Why Do Medicine Prices Anger Bangladesh? Inside the Drug Pricing Puzzle

Dhaka, August 11, 2026 — Walk into any pharmacy in Dhaka, ask for a strip of esomeprazole (a common acid-reflux drug), and you will pay Tk 180 for 14 tablets of the leading brand. Walk into a pharmacy in Kolkata and the same molecule, in the same dosage, from a comparable manufacturer, costs the equivalent of Tk 65. Ask for atorvastatin (cholesterol-lowering) and the gap is even sharper: Tk 360 in Dhaka versus Tk 90 in India. Ask why, and you will get five different answers from a pharmacist, a patient, a manufacturer, a regulator and a doctor — which is exactly the problem.

💊 The Price Gap, In Numbers

A consumer price survey conducted in July 2026 by the Bangladesh Consumers’ Association (CAB), in collaboration with the Public Health Foundation of Bangladesh, compared retail prices of 47 commonly prescribed molecules across 240 pharmacies in Dhaka, Chattogram, Sylhet, Rajshahi and Kolkata, Delhi and Chennai. The findings:

• 📉 42 of 47 molecules were cheaper in India than Bangladesh — by an average of 2.3x
• 📉 28 molecules were more than 2x cheaper in India; 11 were more than 3x cheaper
• 📉 5 molecules were cheaper in Bangladesh (mostly locally manufactured generics like paracetamol, ranitidine and metronidazole)
• 📉 Oncology drugs: Bangladeshi patients pay 3.1x the Indian price for imatinib (leukaemia), 2.8x for rituximab (lymphoma) and 2.4x for trastuzumab (breast cancer)
• 📉 Cardiovascular drugs: Bangladeshi patients pay 2.4x for atorvastatin, 2.1x for telmisartan and 1.9x for clopidogrel
• 📉 Diabetes drugs: Bangladeshi patients pay 2.6x for sitagliptin, 2.2x for empagliflozin and 1.8x for insulin glargine

The total out-of-pocket medicine burden on Bangladeshi households is estimated at Tk 38,400 crore ($3.5 billion) per year — or roughly 1.1 per cent of GDP, one of the highest such ratios in South Asia. With 63 per cent of household health spending going to medicines, any price movement hits household finances directly.

🏛️ The DGDA Pricing Framework

Bangladesh’s drug pricing is governed by the Drug (Control) Ordinance 1982 and the National Drug Policy 2016. The Directorate General of Drug Administration (DGDA) sets a maximum retail price (MRP) for 117 essential medicines on the National Essential Medicines List. For all other molecules, manufacturers are free to set prices — subject only to a notification requirement.

The system has three structural loopholes that consumer advocates say drive the price gap:

• 🔍 117-molecule cap: Only 117 of approximately 1,500 molecules sold in Bangladesh are price-controlled. India’s National List of Essential Medicines (NLEM 2022) covers 384 molecules, and the Drug Price Control Order (DPCO) extends price caps to 874 formulations
• 🔍 MRP, not ceiling-margin: Bangladesh sets an absolute MRP that allows high-cost drugs to carry proportionally higher rupee margins. India caps the manufacturer margin at 16 per cent and retailer margin at 8 per cent for controlled drugs
• 🔍 No reference pricing: Bangladesh does not benchmark against international prices. India’s DPCO requires prices of new drugs to be benchmarked against the price of the same drug in five reference markets (UK, US, Australia, New Zealand, EU)

The result is a market where molecules outside the 117-list can be priced freely, and where the same molecule sold under different brand names can carry wildly different prices — sometimes 4–6x within the same pharmacy. A 2025 study by the Bangladesh Health Watch found that the average price spread between the cheapest and most expensive brand of the same molecule in Bangladesh was 3.4x, compared to 1.7x in India.

👥 Market Structure: Oligopoly with Local Champions

Bangladesh’s pharmaceutical market is dominated by a small number of large local manufacturers. The top 10 companies account for approximately 78 per cent of the domestic market, with Square Pharmaceuticals alone holding 18 per cent, Incepta Pharmaceuticals 12 per cent, Beximco Pharma 10 per cent, Eskayef 7 per cent, ACI 6 per cent, ACME 5 per cent, Renata 5 per cent, Opso Saline 4 per cent, Aristopharma 4 per cent, and Drug International 3 per cent. The remaining 22 per cent is split among 250+ smaller manufacturers.

This concentration is partly a legacy of the 1982 Drug Policy, which restricted foreign ownership and reserved the domestic market for local manufacturers. The policy built a strong local industry — Bangladesh meets 97 per cent of domestic demand from local production and exports $190 million to 152 countries — but it also created a quasi-protected market with limited price competition from international generics.

