Important life-savings drugs
are already highly costly to the point of being unaffordable
By SYED M. ASLAM
April 29 - May 05, 2002
Like most of the countries of the world drugs enjoyed
a tax-free status in Pakistan since it gained independence 55 years ago
barring the single exception of levying of 10 per cent import duty on
imported drugs in 1996 which remain in effect till today. For the first
time ever the government announced to levy a sales tax on all kinds of
drugs be it allopathic, homeopathic, or bio-chemic at the rate of 15 per
cent, on the 21st of last month with immediate effect. Even the
life-saving drugs, including some 850 salts, were not spared from the
However, unified protests by the public and the media
forced the Central Board of Revenue (CBR), the country's apex tax
collecting agency, to issue a list of 256 life-saving drugs exempted
from the sales tax at the retail level. The new list does not only
exclude two-thirds of the drugs previously accepted as life-saving but
also contain many anomalies. In addition, it has left out many important
life-savings drugs which are already highly costly to the point of being
unaffordable. With the imposition of 15 per cent GST they would become
further expensive to aggravate situation for the suffering patients.
For instance, an anti-cancer medicine Taxol, a 30 mg
injection imported by a multinational, retails for Rs 9,642.60 per vial.
This important life-saving medicine in not included in the new list and
thus is subjected to Rs 1,446.39 GST which pushes it price to Rs 11,089
per injection. This medicine is used in a course treatment which
comprise a minimum of 45 injections the total costs of which without the
GST previously totalled an unaffordable Rs 433,917. With the imposition
of GST the total cost of the course would now cost Rs 499,005- Rs 65,000
more than it cost previously. In a country reeling from a low per capita
income of Rs 24,000 the treatment equals 20 years' pay and that too if
every single paisa of it is saved. Taxing an already unaffordable
life-saving drug is a cruel joke to the cancer patients.
Similarly, another anti-cancer medicine, Zoldex 3.6
mg injection, marketed by a multinational is not included in the list.
It retails for Rs 11,007 per vial and with the Rs 1,651.10 GST its price
is pushed to Rs 12,658.46.
Even the medicines used by children in particular are
not included in that all-compassionate list of the CBR. Meronem 500 mg
inter-venous injection is primarily used to treat children suffering
from birth deficiencies. It is life-saving but is not included in the
list. A single dose of this medicine retails for Rs 826.43 which now
retails for Rs 950 inclusive of Rs 123.96 gst. Similarly, P.A. 12 Lac
injection used in the treatment of children with such life-threatening
conditions as hole in the heart and manufactured by a multinational is
just not available for years. The medicine which retails for Rs 15.13
and with the levy of GST will retail for Rs 17.40 is not supplied in the
market by the MNC and though many local companies manufacture a
substitute it is not as effective. Observers blame the unavailability on
factors related to the manufacturer's concern that the medicine offers
'little profit of margin.'
While the preventive injection for Hepatitis-B is
included in the tax-exempt list, its more important curative
counterpart, a tablet, Zefix 150 mg, is subjected to the gst. A
14-tablet pack of Zefix previously retailed for Rs 1,406 per tablet
which with the levy of GST now retails for Rs 1,617. A Hepatitis-B
sufferer has to take one Zefix tablet daily for a whole year and the
course, thus, now costs him over Rs 42,000 compared to Rs 36,656 or an
additional Rs 5,500.
Another example of the anomaly is Amken injection
used both by the children and adult. While the small dose of 100 mg used
to treat children is not exempted from the GST its 250 mg and 500 mg
vials meant for adults are included in the list and thus stand exempted
from the tax. This is one glaring example of discrimination against the
children, our future generation.
Maxipime is a life-saving medicine which many top
surgeons and doctors refer to as an 'elixir'- 'working when all other
other medicines fail.' This third-generation anti-biotic was not
included in the exempt list thus pushing the price of its 500 mg
injection from Rs 387.50 to Rs 445.62 and that of 1 gram vial from Rs
730.08 to Rs 839.59.
Tablet version of Paracetamol, an active ingredient
used in the manufacture of everyday medicines, is exempted from the tax
but Panadol syrup, its liquid substitute is not. This is just one
example of tens of others such anomalies where injections are included
but not the tablets, one variant of a dose is included but the other are
not and vice versa.