Episode Transcript
[00:00:00] Speaker A: You're tuned into the all new freedom 106.5. 106.5.
[00:00:05] Speaker B: Good morning again, Trinidad and Tobago, as promised. I tell you, we don't just talk things haphazardly here, we try to get the individuals. Former president of the Pharmacy board, Ricardo Mohamed is on the line with me. Hello, Good morning, Ricardo.
[00:00:17] Speaker A: Hi, good morning, good morning, good morning
[00:00:19] Speaker B: and thank you very much for taking this call and being with us this morning.
Something was brought to my attention as it relates to drugs in this country, the accessibility of drugs, the pricing for consumers, especially those with critical illnesses.
I know you sat, you still sit on the council and you have some experience there. Let's talk a little bit about accessibility. I have a story, a situation where one particular drug costing 4,700 to 5,000 TT dollars to access 120 tablets. That same drug, same brand, same life saving drug coming from India.
The gentleman said, I asked my brother to research it. He found the drug in India, US$66. He sent it to me.
I was able to get it, same drug, but in Trinidad that is the cost for it. Here, share some insight.
[00:01:12] Speaker A: Sure. So good morning to your listeners and good morning to you and your team. So the pharmaceutical business is very broad based and we have to understand basic differences between generics and original molecules.
Nevertheless, molecules. Now with the technology that we have, generics are able to create the same drug using the same drug, but using maybe different active ingredients to create a formula that is what we call bioequivalent. Bioequivalent means four basic things I.e. absorption, metabolism, distribution and excretion of the drug happens at the same rate, which basically means you get the molecule itself being able to act just in the same way as any brand name product. However, throughout the world there's something called allocated pricing. So for example, big manufacturing companies would take in terms of the currency in which your country trades at, the affordability of a country, etc.
So what may be sold for maybe 10 TT in Trinidad and Tobago in some cases Mesa has 10 US in the United States or it can be sold as 10 rupees as the case may be, you're going to get a price fluctuation because it is price per marketing markets and different strategies. However, we have to look at two concepts for people to understand what really happens here in Trinidad and Tobago. So for example, let's say a specific company. Well, we have been having problems with monopolization in the country. That's number one. But. And we have been having timing of the processes for registration for Many years.
So when I became president of the board between 24 to 26, we started to address these main key issues and we had formed the pprba, which was the Private Pharmacy Retail Business association led by Mr. Glenn Suchet, to look after the needs of the private sector pharmacies. Now what we all have been experiencing is that we have been seeing price increases happening in Trinidad and drugs are becoming more and more difficult to afford for the average person in Trinidad and Tobago. So what most small companies would have tried to do would have tried to improve from other countries that remember, when you're dealing with people's lives, we must get these drugs from stringent regulatory authorities, sometimes refer to SRE countries. Right.
And we would see that we would try to bring in or import products into the country that will be way cheaper. Classic example, like what you just mentioned. There may be products that may be sold in Trinidad for 4,000 through the local distributors or the person who usually brings it in.
And then when patent expires and the drug has been produced in other countries with similar therapeutic efficacy. So what I mentioned earlier with the absorption, distribution, metabolism, excretion, when we try to import these drugs, we are now stymied with our process of registration.
Is it done on purpose? Is it, you know, the process is being stymied for a reason for certain companies to do better.
It's all assumptions. And because we now have the PAAC being conducted, we are now bringing to light a lot of misappropriations that would have happened in the past at the level of registering drugs at the Ministry of Health now. So we are hoping that one through this process at the PAC that the issues will be addressed. Right. And you have to look now at, you know, who is going to be held accountable and so on. We have a current situation where an opposition senator try to alter document by one of the main witnesses in this PAC meeting under parliament.
And you would see this all over the news. Now why are we tampering with witnesses, statements? What are we trying to hide? Who are we trying to protect?
[00:05:30] Speaker B: So we want. I don't mean to cut you, but let me get it back locally on two fronts. One, I have this situation where you talk about generics, right?
[00:05:41] Speaker A: Yes.
[00:05:42] Speaker B: And I want to mention something here. Between Ibuprofen, Motrin, just using.
[00:05:48] Speaker A: Right.
[00:05:48] Speaker B: As a compound. Ib. Motrin is a brand, but that's the. What they call the original, right? Correct. Ib.
[00:05:56] Speaker A: Correct.
[00:05:56] Speaker B: Ibu, whatever it is, it's a generic brand with the same components.
[00:06:02] Speaker A: Correct.
[00:06:02] Speaker B: One is sold at $4 locally. Another at a dollar.
[00:06:07] Speaker A: Right.
[00:06:08] Speaker B: When we look at the same medication, we're not talking generic, we talking.
