if the required treatment is unavailable. A cardiac patient cannot wait indefinitely for a regulatory decision. A child requiring a specific formulation cannot substitute a medicine that does not exist.
In healthcare, delayed administrative decisions rarely remain administrative for long. Eventually, they become clinical consequences. Pakistan therefore needs a pharmaceutical pricing system that is predictable, responsive, and capable of balancing public health with economic realities. Timely decisions based on credible regulatory assessments can help preserve supplies, protect patients, and provide manufacturers with the certainty required to continue production.
The objective should not be medicines that are merely cheap on paper. It should be a system in which essential medicines are both reasonably priced and reliably available. For patients, that is the only definition of affordability that truly matters.