A bitter pill

Bangladesh managed to treat its national drug formulary as a museum piece for thirty years. Then, for seven brief months, common sense prevailed. In January this year, the interim administration introduced a sweeping overhaul of medicine pricing, expanding the state’s price controlled list of essential drugs from a paltry 117 to 295. 

It was an overdue nod to biological reality, bringing modern treatments for diabetes, cardiovascular disease, and cancer under regulatory oversight. Yet on August 3, 2026, during a cabinet meeting chaired by Prime Minister Tarique Rahman, the government executed a quiet, comprehensive U-turn. 

Both the Essential Drugs List 2026 and its companion pricing methodology were scrapped before a single maximum price had been calculated. With that single stroke of an administrative pen, roughly 180 widely used therapeutics were tossed back into the unregulated wild of the open market.

To understand the human cost of this retreat, one must look at the ledger of Bangladeshi family life. In a nation where state healthcare is a fragile promise, out of pocket expenditure accounts for an extraordinary 79.3% of total health spending. That is among the highest ratios anywhere on Earth, with pharmaceuticals devouring nearly two thirds of that total expenditure. 

According to the Power and Participation Research Centre, almost half of Bangladeshi households contain at least one member suffering from a chronic illness requiring daily, lifelong medication. The Bangladesh Institute of Development Studies notes that the poorest households routinely forfeit 35% of their total income to medical bills, compared to just 5% for the wealthiest. Illness in Bangladesh is not merely a biological misfortune; it is a rapid mechanism for impoverishment.

The timing of the cabinet’s surrender makes it all the more callous. Over recent decades, the country’s epidemiological profile has shifted decisively from acute infectious diseases to long term non communicable conditions. 

Insulin, antihypertensives, and chemotherapy agents are no longer occasional remedies; they are monthly subscription fees for continued existence. Releasing these specific therapies from price controls at a moment when inflation has already forced families to trim their food budgets hits the most vulnerable citizens precisely where they cannot defend themselves.

The official justification offered by Dhaka is a masterpiece of bureaucratic pretext. Ministers argued that the 2026 reforms were procedural orphans, adopted without formal consultation with the National Drug Advisory Council as purportedly mandated by the Drugs and Cosmetics Act of 2023. 

On paper, this stance wears the solemn posture of procedural discipline. Under scrutiny, it dissolves entirely. Legal scholars and council members themselves note that the statute grants the council an advisory function rather than a veto over essential drug lists. More damningly, the government’s own decision to tear up the reform was taken without consulting that very council. 

Reconstituted in late June, the body has not convened a single meeting. A government apparatus invoking the silence of an inactive council to justify dismantling a vital public policy is practicing cynicism of a high order.

Behind this procedural smoke screen sits a far more familiar force: commercial lobbying. In January, the Bangladesh Association of Pharmaceutical Industries, an influential cartel representing 157 manufacturers, challenged the new framework in the High Court and secured a stay. Rather than defending a public benefit in court, the cabinet chose unconditional surrender. 

As the industry withdrew its lawsuit, the government withdrew its regulation. Unsurprisingly, the association welcomed the move, having openly rejected the price caps from the start. Industry insiders wasted no time; news reports confirm that manufacturers immediately began recalculating prices upward on drugs that had briefly faced regulation. 

When regulated entities write the eulogy for their regulation and instantly raise prices, the public does not need a degree in political economy to discern whose interests were served.

This executive retreat is not merely spineless; it is legally perverse. In a landmark 2025 judgment, the High Court held that regulating the prices of life saving medicines is a non delegable constitutional duty of the state, one that cannot be abdicated to market forces. 

The court explicitly found that the 1994 decree, which had restricted state pricing power to a narrow strip of 117 drugs, was beyond statutory authority and against the public interest. The January 2026 reform was, in essence, the executive branch finally obeying judicial instruction. By reverting to the 1994 status quo, the Rahman administration has knowingly walked back into a legal posture its own judiciary declared illegal.

The irony is doubled by the fact that Bangladesh once taught the developing world how to tame the pharmaceutical trade. Its landmark National Drug Policy of 1982 eliminated thousands of redundant, hazardous formulations, established a robust domestic manufacturing sector, and reserved state authority over drug pricing. 

That bold intervention did not strangle commerce; it spurred an extraordinary industrial boom. Today, local firms satisfy 98% of domestic medicine demand and export formulations to over 140 countries. Pharmaceuticals represent the nation’s second most successful export story after ready made garments.

An industry capable of competing aggressively across international markets does not need to extract inflated margins from its poorest domestic consumers to remain profitable. Moreover, the repealed 2026 framework was hardly punitive. 

It maintained generous retail markups, provided bonus margins for novel generics and complex biologics, included automatic annual inflation adjustments, and incentivized the domestic production of active pharmaceutical ingredients. It was a well crafted compromise between commercial viability and public health.

Instead, Bangladesh now relies on a drug list three decades out of date. While the World Health Organization updates its Model List of Essential Medicines every two years, Dhaka has restored a 1994 roster that domestic medical experts estimate is 40% obsolete. A modern population confronting chronic diseases is being abandoned to a therapeutic framework older than many of the patients who rely on it.

If the taskforce suffered from procedural flaws, the sensible remedy was to convene the advisory council, not to burn down the house. The health minister's vague promises offer zero protection. The state chose the lobby over the sick, and the impoverished public will pay at the pharmacy counter.

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Asif Shahriyar Sushmit is the Executive Director, Institute of Policy Dynamics