This is the brand name product that I am purchasing in India at $66 is the same brand name product that I'm getting at a local distributor, 66 US a little under 500 TT the same, not a generic. We're not talking, and I just call two brands for you. We're not talking a generic, we're talking the same product. The same product, $4,911, right?
[00:06:45] Speaker A: So we now have to ask the question, what price markups are the distributors using?
And that has been an issue with us within the pharmacy fraternity trying to figure out. Now, you see, if you have situations, it is alleged that certain distributors are getting preferential treatment for registration and they have no other persons being allowed to bring in this particular product. You would find that they could put whatever price markup they want and keep jacking the price up because there is no, what you call real competition.
But from the moment a person is allowed on the proper fair trade practices, right, to import the same drug may be from a different country. So for example, pharmaceuticals for a particular brand, a big brand especially, are not produced in one country. So you would have things produced in Canada, you would have things produced in the uk you would have things produced in India, Australia, New Zealand, etc. Right. And so if you look at the top countries in the world that normally engage in pharmaceutical manufacturing, they normally operate under something called stringent regulatory authority, which is basically ensure that the final product is safe for the patient to take. So there'd be a level of research design and so on. And in different countries, these things have different prices. So if, for example, a local distributor decides, I'm going to bring in a Velocity product, M from the United States of America, and the same product by the same company is being produced in India, then there is a vast difference in price.
So maybe another person, now, let's see, might say, okay, this product M has been sold for $4,000. Before we can help the people of Trinidad, let's apply for a permit to bring this thing in from India so this man could get it for $66.
And then we go through the process and we have to wait 180 days to get a response. Now, we don't know if this response is going to be positive or negative. And in most cases what was happening is that the small distributor, or the small man, as we would say, would apply for this permit, he will wait 180 days and then they will say, well, you need to get this now. And then you said, but why you didn't tell me this from before?
And what was happening is now the goal post would have been continuously shifting, shifted and, and so you're shifting the goalpost. They keep asking for things that are not requirements and what they would assume or they would make you led to believe. It's a policy that is put into place right, when they didn't have any legal rights to do so. And then the process is timing. Now you have to look at the two. A different picture on the snow. When you're dealing with business and you're dealing with first world countries, or you're dealing with countries who deal in huge amounts, Remember Trinidad? Just a drop in the bucket, right, in the scheme of things.
So if you are dealing with a company and you're trying to import a product and you, you request from the manufacturer certain things and you say, listen, I want to import this product into Trinidad and Tobago, I need to get X, Y and Z. They send it to you within 24 to 48 hours. You have all your documents.
You are now going to wait 180 days and then reply to these people and say, listen, I have to wait 180 to get a response from the Ministry.
[00:10:18] Speaker B: And they laugh at you and then it's negative. But then here's the thing.
Where is our Fair Trade Commission? Do they even exist in Trinidad and Tobago?
[00:10:26] Speaker A: Yes. So our fair trade, because we have been pushing and we have been interacting with the Fair Trade Commission, they now have a newly appointed board.
So the board was appointed, I believe, last week or week before.
I can't remember the name of the chairperson, but there's a new chairperson appointed to the board. So now we are hopeful that going forward that we are going to see that the complaints that we would have sent in bear some fruit.
[00:10:53] Speaker B: So, so basically I'm not cutting here, I just have limited time and I'm trying to get some information in. So basically with pass. And, and when I say past administrations, I'm not talking PNM or unc, I'm talking in the past, right. We're just talking in general because we have had different administrations in the past, some longer than some. But yes, did. Could we safely say in Trinidad and Tobago there was a monopoly, there was one particular entity, there were policies created to block individuals, as you say, shifting the goal post to monopolize, monopolize and capitalize on drugs in this country just to make it affordable to selected few to make money.
Well, Daisy Lehman still might put in a Time breaking it down.
[00:11:42] Speaker A: Let me try to, let me put it in my perspective. So there are allegations, and it is alleged that this was the practice that was happening in Trinidad and Tobago for years.
And so we started the process to investigate what was happening through the pasc and we are hoping now that this would be a fruit. Right. So yes, at the end of the day, when you're dealing with big pharma and you're dealing with monopolization, monopolies have one meaning, which is the maximize on money and income and earnings.
We also have a responsibility as pharmacists to ensure that patients get the best health care in the most affordable way.
So we have been lobbying very strong.
We are pretty hopeful that this coming out of this PAAC meeting, it will bear fruit and we will see some positive changes. Because globally, throughout different parts of the world are sold at different prices. The same drug are sold at different prices, but the markup or the percentages used to put markups on these things are regulated. The problem we have in Trinidad is that we have a lot of old laws that needs to be updated.
And even within the Pharmacy Board act, the Pharmacy board Act of 1962, there have been minor amendments with one or two items in different time frames. I think the last one was done in 2006.
So 2006, that's 20 years ago, you understand?
