I have travelled to Trinidad frequently over the last few years, and I am often inundated with questions
about the cost of prescription medications in the USA. It is quite clear that, with the exception of recently developed brand-name drugs, the cost in T&T is six to 30 times the comparable cost of medications in the USA.
This is true even when one takes into account the US/TT exchange rate, and these US prices are for patients without
medical insurance (ie, cash prices at the pharmacy).
It amazes me that in a country in which heart disease is the number-one killer, many patients are not taking their
life-saving medications because they cannot afford to buy them. Some of these medications are available from
the T&T CDAP programme, but many of the commonly prescribed and most effective ones are not on the CDAP formulary, and I understand that CDAP medications are often in short supply. Several of these medications, such as statins and ACE
inhibitors, have been shown to prolong life, and often patients may be able to tolerate only one of them
in a given class of drugs. Even though CDAP may offer one of the medications in a given class, it is often
not one of the more effective drugs. It seems that the CDAP formulary needs to be updated and this
should be done on the advice of physicians in the respective specialities, based on evidence in the
One of the common questions that arises is whether generics are effective and safe to take. The United
States Food and Drug Administration (FDA) has one of the most intense screening protocols for
medications. While this may delay the availability of new medications to American patients, it
considerably reduces the risk of adverse reactions from ineffective or poorly manufactured drugs. In my
more than 30 years of practice in the USA and Canada, I have rarely had complaints from patients about
generic drugs, and more importantly, the medications are clearly effective as evidenced by their effect
on blood pressure, cholesterol and other relevant parameters.
T&T could safely use US generics without serious risk of adverse effects. It is admirable that T&T has a food and
drug administration, but the procedures are unlikely to be more rigorous than those used in the USA.
'Govt's must have political will to control these prices'
The governments of some “developed countries” such as Canada and the United Kingdom can obtain
medications and medical devices (such as coronary stents) at considerably lower prices than in T&T.
Their national health systems (which in some ways are similar to the RHA system in
T&T) negotiate discounted prices for items, based on bulk purchasing.
While T&T, with a population of only 1.3 million people may have difficulty convincing multinational
medical device and drug manufacturers to reduce prices, the CARICOM nations together almost certainly
would. Of course, this would require a political will on the part of the respective governments to make
I am aware that pharmaceutical agents have a vested interest in maintaining these exorbitant drug
prices. However, when life-saving drugs are unaffordable, there is little chance of reducing the incidence
of ailments such as heart disease, diabetes, and high blood pressure. Treatment costs for other common
killers such as cancer may also be prohibitive.
It seems reprehensible that drug suppliers and some pharmacies are willing to put corporate profits
ahead of the health of patients. I am also surprised that the Government is not aware of this vast
discrepancy in drug prices between the USA and T&T.
Certain websites, (such as GoodRx.com and others), can give anyone an estimate of the cost of a given
drug at multiple different US pharmacy chains, and these are cash prices for patients WITHOUT health
More recently, I understand that some customs officials at the airport have been asking passengers to
declare what medications they are taking! Are these officers now being asked to practice medicine? It
seems ludicrous that patients who are trying to acquire their life-saving medications at an affordable
price, may be taxed while doing so.
Until the Government develops the political will to control these prices, and perhaps offer a wider range
of drugs on CDAP, the greed of large corporations will go unchecked, at the cost of patients' lives. No
government should tolerate such egregious behaviour.
Dr Colin Nath specialises in Invasive and Interventional Cardiology.