Lebanon: Patients Hostage to Medicine Merchants

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The Lebanese Health Ministry also prohibits free offers on medications, though it is not strict in its enforcement. (Photo: Marwan Bou Haidar)

By: Minhal al-Amin

Published Wednesday, October 30, 2013

A pharmacist's job is to sell goods, like any other merchant. The pharmacy is a shop, and patients are customers.

This story begins with the promotions provided by companies that import pharmaceuticals to Lebanon. Some pharmacists who spoke to Al-Akhbar explained how they are forced to sell certain promoted medicines by any means necessary.

Offers to Entice Pharmacists

Ali Safa, a pharmacist, explains that sales representatives are flooding Lebanese pharmacies with very attractive offers, such as providing 18 boxes free for every 20 bought by the pharmacy, which is the case with a stomach ulcer medicine. For anti-inflammatory medications, the promotion could promise 110 boxes free for every 100 purchased.

The value of such promotional offers add to the pharmacists’ profits, which is officially and legally set at 22.5 percent of the sales. Safa maintains that current profits by pharmacists, due to the promotions, are between 65 and 70 percent, which they are not entitled to at all.

Article 80 of the law regulating the profession prohibits the raising or lowering of the price of medications. The Lebanese Health Ministry also prohibits free offers on medications, though it is not strict in its enforcement.

But how could pharmacists hide their actual profits when they are obliged to present their financial accounts for inspection? Safa thinks it is likely that agents tamper with the original price of the drug, which means there is a clear collusion between factories and exporters in the countries of origin. This makes it easier for agents to put a 20,000 Lebanese lira ($13) price on a certain medication, claiming they bought it for 12,000 lira ($8), while its actual cost would not exceed 5,000 lira ($3).

Pharmacists can also neglect to mention such offers altogether in their accounts. Safa speaks about his personal experience, saying that all pharmacists are doing it. The offers are noted on the invoice margin (with a pencil for example) and do not go into the official sales and purchases accounts.

Corrupt Medicines

A source in the Lebanese pharmacist syndicate indicates that this issue had been raised in the union's council.

"There is something similar to an alliance between the pharmacist syndicate and the importer syndicate, which allows such shady deals to happen," the sources explain. They maintain that plenty of evidence exists for such an alliance. For example, the head of the pharmacist syndicate could also be an importer. Several pharmacists are actually employed by the companies importing and distributing medications in Lebanon.

According to the same sources, the electoral process inside the syndicate is governed by this "cartel," whereby importers influence who wins and who loses. This is in addition to the political cover provided by some politicians, who are also major importers or backers of such importers.

One pharmaceutical import company is owned by and named after Lebanese MP Michel Pharaon. The companies Catafago and Macromed are owned by current head of the pharmacist syndicate Rabih Hassouna.

Leaving medicines in the hands of a corrupt system will put the people's health at the mercy of the pharmacist who is bombarded with enticing offers and will do anything to sell the goods before they expire. This system also impacts medicine prices. Medicine bought at 20,000 lira ($13), for example, should only cost 9,000 lira ($6), if the law specifying a pharmacist’s margin of profit is applied.

There is no end to the scandal. Sometimes it appears on the radar of accountability and, at rare times, individuals are prosecuted, but it soon disappears after the interference of a well-connected individual.

Expired Medications

No less dangerous are importers’ promotional deals that leave pharmacists with near-expired drugs. Lebanese law prohibits pharmacists from selling drugs with expiry dates of three months or less. This is meant to protect the pharmacists and the consumers, so that the former would not have to sell medications arbitrarily and the latter would not consume expired medications.

According to a document obtained by Al-Akhbar, some companies communicate with pharmacies publicly, through a protocol between the importers and pharmacist syndicate, "concerning pharmaceutical products that cannot be returned or replaced before their expiration date." These medicines are stamped in blue, instead of yellow, to alert pharmacists.

Although the agent is required to recover these pharmaceuticals to dispose of them in the appropriate manner, they circumvent the law. However, one condition is added, constituting a threat to the health of consumers, which is that pharmacists cannot return medicines covered by the offer before their expiry.

Pharmacists are left with only one choice: sell the products at the expense of the patient's well being.

This article is an edited translation from the Arabic Edition.

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