How rogue pharmacists are robbing the sick

A nationwide three-month investigation by the Healthy Nation team has uncovered widespread price gouging by pharmaceutical outlets, with essential medications marked up over 300 per cent above recommended retail prices. This exploitation, enabled by a lack of regulations in the free-market system, leaves countless Kenyans struggling to afford life-saving treatments, sometimes leading to skipped medication and even death.

For years, desperate Kenyans seeking medical care have been fleeced by this unregulated system. Kenya's free-market drug pricing policy, while aiming for competition, has resulted in patients paying exorbitant prices. The choice is stark: pay whatever is demanded for life-saving medication or skip the prescription, potentially risking their health or even their lives.

The investigation exposes an alarming lack of logic in drug pricing, driven solely by profit maximisation. Prices vary significantly depending on the seller, location, and even the buyer's appearance, mode of transportation and insurance status. Patients with insurance cards were charged more than those paying cash, and even the same drug from the same supplier could have different prices in different pharmacies or even within the same hospital. Even pharmacies sharing walls and hospitals within the same region offer wildly different prices for the same medications.

Examples abound: neonatal antibiotics, drugs for anaemia and respiratory infections, and diabetes medications are all subject to this predatory pricing. In some cases, the price is inflated over three times, placing these vital medications firmly out of reach for the average Kenyan.

Elizabeth Njoroge, who has Type 2 diabetes, had to cough up more money when a city pharmacy ran out of the drugs that she had been using. “I use both the short-acting insulin-Actrapid and long-lasting insulin - called Lantus (Vial).I would get these drugs from a specific pharmacy in Tea Room, Nairobi because I considered their pricing relatively fair,” says Elizabeth.

“I used to buy an Actrapid at Sh1,100. But when the pharmacy ran out of the drug, I went to a nearby pharmacy and bought it at Sh2,250,” she explains.

“If you walk into a pharmacy in pain or to buy emergency medicines, it is unlikely that you will be in a position to bargain. All you want is to get better,” she said.

“I questioned the price disparity and was told it was because it takes a long time to restock the drug, and once it is back in stock, it moves fast. I figured they take advantage of its high demand to obtain quick profits. I had to take only fewer doses that I could afford, which was not the correct dosage,” she says

At Kijabe Mission Hospital, Actrapid is sold at Sh580, almost half the price of how it is sold in Nairobi chemists. Lantus insulin is sold in a Bomet chemist at Sh2,183. Mixtard, which contains both short-acting and long-acting insulin, costs Sh581, while in a Bomet County chemist, the drug goes for Sh593. 

In the same hospital, Augmentin syrup, also a neonatal antibiotic, goes for Sh368, while a Bomet County chemist sells it at Sh855. Erythromycin, used to treat respiratory infections, sells at Sh15 per 500mg tablet at Kijabe Hospital but goes for Sh17 per tablet in a Bomet County chemist.

Dr Mbau Gitau, a pharmacist in Nairobi, explains that the disparity is brought about by different factors including the cost of running the business, rent, cost of labour and the procedure of acquiring drugs.

“A pharmacy business in Lavington, Nairobi that probably pays a rent of Sh200,000 will use patients to offset that bill. There is also the cost of labour, arising from the fact that some pharmacies are owned by pharm techs and run by qualified pharmacists, while others hire quacks. This cheaply acquired labour is dangerous because these quacks will not guide the patients in terms of pharmaco-vigilance, drug interactions, food and drug interactions and more. When you go to a qualified pharmacist who is paid a premium, it will be quite expensive. Their quality of service reflects on the pricing,” he says.

“Nairobi County charges small pharmacies about Sh50,000 for annual licence fee up from Sh22, 000. We are also charged separate annual licence fees by the Pharmacy and Poisons Board and the county government. Besides, some people acquire the drug on credit, others get the drugs via dubious means, while others pay with cash. If you pay with insurance, the pharmacist is going to be paid after 90 days, without interest. The person doing the legit business is going to be pressed to transfer the cost to the patient,” he says.

