Joshua Seemu­n­gal

Se­nior In­ves­tiga­tive Jour­nal­ist

joshua.seemu­n­gal@guardian.co.tt

Gov­ern­ment has spent more than $4.4 bil­lion in tax­pay­er dol­lars on the Chron­ic Dis­ease As­sis­tance Pro­gramme (CDAP) over the past decade. 

Now, amid grow­ing con­cerns about ris­ing drug prices, sup­ply short­ages, and the con­cen­tra­tion of con­tracts among a lim­it­ed num­ber of sup­pli­ers, Health Min­is­ter Dr Lack­ram Bo­doe has or­dered a com­pre­hen­sive re­view of the pro­gramme.

The CDAP ini­tia­tive is in­tend­ed to pro­vide free, life-sav­ing med­ica­tion to tens of thou­sands of cit­i­zens with chron­ic ill­ness­es such as di­a­betes, hy­per­ten­sion, and asth­ma.

Health Min­is­ter Dr Lack­ram Bo­doe said Gov­ern­ment was tak­ing drug cost con­cerns se­ri­ous­ly and has ini­ti­at­ed a re­view of the CDAP pro­gramme, along­side plans to up­date the Na­tion­al For­mu­la­ry and ex­am­ine pro­cure­ment prac­tices.

“All con­cerns re­gard­ing the cost of drugs are tak­en very se­ri­ous­ly. Of course, over the years, the drug bill for the Gov­ern­ment has been high, but ac­tu­al­ly, as we speak, I’ve asked a team to look at the CDAP pro­gramme, in the first in­stance and to re­view that with a view to up­dat­ing and ex­pand­ing that pro­gramme, and al­so it is the in­ten­tion to re­view the Na­tion­al For­mu­la­ry, and of course all pro­cure­ment process­es in terms of how drugs are pro­cured will be looked at,” he told Guardian Me­dia out­side the Par­lia­ment build­ing in Port-of-Spain on Fri­day.

The CDAP pro­gramme, launched in 2003, had more than 87,000 ac­tive pa­tients as of 2023 and cur­rent­ly sup­plies med­ica­tion through more than 230 phar­ma­cies na­tion­wide.

As of May 31, 2024, Gov­ern­ment re­port­ed that phar­ma­ceu­ti­cal sup­pli­ers were owed over $352 mil­lion.

Mean­while, Min­is­ter in the Min­istry of Health Dr Rishad Seecha­ran con­firmed that mul­ti­ple phar­ma­ceu­ti­cal as­so­ci­a­tions, in­clud­ing the Phar­ma­cy Board of Trinidad and To­ba­go, have con­tact­ed the min­istry to raise con­cerns about prac­tis­es in the lo­cal phar­ma­ceu­ti­cal dis­tri­b­u­tion sec­tor.

“We are try­ing to arrange meet­ings with those per­sons. We just want to get a con­sen­sus on what is the over­all feel from the phar­ma­cy pro­fes­sion­als about what per­tains cur­rent­ly in Trinidad and To­ba­go,” he said.

With re­gards to a (per­ceived) mo­nop­oly, that will be an is­sue for the Fair Trade Com­mis­sion. So we would let them as­sess that, but in terms of free ac­cess to do­ing their busi­ness in a le­gal and a fair way, we would con­sult with the phar­ma­cy as­so­ci­a­tions and make sure every­thing is in place for them to car­ry out their trade.” 

Be­tween Feb­ru­ary 2015 and Feb­ru­ary 2025, the cost of phar­ma­ceu­ti­cal drugs in Trinidad and To­ba­go in­creased more sharply than food prices.

Ac­cord­ing to Cen­tral Bank da­ta, the Con­sumer Price In­dex (CPI) for phar­ma­ceu­ti­cal prod­ucts rose by 57.3 points over the decade, com­pared to a 53.5-point in­crease for food items. 

The CPI tracks the av­er­age change in prices paid by con­sumers for a stan­dard bas­ket of goods and ser­vices.

CDAP con­tracts

Doc­u­ments ob­tained through a Free­dom of In­for­ma­tion Act (FOIA) re­quest show that be­tween 2015 and 2024, 16 phar­ma­ceu­ti­cal com­pa­nies col­lec­tive­ly re­ceived $4.4 bil­lion in CDAP con­tracts.

One sup­pli­er, Smith Robert­son & Co. Ltd, ac­count­ed for ap­prox­i­mate­ly 42 per cent of those con­tract val­ues ($1.8 bil­lion), while Bry­den Pi Lim­it­ed re­ceived the sec­ond high­est share at 17 per cent ($742 mil­lion).

