Drug pricing reforms scrapped as govt returns to three-decade-old medicines list

When Bangladesh’s interim government overhauled the country’s essential medicines policy earlier this year, it presented the changes as a long-delayed attempt to give the state greater control over the prices patients pay for critical drugs.

The National Essential Medicines List 2026 nearly doubled the number of medicines subject to special government protection, expanding the list from 159 to 295. Alongside it, the government introduced a Medicine Pricing Methodology that, for the first time, established a legal framework for setting the prices of medicines on the list.

Public health experts saw the two measures as potentially significant in a country where patients pay much of their medical expenses out of pocket. Government officials said the reforms would make essential medicines more accessible and bring greater transparency to drug pricing while at the same time strengthen consumer protection.

But the pharmaceutical industry objected almost immediately.

Manufacturers argued that the measures had been drafted without sufficient consultation and warned that the pricing system could hurt an industry already contending with inflation, higher production costs and foreign currency shortages.

On June 30 this year, the Bangladesh Association of Pharmaceutical Industries, or BAPI, wrote to the health minister seeking an urgent meeting to review the policy. 

The association said years of limited price adjustments had squeezed profit margins, discouraged investment in new medicines and placed growing pressure on smaller manufacturers.

On Monday (August 2), the government effectively reset the process.

The Cabinet revoked both the National Essential Medicines List 2026 and the Medicine Pricing Methodology 2026, saying they had been adopted without obtaining advice from the National Drug Advisory Council, as required under the Drugs and Cosmetics Act, 2023.

Until a new list is prepared, the government said, Bangladesh will revert to its 1994 Essential Medicines List.

A win for the industry, loss for consumers 

The decision was quickly welcomed by the pharmaceutical industry.

Zakir Hossain, a former secretary general of BAPI, told Prothom Alo newspaper that the move would end nearly two years of uncertainty and deadlock and restore stability to the pharmaceutical sector.

Industry leaders who spoke privately with Daily Waadaa also welcomed the withdrawal. They noted that the 2026 measures had never actually taken effect and therefore had produced no measurable changes in medicine prices or the broader market.

That response has sharpened questions among public health specialists and some of the officials involved in drafting the reforms about whose interests the reversal ultimately serves.

Professor Sayeedur Rahman, one of the architects of the reforms and a former special assistant to the chief adviser of the interim government, said pharmaceutical companies were entitled to advocate policies affecting their businesses. 

But, he wrote, “such enthusiastic support inevitably creates a public perception that the decision may better serve commercial interests than consumer interests.”

The stakes extend well beyond a dispute over regulatory procedure. Bangladesh’s pharmaceutical market is worth more than 40,000 crore taka, and the price of medicines directly affects a population of nearly 180 million, many of whom bear a substantial share of their healthcare expenses themselves.

Two policies, Rahman says, were designed to operate together. The Essential Medicines List identifies drugs considered important enough to warrant special public protection. The pricing methodology establishes the mechanism through which the government can regulate their prices. 

Withdrawing both at the same time, Rahman argues, creates uncertainty over which medicines should receive that protection and how their prices should be determined.

The legal dispute stems from the Drugs and Cosmetics Act, 2023, and a subsequent High Court ruling.

Section 30 of the law gives the government responsibility for regulating the prices of essential medicines. In July 2025, the High Court ruled that the responsibility could not be delegated to private pharmaceutical manufacturers and directed the statutory Price Fixation Committee to determine maximum retail prices for essential and life-saving medicines.

The court also instructed the government to establish clear guidelines for preparing the Essential Medicines List.

The interim government introduced the 2026 list and pricing methodology after those legal developments. The current government argues that the process was flawed because the National Drug Advisory Council had not been consulted before the measures were adopted.

Sayeedur Rahman disputes that interpretation. He argues that Section 13 of the law establishes the council as an advisory body but does not make its consultation a mandatory legal condition for publishing an Essential Medicines List.

Rather than withdrawing the measures, he said, the government could have defended that interpretation before the High Court. Any procedural deficiencies, he added, could have been corrected through amendments without abandoning the broader pricing reforms.

Other public health specialists have raised similar concerns.

What experts say

“The Essential Medicines List and the pricing methodology should not have been scrapped,” said Dr M Mushtuq Husain, a public health specialist and former adviser to the Institute of Epidemiology, Disease Control and Research. 

“If there were concerns, the government could have revised them after consulting stakeholders. There was no need to withdraw the entire framework,” he told Waadaa.

Husain said reverting to a list dating from 1994 was particularly difficult to justify given how much medicine and pharmaceutical manufacturing have changed over the past three decades.

“Medical science has changed significantly since 1994,” he said. “Many medicines from that period are no longer used, while many new medicines have been introduced. Advances in manufacturing technology have reduced production costs, making it reasonable to revise and lower medicine prices.”

For patients, he said, the consequences are not abstract. The cost of medicines can determine when — or whether — people seek treatment.

“We have seen during measles and dengue outbreaks that many people delay going to hospital because they fear the cost of treatment,” Dr Mushtuq said. “They often seek care only at the last moment. If medicines were more affordable, they would seek treatment earlier and avoid serious complications.”

The decision also puts the government’s drug policy against commitments made by the Bangladesh Nationalist Party before taking office.

The BNP’s 31-point reform agenda promises universal health coverage built around the principles of “Health for all” and “No death without medical treatment.” Its Vision 2030 pledges to reduce medicine prices, regulate drug prices and provide essential medicines free to poor patients.

“If the government wants to achieve universal health coverage, it should expand the list of essential medicines, not withdraw it,” Dr Mushtaq said. “The framework could have been improved if necessary, but scrapping it altogether is a step backwards.”

There is one important limitation to the debate. Neither side can point to evidence of how the 2026 system actually affected medicine prices because it was withdrawn before it was implemented.

The Directorate General of Drug Administration said it had not yet received the ministry’s formal order and could not assess what effect the Cabinet decision would have.

“We have not yet received the official order from the ministry,” Akter Hossain, a director at the DGDA, told Waadaa. Nor, he said, was it possible to determine whether the discarded reforms would have worked.

“It was never implemented,” Hossain said. “Had it been implemented, we could have compared whether it brought benefits or created problems. Since it was not implemented, that comparison cannot be made.”

That leaves the government with a policy gap of its own making.

It has said that the Essential Medicines List will be updated, but has not publicly detailed what will replace the discarded pricing methodology, how the new system will reconcile the competing interests of manufacturers and consumers, or when it will take effect.

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