Access to Anti-Cancer Medicines in Pakistan: An Analysis of NEML Inclusion, Registration, Local Production, Availability, and Prices

OBJECTIVES: Access to anti-cancer medicines is crucial for cancer management, achieving Universal Health Coverage and Sustainable Development Goal 3 by 2030. With rising cancer incidence, access to anti-cancer medicines is a global health challenge, especially for developing countries like Pakistan. This study evaluates NEML inclusion, registration, local production, import of anti-cancer medicines and estimates their availability, and pricing in the healthcare outlets of Pakistan.

METHODS: The NEML 2023, registration list, local production and import information was extracted from the Drug regulatory Authority of Pakistan (DRAP) based on WHO EML 2023. The availability, and prices of anti-cancer medicines were determined using a variant form of WHO/HAI method at May-June, 2024. Eighteen outlets from five survey areas of Pakistan participated, and 67 anti-cancer medicines (lowest priced generics (LPG) and originator brands (OB)) were selected. The data was entered and analysed in Microsoft Excel. The study was approved by ERB committee of Health Service Academy, Pakistan.

RESULTS: Pakistan has adopted WHO EML 2023 abruptly, registered 75% (50) anti-cancer medicines, producing 39 of agents from WHO EML 2023, and imports from 20 different countries. Overall availability of anti-cancer medicines in all type of outlets was very low. The availability of lowest price generic (LPG) and originator brand (OB) in public hospital, retail pharmacies, NGOs-based hospitals, private hospitals were 35.57%, 17.01%, 66.67%, 41.42%, and 4%, 13.73%, 4.98%, and 4.48% respectively. The lowest median price for LPGs and OB was 0.00 whereas highest median price was 12.95 and 0.07 respectively.

CONCLUSIONS: Pakistan has adopted and registered well WHO EML 2023 but the availability of these medicines was lower than WHO target of 80%. Local production of these agents is an important capacity suggested by WHO to increase access. More robust studies are needed to evaluate the role of local production to increase access.