Coping with increasing medicine costs through greater adoption of generic prescribing and dispensing in Pakistan as an exemplar country

Ensuring safe, effective and affordable medicines and vaccines is an integral component of the Sustainable Development Goals (SDGs) to reduce future morbidity and mortality across countries [1,2]. However, currently for more than a quarter of the world's population, essential medicines are either unavailable, inaccessible or of low quality, exacerbated by high rates of co-payment and issues of affordability without universal healthcare [3]. It is crucial to address these challenges, and reduce the financial burden of care and its associated morbidity and mortality, especially as the cost of medicines currently account for an appreciable proportion of the overall cost of care in developing countries [3]. This is currently the situation in Pakistan, which is a lower-middle income country and the fifth most populous country globally with population of over 230 million in 2023 [1,4]. However, approximately 60% of the costs of healthcare in Pakistan is currently borne by patients [1,5]. Despite price controls, the affordability of medicines in Pakistan remains a problem for most due to appreciable prescribing and dispensing of originator brands (OBs) and high-priced branded generics (BGs) as well as substantial price variations in OBs, BGs and low-priced generics (LPGs). Such issues are exacerbated by concerns with the ability of the Drug Regulatory Authority of Pakistan (DRAP) to properly regulate prices [1,5,6].