A sharp increase in the price of medicine in Rwanda has added to the suffering of patients who are caught between medical underwriters — who have not revised catalogue price agreements — and pharmacists, who are now forcing medical insurance policy holders to top-up the price differential on certain prescribed medicines.
Pharmacies say they have no choice but to pass on the additional costs to patients since the prices of drugs covered by insurers have not been reviewed to reflect current changes in the market.
Wholesalers blame the hike on the depreciation of the Rwandan franc against the dollar.
“We buy drugs in dollars or in euros and sell them in Rwandan francs and the current hike is due to the exchange rate variability,” said Nzabonimpa Aloys, the managing director of dépôt Pharmaceutique, a medical supplies importer.
Price of drugs
The Rwandan franc has dropped significantly against the dollar since 2016, but the price of drugs has only changed significantly in recent months.
Marie Claire Nyinawinkindi, the treasurer of the Rwanda National Pharmacy Council blamed the limited capacity of wholesalers in the country to procure large stocks, as causing the scarcity of some drugs and thus fuels speculative prices.
Some observers suspect the increase in the cost of brand name drugs is driven by those in the drugs supply chain who want to promote the use of generic drugs.
However, generic drugs are cheaper than brand name medicine in most countries. In Rwanda, the price of drugs is largely set by supply and demand and stakeholders are call for regulation.
“There is a need for harmonisation of prices of medicine, because currently, pharmacies have the autonomy to set the retail price of any medicine, which allows some to speculate, especially when a specific drug is scarce,” said Benjamin Muhigirwa, who works with the Rwanda Social Security Board.
Drugs pricing policy
According to Mr Muhigirwa, who is a pharmacist, the government and private sector should develop a mechanism that controls the cost of medicine from production, wholesale and retail stages to avoid speculative fluctuations.
The Ministry of Health said there is a plan to introduce a drugs pricing policy, which is expected to remedy the current challenges.
“Negotiations over the pricing policy of medicine have been ongoing, but there were many priorities including the establishment of the Rwanda Food and Drug Administration, which is in its final stage and which was a prerequisite to having a pricing policy,” said Muhoza Frederick, the pharmaceutical services supervisor in the Ministry of Health.
The Rwanda Social Security Board, which runs the country’s biggest health insurance for public servants and the community-based health insurance — Mutuelle de Sante — together with other insurers all play a role in setting the price of drugs.
Not aware of hike
Some insurers said they were not aware of the price hike. Contacted for comment, an official from UAP Insurance said they were not aware of the situation and promised to investigate the matter and then get back to us.
The official said customers should report such increases to the company. In addition, the firm said there is an ongoing process of updating the list of covered drugs and prices.
The price of branded medicine has significantly increased in the past three months. A mini survey by Rwanda Today in pharmacies around Kigali shows that the price of commonly prescribed medicine has gone up by at least 20 per cent.
The price hike mostly affects brand-name medicine as opposed to generic drugs mostly from India.
“I was surprised to find that Paidoterin was being sold at Rwf4,000 ($4.64), after increasing by Rwf1,000 ($1.16) in a span of two months,” said Isabelle Mukamurangwa, a resident of Kicukiro.
Retailers say the wholesalers are selling Paidoterin for Rwf2,600 ($3.02) from the previous price of Rwf1,900 ($2.20), three months ago.
Oracefal, which is an antibiotic used to treat a variety of bacteria, is now sold for Rwf8,000 ($9.28) from Rwf5,500 ($6.38). Retailers says they get it at Rw5,500 ($6.38). from Rwf4,000 (4.64).
The price of Amarel 2mg, for non-insulin-dependent diabetes (type 2), has gone up by 50 per cent. Before, a box of 30 tablets was sold at Rwf4,500 ($5.22) by wholesalers but now costs Rwf6,200 ($7.19). Retailers sell it at Rwf300 ($0.35) per tablet.
The price of Coartem, an anti-Malarial has risen from Rwf3,000 ($3.48) to Rwf3,600 ($4.18) a course.