So I know as being a member of council and Pharmacy Board that the Pharmacy Board is working very hard to make submissions with regarding amendments to the law and hopefully the law review committee at the Pharmacy Board will be making those submissions very soon this year.
[00:13:42] Speaker B: Because here's the thing. Life saving drug. I have a, I have a drug here. I can't even pronounce the name because you know me, no medical practitioner, I can make an attempt. Atizole, Zumba, Zimabo, whatever it is, it is A T E Z O L I Z U M A B. Now it's not available in the public health sector, but a company is selling it in Trinidad and Tobago. Two doses for about 36, 36,000 TT.
Yeah, but you find our drug in Mexico, just under a thousand USD.
Yeah, but there's a lot of red tape to bring it in from that country.
[00:14:19] Speaker A: No, so, so, so we have to look at, we have to look at two things. One, is the drug registered for sale in Trinidad? Meaning is it coming through the proper channels?
And two, if the company that is bringing it is a legitimate company and not price gouging, so we have things that happen on the trade.
So for example, we know for a fact not everything is perfect in Trinidad and Tobago. We know for a fact that we have flaws within customs and so on. So things get into the country and sometimes you may have importer who may import something outside the realm of the registered, distributed import something outside the realm of it being registered. So you may have it a legitimate product coming into the country, but not registered for sale in the country, if you understand what I'm saying. Yeah. And then these things now are sometimes sold at exorbitant prices because the name of the game is to make money.
And patients feel the blunt of this. And this is where we step in to make sure that we try to prevent this as best as we can. I think once we improve the registration processes, you're going to get a lot more people to comply to do the right thing and bringing the goods or pharmacy through the proper channels.
[00:15:39] Speaker B: I got you. But why is it difficult for persons to acquire these licenses or permits? Because what I see happening here from one administration to the next, it seems to me that there's a pharmaceutical cartel in Trinidad and Tobago.
[00:15:57] Speaker A: Well, it can be assumed that because processes in the past for some companies were easier for some. So we know, for example, I mean, Trinidad is a small place.
We know, for example, some of the bigger companies may have gotten things approved in a very short space of time, sometimes within two months, three months. And there are some companies who are waiting years.
And really this now creates an unfair playing field for persons who are trying to do the right thing.
[00:16:31] Speaker B: Let me ask you a quick question again, I don't mean to cut here, I just trying to squeeze in. Right, so let me ask you a question.
Approved drugs for Trinidad and Tobago, especially drugs for chemotherapy, drugs for cancer patients. Approve the drugs on our listing because there are other drugs out there that as you mentioned, it's not on the listing, but it's good. It's maybe FDA approved research went into it, it's good drug, but it's just not approved in Trinidad Tobago yet. Maybe they incorporated, they denied it to the list. But the ones that are on the list. The ones that are on the list, right.
What is the issue where local citizens are now reaching out? So you have a brother, sister, aunt, a cousin in, in the us, in Mexico, in, in Argentina, living in England, India, and they decide, listen, I have to get this drug to Trinidad and Tobago, Let me send this to my, to my family because they can't seem to be able to afford it locally. Why do we have these red tapes in terms of getting it through Customs. Why the blockage even if the drug is approved for sale in this country?
[00:17:31] Speaker A: Okay, so different countries would have different regulations, Right.
And I think something that a lot of people don't know is that sometimes drugs are manufactured for different regions based on the climates. Right.
So for example, coal countries.
Right. The drugs will carry a written and manufactured in a special way to be stored in cold countries, to be sold only in temperate countries. Right.
And in tropical countries it is given a different rating as well. Right. So drugs are manufactured specifically for different regions. And sometimes it has a lot to do with the temperature of the drug or how the drug is stored.
Right. Because that could affect the molecule itself. Right? Now when somebody, let's say for example a drug is producing, I'll use a quick example.
One company may have poultry manufacturing plants. So let's say the manufacturing plant in Turkey is producing for the Central American region, which is similar to our temperatures here. And the branch in London is producing for the US and uk.
When we have to import these drugs, sometimes the stability of the drug is what allows the drug to do its job. So if you take a drug that was really manufactured for a temporary country, same drug, right? But maybe just more too little different properties in terms of how plastic it dissolves or the coating on the tablet, etc. Right.
And you ship it to a country. Normally what we have to do is analysis to see the stability of the drug and how it will uphold to the temperatures here.
So that is why, for example, if you're bringing the same drug from two different regions, they want you to have a registration for it. Now let's just say, for example, let's say you, in case, let's say you have a company and you're bringing in drug C from the USA and you registered here in Trinidad and Tobago, right? Nothing stops me now from going to the same company in the United States and bringing it in same drug tea, simply because it's already registered for sale in the country.
Right? But what was happening is that persons know which, which is law. Persons now in the past were trying to do similar activities.