💬 Industry Defence

Pharmaceutical industry leaders reject the comparison with India as simplistic. Abdul Muktadir, President of the Bangladesh Association of Pharmaceutical Industries (BAPI) and Chairman & Managing Director of Incepta Pharmaceuticals, told a press briefing on August 9: “India’s prices are lower because India’s market is ten times bigger, with massive economies of scale, lower per-unit raw material costs, and fierce generic competition among 10,000+ manufacturers. Bangladesh has 250 licensed manufacturers, smaller batch sizes, and 30–40 per cent higher API (active pharmaceutical ingredient) import costs because we import from China and India rather than manufacture locally.”

BAPI also points out that Bangladesh’s pharma sector employs 200,000 people directly, pays Tk 6,400 crore in annual VAT and corporate tax, and provides medicines to a domestic market of 170 million people at prices that, while higher than India, remain well below Western levels. “If we apply Indian-style price caps across the board without addressing API costs, batch sizes and import duties on critical excipients, we will bankrupt the local industry and end up importing medicines at even higher prices,” Muktadir warned.

⚖️ The TRIPS Waiver and LDC Graduation

A looming structural shift complicates the picture further. Bangladesh, as an LDC, currently enjoys a TRIPS waiver that allows local manufacturers to produce generic versions of patented drugs without licensing — a critical advantage that has enabled the country’s oncology and HIV/AIDS drug production. This waiver expires in November 2026 with LDC graduation, after which Bangladesh will need to comply with international patent law.

The implication: between 2027 and 2033, Bangladesh will progressively lose the right to manufacture generic versions of patented drugs. As the pipeline of generics shrinks, prices of newer molecules will rise further, not fall. BAPI has asked the government to negotiate a transition period with the WTO and to accelerate local API manufacturing to reduce dependence on Indian and Chinese imports.

🤝 The Reform Agenda

Patient advocacy groups, public health experts and a growing number of policymakers have begun to articulate a four-point reform agenda:

• ✅ Expand the essential medicines list from 117 to 350+ molecules, aligned with the WHO Essential Medicines List 2023 and the Indian NLEM 2022
• ✅ Adopt ceiling-margin pricing instead of absolute MRP — capping manufacturer margin at 20 per cent and retailer margin at 16 per cent for controlled drugs
• ✅ International reference pricing for all new molecules, benchmarked against the Indian DPCO ceiling price and the WHO Price Information Exchange
• ✅ Generic substitution mandate — allow pharmacists to substitute a cheaper generic for a branded molecule unless the prescriber explicitly forbids it (currently not permitted in Bangladesh)

The Ministry of Health and Family Welfare has indicated it will review the Drug (Control) Ordinance in the next parliamentary session, with a draft amendment likely by January 2027. BAPI has asked to be consulted throughout the process and has proposed its own counter-reform package focused on API manufacturing incentives, duty reduction on imported excipients, and a longer TRIPS transition period.

🌏 The Patient’s View

For the average Bangladeshi patient, the policy debate is abstract; the monthly pharmacy bill is concrete. A 2026 ICDDR,B study of 4,200 households found that 38 per cent of chronically ill patients skip or split doses due to cost, 22 per cent borrow money to buy medicines, and 11 per cent forego treatment entirely. Cancer patients are hit hardest: a year of standard imatinib therapy costs Tk 4.8 lakh — seven times the per capita income. For trastuzumab, the cost is Tk 12 lakh per year — 17 times per capita income.

The Bangladesh Patients’ Rights Forum, a coalition of 64 patient advocacy organisations, has called for a public protest on August 18 in front of the National Press Club, demanding immediate expansion of the essential medicines list and the introduction of ceiling-margin pricing. “We are not asking for free medicine,” the forum’s convenor said. “We are asking for fair medicine. We are asking that a molecule invented 30 years ago, manufactured locally, and sold at one-fourth the price across the border, not be allowed to bankrupt Bangladeshi families.”

✅ What Comes Next

The DGDA, the Ministry of Health, BAPI and patient groups have all been asked to submit positions to the Cabinet Division by September 15. The Cabinet Committee on Health is expected to take up the Drug (Control) Ordinance amendment in October. For a country that produces 97 per cent of its own medicines, has 250 licensed manufacturers, and exports to 152 countries, the puzzle is not supply — it is governance. The next three months will determine whether Bangladesh’s patients finally get a pricing system designed for them, or whether the puzzle remains unsolved for another decade.