The prolonged shortage of more than 100 essential medicines across Pakistan has opened the door for counterfeit and substandard products to flood the market, as the federal government continues to delay a decision on price revisions that manufacturers say are now critical to keeping production viable.
At the centre of the crisis is a pricing deadlock that has dragged on for more than two years. The Drug Regulatory Authority of Pakistan (DRAP) recommended price revisions for 105 hardship-category medicines, but the federal cabinet has yet to approve the proposals.
DRAP’s drug pricing committee had concluded that surging costs of imported raw materials, energy, packaging, transportation, labour, financing, and currency depreciation had made the production of many essential medicines commercially unviable. Yet with the recommendations still gathering dust, several manufacturers have either scaled back or suspended production entirely, deepening the shortage of critical drugs nationwide.
What Is Missing from Shelves
Abdul Samad Buddani of the Pakistan Chemists and Druggists Association (PCDA) said 105 medicines are either completely unavailable or in critically short supply. The list includes oral morphine capsules in 10mg and 30mg strengths used for severe cancer pain, streptokinase injections for heart attack patients, chemotherapy drugs including cisplatin, carboplatin, and doxorubicin, paediatric digoxin liquid, pilocarpine eye drops, yellow fever vaccine, folic acid tablets, and several immunoglobulin products.
Counterfeit Risk Grows
The growing supply vacuum has raised alarm over the integrity of the pharmaceutical supply chain. Industry representatives warn that the prolonged unavailability of genuine medicines is creating a dangerous opening for counterfeiters.
“When authentic medicines disappear from the market, patients become desperate and often turn to unreliable sources. That increases the risk of counterfeit and substandard medicines entering the supply chain, particularly expensive cancer medicines and other life-saving drugs,” Buddani said.
‘Financially Unsustainable’
Pharmaceutical manufacturers argue that the shortages are a direct consequence of the government’s failure to implement the hardship pricing mechanism. They say the current pricing structure has made producing several essential medicines financially unsustainable and have urged the government to expedite pending decisions before supplies deteriorate further.
A senior member of the Pakistan Pharmaceutical Manufacturers’ Association (PPMA) said successive governments had delayed decisions on hardship-category medicines despite clear recommendations from the Drug Pricing Committee, discouraging manufacturers from continuing production.
“If manufacturers cannot recover even the basic cost of producing essential medicines, production simply cannot continue. The pricing policy exists to ensure these medicines remain available to patients, and timely decisions are necessary to achieve that objective,” he said.
DRAP Says It Has Done Its Part
Officials at DRAP confirmed that the cases have remained pending since February 2024 despite the Drug Pricing Committee’s findings that manufacturing many essential medicines had become commercially unviable under existing prices.
DRAP Chief Executive Officer Dr. Obaidullah Malik said the regulatory authority had completed its mandate by processing the applications and forwarding its recommendations to the government. “The final decision rests with the federal cabinet, which has to determine the matter in the broader public interest,” he said.
For now, patients across the country remain caught in the middle — facing not only the scarcity of life-saving drugs but also the growing risk that whatever is available may not be genuine.
