Lebanon's pharmacy sector faced daunting challenges amidst economic turmoil, political upheaval, and multiple crises. Soaring medication prices, government support measures, and unethical practices all played a role in shaping the landscape. However, the industry's resilience and adaptability emerged as beacons of hope, bringing relief and affordable medications to those in need. Let us navigate through some of the highlighting factors.
Throughout its history, Lebanon has passed through a lot of turmoil, but none more damaging than the most recent series of unfortunate events. Before the COVID pandemic struck, Lebanon was in the midst of a revolution against the political regime that was governing at that time. This meant that the country as a whole, and most importantly, the banking sector, was shut down for a couple of months, after which the pandemic took place, and finally the port explosion. All those events obliterated the economy in Lebanon and lead to the collapse of the currency. This collapse was felt throughout all the Lebanese sectors, especially the pharmacy sector.
“I recall during that time, most patients would come in, ask for their medications, have this blank expression on their face when I tell them the price of the medication. They could not handle the new reality; the reality that they could not afford the brand nor the generic, which meant they could not take their medication,”Dr. Samir Hanna, a PharmD holder
Naturally, with the collapse of the currency, everything became expensive simply because the majority of people were still earning a salary at the original rate while the black-market rate increased. Since then, the salaries were always playing catch up to the black-market rate.
During the crisis, access to essential medications became a significant challenge. The economic constraints led many individuals to opt for generic drugs instead of brand-name ones. Some even had to go without medication for a month to save money and buy it the following month. Another strategy was to seek help from relatives abroad to send them the required medication.
Moreover, certain medications became so expensive that suppliers ceased importing them due to financial impracticality. Tragically, there were cases of individuals passing away at a relatively young age, around 60 or 65, because they couldn't afford their antihypertensive or antidiabetic medications. This situation deeply affected healthcare professionals, like Hanna, who witnessed some of their patients from the neighbourhood succumbing to their conditions after discontinuing their medication.
During this time, the Ministry of Public Health sought action to combat the hefty price tags of the drugs. The ministry set a list of medications that were supported financially by the government. In other words, the government would pay for part of the medication to reduce the financial burden on the patient. In addition, the local production of drugs saw a surge because there was a need for cheaper drugs.
Although the government did try to support the patients financially, it had little money left, which meant that the suppliers were not getting paid the money that was due from the government. On the other hand, some regulations forbade the suppliers from selling the medications at their original price, which left the suppliers with one move which is to stop distributing medications supported by the government. This translated to a shortage of medication and left the patient with either the brand medication which was too expensive or nothing.
“I feel sorry for the pharmacy students that had their rotations during that time. All they learned to say was that this or that medication is not available. At that time, most of the medications people sought were not present on the market.”Reem Taha, pharmacist at Mouneshih Pharmacy
When the agreement between the suppliers and the government was honored, and the government paid what it was due, the suppliers did distribute the medications. Unfortunately for the patients, another roadblock manifested.
Pharmacies started hoarding medications because they knew that one or two years down the line, the agreement between the supplier and the government would end, and the medications would return to their original price. The pharmacies wanted to buy the medications at a cheaper rate.
On top of that, some pharmacists would inflate the price of certain medications. As mentioned before, certain drugs were too expensive for the supplier to bring so it was discontinued in the market, and only upon request were they ordered. However, there were still patients who needed the medication. So, what happened is that the pharmacist would order the medication from the supplier, and then sell them at an inflated price.
There was a troubling incident involving a pharmacy technician who collaborated with a senior pharmacist to carry out questionable practices. At the pharmacy where they worked, the technician fulfilled requests from the pharmacist to overcharge patients for their medications. However, when the technician switched to another pharmacy, he continued the unethical conduct by reaching out to the patients he had previously served and offering to supply them with the medication at a lower price, which was still higher than it should have been.
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Eventually, after the country began to stabilize and adjust to inflation, and the salaries caught up to the black market, all these antics were stopped by the Ministry of Public Health. Multiple raids occurred, some pharmacies were shut down, and most of the pharmacies that hoarded the medications did not benefit as much as they thought they would. The suppliers did not allow any return policy whatsoever on the medications bought during the agreement with the government, which left the pharmacies with a lot of stock that simply expired.
Nowadays, there is no shortage of medication, and there are generics for most medications on the Lebanese market at affordable prices.
The Lebanese pharmacy field has seen its fair share of dark days and has shown its adaptability in good ways and bad. One can only hope that should these dark days show up again, the patients don't receive the short end of the stick.
Follow the Author on MedBound: Majd Fawaz (@MajdFawaz)