EDITOR, The Tribune.

I recently read a letter published in your paper in which a concerned citizen called on the government and insurance companies to negotiate better drug prices, citing the high cost of medication in The Bahamas. While I deeply understand and empathize with the frustrations expressed—especially in today’s economic climate—it’s important to clarify the realities of the pharmaceutical industry in our country and attempt to debunk some common misconceptions.

First and foremost, The Bahamas is a small nation with a population of fewer than 500,000 people. For context, Canada has over 40 million, and the United States over 340 million. This matters because it speaks directly to the concept of economies of scale. Larger countries are able to negotiate lower prices with pharmaceutical manufacturers simply because of the volume they can commit to purchasing. Our market size does not afford us the same leverage.

The suggestion that the government should negotiate directly with manufacturers may work in very specific cases—such as for high-demand medications like those for hypertension or diabetes—but this approach falls apart when it comes to specialty medications with low regional demand. In such cases, manufacturers typically assign a single distributor to serve the entire Caribbean through Latin America. This adds layers to the supply chain, all of which affect pricing.

Moreover, the US, Canada, and UK operate under different regulatory environments and distribution models that impact their drug pricing structures. Ironically, for branded medications, Caribbean countries often have better pricing than those large markets. For example, the Eliquis 5mg “Retired Expat” referred to, from my research, it retails for ~$650 for 3-month supply in The Bahamas vs ~$1800 in the USA. Therefore, the 40% price reduction in USA prices would have no impact on us because we are already significantly lower than USA. But this leads us to another critical distinction: brand-name drugs versus generics.

Branded pharmaceuticals are inherently more expensive because the manufacturers invest heavily in research and development, global clinical trials, marketing, and ongoing safety monitoring. The only reason many of us know the names of our medications is because of television commercials, magazine ads, or social media campaigns—efforts all funded by those manufacturers. Comparing the price of a branded medication to a generic version is like comparing apples to oranges.

It is also important for the public to know that the Bahamian government does, in fact, have systems in place to secure affordable medication. The public tender process is one such mechanism through which the government negotiates prices on over a thousand products—primarily generics—for use in the public healthcare system. Accessing these prices requires filling prescriptions through a public hospital or clinic.

Additionally, the National Prescription Drug Plan provides free medications for over 15 chronic conditions through approved private pharmacies, increasing convenience and access for many patients.

A frequent misunderstanding is that pharmacies and wholesalers are intentionally inflating prices. The truth is, due to our small market, we have limited negotiating power with international manufacturers. When certain generics are not available through contracted sources, we are often forced to purchase them from the US, Canada, or UK at their wholesale price and then apply a modest markup to cover operational costs.

These operational costs are not trivial. As healthcare institutions, every pharmacy must employ licensed professionals who have invested years and thousands of dollars in their education. These professionals are responsible for ensuring the safety and effectiveness of every medication dispensed—a task that requires precision, care, and accountability. Proper pharmaceutical storage, temperature control, patient counseling, insurance compliance, and safety protocols all require significant investment, and rightly so.

Unfortunately, some citizens equate the Bahamian pharmaceutical sector with “Big Pharma” in the US, but that comparison is deeply flawed. We do not set international prices. We operate under price control regulations, we employ trained professionals, and we exist within a much tighter margin of risk and reward.

I understand that calls for dramatically lower prices may seem like an easy fix, but they come with dangerous trade-offs: increased risk of substandard or counterfeit medications, lower wages for professionals, and the erosion of a sector that employs hundreds of Bahamians. We risk discouraging future generations from entering the pharmacy profession if we devalue the work and expertise it demands.

To be clear, I am not saying that the system is perfect. But I am asking for balance. Many of us in the pharmaceutical industry chose this path because we genuinely wanted to help people. We aim to serve the public while also earning a fair living—two goals that should not be mutually exclusive. Yet somehow, over time, the public has been bamboozled into thinking we are public enemy #1.

Let’s continue to advocate for more accessible healthcare—but let’s do it with a clear understanding of the facts and respect for those of us working every day to keep Bahamians healthy.

PHARMACIST

Nassau,

July 28, 2025.