“We need to ensure that pharmacy is a holistic place to serve the client and to address cost to make sure that it doesn’t hurt the patient.”

In Kisii, in some pharmacies, Azithromycin goes at Sh100 per tablet, amoxicillin at Sh480 while Augmentin goes at Sh700 . This is bound to increase depending on one’s physical appearance.  For instance, a person who gets to a pharmacy using a car will be judged to be having some money hence he/she will be sold drugs  at high prices. 

“The price we will tell someone who arrives with a car is not the same price we will sell to a person who walked his way here. Those who walk to shops like bargaining as they claim to be struggling financially. We therefore negotiate with them unlike those who own cars who will just pay the money you tell them first,” a pharmacist at the General Roundabout who sought anonymity says. 

Most chemists in Kisii town are concentrated at the General Roundabout because of its proximity to the Kisii Teaching and Referral Hospital. 

“There are no drugs inside that hospital yet we are always told that they have been procured by the county government. I brought my mother here, who is diabetic, and I have been told to buy drugs worth Sh2,000 from outside. The drugs here are very expensive,” Obed Mokua, a resident of Keroka, says. 

Often, patients are instructed by medics to buy life-saving commodities from private pharmacies that are strategically positioned outside such facilities. 

The same case applies to Western Kenya, and what is emerging is that a number of public hospitals do not store drugs, hence send patients with prescriptions to buy drugs in chemists.

Jacob Otieno, who hails from Muhoroni, was diagnosed with diabetes in 2011 and it has not been easy for him to get treatment since he has to cough up thousands of shillings every month to buy his drugs.

At  Kisumu District Hospital , where he attends his monthly clinic visits, he says most of the time he is given a prescription to buy the drugs from private facilities due to the unavailability of the commodity in the public facility.

The type 2 diabetes patient says some of the drugs he always buys include metformin and glibenclamide. A 500 milligram (mg) tablet of metformin goes for Sh17 at the hospital but when bought outside, it is four times the amount. “I have gone without my drugs for a number of months because they are too expensive. If only we could have all the outlets sell at the same price, then I would constantly be on my drugs,” he says.

Missing his dose means it may cause blood glucose levels to increase. This can lead to emergencies such as diabetic ketoacidosis (DKA)—a condition where your body produces an unsafe level of ketones. Ketones are natural substances that are created when fat is being used for energy instead of glucose. Too many ketones in your blood can cause unsafe changes in blood chemistry, increasing the risk of some diabetes-related problems.

The private pharmacies in the lakeside city, however, sell the commodity at different prices while the owners claim that the amount is largely influenced by the suppliers. In one of the chemists located in the Kisumu CBD, a full dose of premixed insulin is priced at Sh810.

“The drug-selling business is a free market, which is largely influenced by the demand and supply of the commodities,” said an insider at one of the major pharmacies in Kisumu

For instance, the prices of neonatal drugs such as 200mg azithromycin price ranged between Sh150 to 175 for the generic brand while the original brand, Zithromax Syrup 200mg, ranged from Sh900 to Sh1,000 in several chemists. Augmentin syrup (original) on the other hand goes for Sh1,300 while some drug dealers sell it at Sh750. The same drugs go for Sh270 atJaramogi Oginga Odinga Teaching & Referral Hospital.

A  pharmacist in Kisumu, who requested anonymity,  explains that the prices are also largely influenced by a pharmacist's ability to negotiate with suppliers to get a better deal and the amount of supply they order.

“It is just like any other industry, once you have built a relationship with the suppliers, you will end up getting better deals if you know your way around. In terms of profit margins, each business has its way of determining the prices , which vary depending on the location of the business and the supplier.”

She also explains that the drugs acquired from Nairobi always include the delivery cost, which may make the drugs a little expensive.

In Kericho,  injectable insulin for diabetic patients in chemists is sold at Sh800. The same goes for Sh300 in public facilities.

Antibiotic prices in chemists vary from Sh700 to Sh1,000 for Augmentin, with pharmacists saying the difference in the pricing is caused by the packaging policies that were introduced by the government during Covid-19.

