To improve access to public health services in underdeveloped and developing countries, the World Health Organization (WHO) first published a list of 200 medicines in 1977, identifying them as essential medicines.
The WHO medicine selection process is based on three core criteria: priority public health needs, relevance to population health, and the efficacy, safety and affordability of medicines. Under WHO guidelines, essential medicines should be available in appropriate dosage forms to meet patient needs, be of assured quality and be accessible at affordable prices. The concept of essential medicines serves as the foundation for public sector medicine procurement and supply, insurance reimbursement, medicine donations and local pharmaceutical production. The WHO updates its essential medicines list every two years in response to evolving needs. The current list contains about 500 medicines.
Recently, with the aim of expanding healthcare access for a larger share of the population, Bangladesh increased its national essential medicines list to 296 items by adding 135 new medicines. This is a commendably positive step. However, two accompanying policy measures raise serious concerns about the sustainable development of the pharmaceutical industry. The first is the requirement that at least 25 percent of a company’s total medicine sales must come from essential medicines. The second is the imposition of strong price controls.
Bangladesh currently has about 1,500 generic medicines, of which roughly 20 percent are classified as essential. In most cases, essential medicines are priced several times lower than non-essential medicines, and many also have market alternatives. Expecting companies to generate 25 percent of total sales from medicines that make up only 20 percent of products and are significantly lower priced is unrealistic for most manufacturers.
Capacity constraints further complicate the situation. Not all companies can produce every dosage form. Firms with limited dosage form capabilities may face even greater difficulties, as they would be forced to make new investments to meet government targets while operating in low-price segments. From a business perspective, this is an impractical expectation. Market dynamics add another layer of complexity. Growth does not necessarily follow the structure of the essential medicines list. In 2025, the pharmaceutical market in Bangladesh grew at an average annual rate of 9.2 percent. Yet the largest segment, anti-ulcerants, grew by only 7.2 percent. By contrast, cardiovascular and nervous system medicines expanded faster than the overall market, at 14.42 percent and 10.36 percent respectively.
These therapeutic classes are not evenly represented in the essential medicines list. It is therefore natural for companies to prioritise higher growth segments to ensure survival. Market momentum is increasingly driven not by large established segments, but by medium and small specialised therapies, pointing to gradual diversification within the industry. Many specialised therapy medicines are priced several hundred times higher than the average essential medicine. Not all companies manufacture these products, nor do all need to. Firms that depend mainly on technologically advanced, high-value medicines will find it almost impossible to meet a 25 percent essential medicine sales requirement.
Another question merits attention: does Bangladesh actually need an annual essential medicine market approaching Tk 10,000 crore, equivalent to 25 percent of total sales across all companies? This issue requires a proper survey-based assessment. Price regulation also deserves careful scrutiny. The cost of pharmaceutical raw materials varies widely depending on sourcing and import volumes. Operational, production and transportation costs differ across companies and directly influence final prices.
Against this backdrop, it is worth examining whether markup-based or direct price control mechanisms can adequately reflect these business realities. Excessive price control can have negative short and long-term effects, including reduced incentives for quality improvement, supply shortages, distorted competition and weaker investment. Rather than rigid price controls, a rational and realistic pricing framework, developed through inclusive participation of all stakeholders, could better protect consumers while supporting the long-term sustainability of Bangladesh’s pharmaceutical industry.
The writer is deputy general manager at UniMed UniHealth Pharmaceuticals. He can be reached at [email protected]