Their processes were being stymied and their processes were being kept back. So you found that there was some form of unfairness in the industry and then what that would lead to is somebody trying to do the illegal thing now and trying to bring a team under the front source, you know, so that is where we would have.
[00:20:24] Speaker B: So here's my thing, right? Here's my thing. And I want to, as we wrapping, you mentioned different regions. So some climates are Cold, some hot. India don't have snow. Trinidad don't have snow. You have turkey snow. America snow. But let's say this drug is to be stored at a particular temperature. Cool, refrigerated.
We have, we, we, we. When we bring those drugs into the country, is it that we can't create the refrigeration to have those drugs stored at the right temperature? So why are we concerned about which region and the properties for climate and all of that?
[00:21:02] Speaker A: We could mimic that well when we reach out to the patient level now. So, for example, there's something called cold chain storage that is maintained from manufacturer to the pharmacy to the patient, right?
So we can guarantee this temperature is being stored at the pharmacy level. So if it left the manufacturing plant at 2 degrees, when you as a consumer buy from the pharmacy, you get it at 2 degrees, right? Now, the problem with that is patients on the whole are not very well trained. So they go home, they jump in the car, they leave the tablet on the seat, you understand? They stop any mall, they go shopping for an hour or two, right? Then they say, oh, shucks, you know, I forget to drop this tablet home, I leave it on my car seat. They don't think anything much about it, so they go home. Now the rest is on our countertop and the sunlight piercing through the window, cracking the window, heating up this road for a little half an hour, 45 minutes, right? And then they put it, eventually it ends up in a proper cupboard. Because they thought, well, yeah, we do the correct thing. And they say, well, I find like, this drug ain't working good. You know, I'm feeling upset with it, but not taking this happening. So then there are mechanism in place to treat with that, right? But at the end of the day, that is the main reason for the safety of the patient. So, okay, when it's manufactured for different zones, that is one of the reasons for it.
[00:22:24] Speaker B: And, and I mean, Trinidad and Tobago listening, we can't refute that because there is. I remember even with my sons, they had some flu and you would get some, some cool meds or antibiotics. So mix. They'll have to mix the drug for you. They will mix it and they will tell you, keep refrigerated. So they give it to you. They give it to me cold and they say, get. Are you heading home now? Yes.
[00:22:45] Speaker A: Yeah.
[00:22:45] Speaker B: Go straight home, put it, get it refrigerated and give them this drug up to seven days. If there's any leftover in the bottle, discard it.
[00:22:55] Speaker A: Correct.
[00:22:56] Speaker B: Don't try to keep it it is good for the next seven days for your son, keep it refrigerated. So I know when I left the pharmacy I had to go straight home because you're correct, if I leave it in the car, it gets warm, then I go in the fridge, you know, it changes the components of the drug.
[00:23:15] Speaker A: Right, but so let me put a different scenario for you now quickly, so you can, you can quickly, you could understand that not everybody in society will think the same way and not everybody in society be educated the same way. So you may tell somebody to do something and they do something totally contrary to what you tell them.
Right? It's like buying a Panadol in a shop versus bath panel in our pharmacy. Pharmacies are temperature controlled. They're all mandated to be temperature controlled.
Sometimes in a little shop on Apollo, you go to buy a Panadol and you might find I find I take this panel and it'll work anyway. It's supposed to work simply because the shop may not have air conditioned. It might be a little power. But you find out when they buy the panel, don't buy this man who you are customer to the pharmacy. Hey, look in this thing, when I take you panel, same panel in them, temperature makes a difference. Temperature makes a difference on how fast your headache is going to disappear. Right now I want to. There's one, sorry, there's one concern that we have.
I want to let members of the public know that not everywhere you see Panadol being sold. It is being sold legally in the country.
Persons must apply for a OTC license and it must be clearly displayed. And if those things are not clearly displayed, it's a breach of the law. One and two, we don't know if they are legitimate or not and if they have the proper storage for these products as the case may be. Because if you read any package you will see store below 30 degrees Celsius and the average temperature in Trinidad is over 32, 33 degrees air conditioned. In your place, you already lost.
[00:24:48] Speaker B: Thank you so much for sharing with me, Mr. Muhammad. And again, we're looking forward to this PASC reports and see what's coming out of it. Because the price gorging, it is terrible. In Trinidad and Tobago at least we have a different perspective as to the procurement process and you know, the tender and what is happening. 180 days, that's ridiculous. That's past three months. That is ridiculous. And then when I do get a feedback, you're telling me I'm missing this. That's madness. But thank you for highlighting those problems. And again, we will chat in the not too distant future. Look out for a call from me. Again, I appreciate you. Thank you.
[00:25:22] Speaker A: You're welcome. Tuned into the all new freedom 106.5. 106.5.