“Even as the government shifts focus from curative to preventive measures to control disease outbreaks, drugs are increasingly becoming out of reach for the poor, the elderly and children in the society,” a nurse in Kericho County says.

She emphasises the need for county governments to stock drugs in hospitals, health centres and dispensaries so that the poor in rural areas can afford and access them.

"It's hard to dictate the price of drugs since they all have different manufacturers. Other price determinant factors are the manufacturing company and packaging, but then, the stronger the medicine the better the packaging,” says Jacinta Gathoni, a pharmacist in Nyandarua.

At Moi Teaching and Referral Hospital (MTRH) in Eldoret, Azithromycin is going for Sh57 per tablet, Amoxicillin Sh10 per tablet and Erythromycin Sh10 per tablet (for the generic tablets).  In private hospitals in Eldoret, Azithromycin is retailing at Sh400, with some selling as high as Sh1,100.

In recent years, the town has witnessed an upsurge in the number of chemists, selling both over-the-counter and prescription drugs.

In Nakuru, the price of Augmentin, which is one of the widely used antibiotics, is sold between Sh950 and Sh1,470, with Dr Victor Achoka, a pharmacist who has worked in the region for the last two decades, saying that the cost of medicines is dictated by the forces of supply, demand and location.

“If you locate your pharmacy in a mall and downtown, the prices are different. In a mall, you expect fewer clients, forcing one to stock both cheaper and pricier brands hence the difference in the pricing,” Dr Achoka said.

According to a local manufacturer who sought anonymity because of the complexity of the matter, several factors are raising the cost of medicines in the country; including sporadic power and low quality water supply and poor roads.

“We operate in an environment where we often have to invest in boreholes and power generators, thus raising our costs of production,” says one of Kenya’s leading medicine makers.

The investigation gave a reflection on the findings of a synthesis report done in 2009 by the World Health Organisation that showed that low procurement prices did not always translate to affordable medicine prices for the patient due to price add-ons along the supply chain.

The survey done to examine the barriers to medicine access indicated that lack of transparency gives the drug sellers and pharmaceuticals the upper hand in price negotiations. “This is possible because secrecy is rampant in this field,” says the report. “Patient prices were higher in the private sector compared to public and mission sectors. Pricing of medicines varied from where the drugs were sourced from, the location of the premise and the supplier of the drugs.”

Although the private-for-profit outlets were found to be the best stocked, they were also established to be prohibitively expensive. Some pharmacists and illegal retail outlets have taken advantage of the lack of a national medicines pricing policy to raise their prices arbitrarily.

“There is a wide variability in medicine prices, which calls into question the price-setting mechanisms through the supply chain,” says the survey. 

“There is an obvious need to establish a form of reference pricing for medicines in the private sector to prevent excessive pricing.”

Even with the survey findings, when it comes to drug pricing in the country, it is still a free market. The Ministry of Health specifically has not attempted to regulate the market despite complaints from patients.

The survey recommends that the government investigates options in the private sector to increase pricing transparency and consequently reduce medicine prices while undertaking further research into pricing structures of other medicines in other locations.

The government has also been tasked to enforce price declarations on imported medicines and develop transparency in pricing and procurement systems.

Before 1984, there was an understanding among drug importers, wholesalers and retailers in the pharmaceutical sector that established markups on medicines. Importers levied a 15 per cent markup, wholesalers 10 per cent and retailers 33 per cent. These markups were cumulative. With the liberalisation of the economy, medicine price control was abandoned and the prices are now based on the market forces of supply and demand.

The Kenya Drug Authority Bill 2022 is one of the proposed legislations meant to regulate the pharmaceuticals sector and hopefully, it will address the price of medicines in the country once Parliament gives the Bill a nod and the President ascents to it.

Reported by Angela Oketch, Mercy Chelangat, Ruth Mbula, Wycliffe Nyaberi, Angeline Ochieng, Stanley Kimuge, Waikwa Maina and Vitalis Kimutai