Smith Robert­son & Co Ltd–$1.8 bil­lion

Bry­den Pi Lim­it­ed–$742 mil­lion

Massy Dis­tri­b­u­tion–$283.2 mil­lion

Al­stons Mar­ket­ing Com­pa­ny Ltd–$275.6 mil­lion

Ver­non Tech­nolo­gies Ltd–$231.5 mil­lion

A A Laquis Lim­it­ed–$230.5 mil­lion

Su­pe­ri­or Phar­ma Ltd–$206.7 mil­lion

Phar­ma­co In­dus­tries Ltd–$152.2 mil­lion

Ul­tra Pharm Mar­ket­ing Ltd–$137.2 mil­lion

Sun Crest In­ter­na­tion­al Ltd–$122.7 mil­lion

AP Scott Trinidad Ltd–$64 mil­lion

Eye See You Oph­thalmic & Med Sup­plies Ltd–$54.6 mil­lion

The Med­ical Sup­ply Co Ltd–$50.8 mil­lion

Me­di Sup­plies Ltd–$47.5 mil­lion

Physi­cians Phar­ma­ceu­ti­cals–$21 mil­lion

Bpl Genethics Ltd (a sub­sidiary of Bry­den)–$8.7 mil­lion

Ear­li­er this year, a re­port by the Pri­vate Phar­ma­cy Re­tail Busi­ness As­so­ci­a­tion—based on a sur­vey of over 100 mem­ber phar­ma­cies—al­leged that one com­pa­ny op­er­at­ing in T&T held con­trol of ap­prox­i­mate­ly 85 per cent of the ma­jor in­ter­na­tion­al phar­ma­ceu­ti­cal brands dis­trib­uted lo­cal­ly.

Ac­cord­ing to the as­so­ci­a­tion’s find­ings, this same com­pa­ny is es­ti­mat­ed to ac­count for 67 to 70 per cent of all third-sched­ule phar­ma­ceu­ti­cal sales to rough­ly 500 phar­ma­cies na­tion­wide. The as­so­ci­a­tion claims this lev­el of mar­ket share ex­ceeds the 40 per cent cap typ­i­cal­ly ob­served by the Fair Trade Com­mis­sion (FTC).

“It cur­rent­ly con­trols 67 to 70 per cent of all third-sched­ule phar­ma­ceu­ti­cal sales to 500 phar­ma­cies na­tion­wide. Laws state 40 per cent is the max­i­mum (mar­ket share) al­lowed by the Fair Trade Com­mis­sion (FTC),” the re­port stat­ed.

The re­port al­so al­leged that there have been mul­ti­ple price in­creas­es an­nu­al­ly—some­times four to five times per year—af­fect­ing pa­tients’ abil­i­ty to af­ford crit­i­cal med­ica­tion. 

It not­ed that most oth­er com­pa­nies ap­plied in­creas­es in­fre­quent­ly and in small­er mar­gins.

“The oth­er com­pa­nies have in­signif­i­cant in­creas­es, rarely,” the as­so­ci­a­tion wrote in the re­port it com­piled.

These claims have not yet been ver­i­fied by reg­u­la­to­ry au­thor­i­ties. The FTC has not pub­licly com­ment­ed on the mat­ter, and no de­ter­mi­na­tion of an­ti-com­pet­i­tive con­duct has been made.

Glob­al and re­gion­al phar­ma price pres­sures

Ac­cord­ing to Unit­ed Na­tions trade da­ta, T&T im­port­ed $9 bil­lion in phar­ma­ceu­ti­cal prod­ucts be­tween 2017 and 2024.

Be­tween 2017 and 2024, one com­pa­ny re­port­ed rev­enues of $10 bil­lion in phar­ma­ceu­ti­cal items. Al­so, be­tween 2017 and 2023, an­oth­er com­pa­ny’s prof­its rose by 125 per cent (from $65.6 mil­lion to $147.7 mil­lion).

Some re­ports in­di­cate that new drugs in 2023 launched at prices 35 per cent high­er than the pre­vi­ous year. In Jan­u­ary 2024 alone, man­u­fac­tur­ers raised the prices of 250 brand­ed drugs, with an av­er­age in­crease of 4.5 per cent.

In the Unit­ed States, phar­ma­ceu­ti­cal price hikes have drawn sim­i­lar scruti­ny. 

In­dus­try an­a­lysts at­tribute glob­al price trends to fac­tors such as high­er re­search and de­vel­op­ment costs, the per­ceived val­ue of new­er drugs, and evolv­ing pric­ing strate­gies by man­u­fac­tur­ers.

Guardian Me­dia reached out to Agos­ti­ni Lim­it­ed, which owns Smith Robert­son & Co Ltd for com­ment on its mar­ket share, but the com­pa­ny de­clined to com­ment.

Re­quests for com­ment were al­so sent to the com­mu­ni­ca­tions team at AS Bry­den, but no re­sponse was re­ceived by late yes­ter­day.