Big does not nec­es­sar­i­ly mean bad.

In the past five years, Aven­ta, the phar­ma­ceu­ti­cal dis­tri­b­u­tion and man­u­fac­tur­ing arm of com­pa­nies with­in the Agos­ti­ni Group, has pushed for­ward with ex­pan­sion across the re­gion.

That ex­pan­sion has seen some with­in T&T phar­ma­ceu­ti­cal sec­tor raise con­cerns about a grow­ing mo­nop­oly, prompt­ing Agos­ti­ni to re­spond via an ad­ver­tise­ment in De­cem­ber, in which it stat­ed the phar­ma­ceu­ti­cal dis­tri­b­u­tion sec­tor is reg­u­lat­ed and com­pet­i­tive, with more than 70 reg­is­tered dis­trib­u­tors sup­ply­ing med­i­cines across T&T.

Re­fer­ring to the Gov­ern­ment’s phar­ma­ceu­ti­cal ten­der awards, Agos­ti­ni said, “For the 2023–2025 ten­der cy­cle, Aven­ta se­cured 34.3 per cent of the awards by val­ue and 16.6 per cent by num­ber of prod­ucts sup­plied.”

Aven­ta CEO James Walk­er ex­plained that the group’s ex­pan­sion was part of an at­tempt to en­sure the re­gion had greater lever­age to ne­go­ti­ate the prices of phar­ma­ceu­ti­cals across the re­gion.

“There’s this per­cep­tion, maybe that big is bad. Big doesn’t have to mean bad. Big shouldn’t mean bad,” he said in an in­ter­view with the Sun­day Busi­ness Guardian last Wednes­day at Aven­ta’s head­quar­ters in El So­cor­ro,

“Aven­ta is the size that it is be­cause over more than 100 years, it’s been in busi­ness. It’s in­vest­ed and grown its in­fra­struc­ture, re­la­tion­ships and sys­tems in or­der to be where it is to­day, and through ac­qui­si­tions and oth­er things as well, of course, and that scale has been im­por­tant for us to be able to in­vest in these qual­i­ty sys­tems.”

He added that the ex­pan­sion, as well as last year’s re­brand­ing, al­lowed the group to fur­ther op­er­ate un­der a com­mon pur­pose, “ Ad­vanc­ing Health, En­hanc­ing Lives.”

“Ad­vanc­ing Health; En­hanc­ing lives has a big­ger as­pi­ra­tion around the pub­lic health and the health land­scape and health­care with­in the Caribbean. We feel that with the reach that we have and with the scale that we have—with reach in­to every phar­ma­cy, in­to every gov­ern­ment hos­pi­tal, in­to every pri­vate hos­pi­tal—al­lows us to have that sort of abil­i­ty to bring med­ica­tions, bring in­no­va­tion and nov­el treat­ments as well that may not ex­ist in our ter­ri­to­ries right now,” he said.

He not­ed that Aven­ta’s re­gion­al scale al­so al­lowed in­ter­na­tion­al sup­pli­ers to ne­go­ti­ate with one body in­stead of hav­ing to nav­i­gate dif­fer­ent coun­tries with dif­fer­ent reg­u­la­tions and process­es.

Walk­er ex­plained that with the high in­ci­dence and mor­tal­i­ty rates of non-com­mu­ni­ca­ble dis­eases (NCDs) like prostate can­cer, breast can­cer, di­a­betes, and kid­ney dis­ease in the Caribbean, this ap­proach was cru­cial, par­tic­u­lar­ly giv­en that the Caribbean’s ag­ing pop­u­la­tion has grown more sus­cep­ti­ble to these ail­ments. That has made Aven­ta’s lever­age in­creas­ing­ly im­por­tant.

Walk­er said that in the last year or two, Aven­ta re­cruit­ed mar­ket ac­cess man­agers, who are em­ploy­ees whose fo­cus is get­ting new drugs in­to med­ical sys­tems in re­gions.

“So, I have this new prostate can­cer treat­ment. How am I go­ing to get this avail­able in­to the sys­tems in the Caribbean? How are in­sur­ers go­ing to pay for this? How are gov­ern­ments are go­ing to con­sid­er whether they should in­clude this or not? That takes a lit­tle bit of work. It’s not au­to­mat­ic, not just be­cause some­thing is hap­pen­ing out­side, do we in­clude it au­to­mat­i­cal­ly. We need to con­sid­er how we make it hap­pen,” he said.

He ex­plained that, like much of the coun­try, the com­pa­ny was al­so con­cerned about the news of var­i­ous clo­sures and the ris­ing cost of liv­ing.

“It’s con­cern­ing to me, just as an in­di­vid­ual, when I see things like News­day clos­ing down and Movi­eTowne To­ba­go. I’m see­ing busi­ness­es clos­ing down and what­not. You’re re­al­ly con­cerned for the peo­ple be­hind those busi­ness­es. They’re peo­ple em­ployed in those busi­ness­es, there are jobs that were at stake, and liveli­hoods and af­ford­abil­i­ty. Now, what hap­pens to those peo­ple? It’s con­cern­ing for us, too,” he said adding that the eco­nom­ic sit­u­a­tion did come in­to the com­pa­ny’s con­sid­er­a­tion with re­gard to pric­ing.

“What’s al­so not lost on us is the pric­ing, the prices of med­ica­tion, and the con­ver­sa­tion around prices and the chal­lenges that we face as a coun­try and as a re­gion around that,” he said.

Point­ing to Cen­tral Sta­tis­ti­cal Of­fice da­ta, he ac­knowl­edged that the cost of health-re­lat­ed prod­ucts had grad­u­al­ly gone up as had most items list­ed on the in­dex.

“In health costs, it’s a share of the bas­ket of in­fla­tion. It’s a share of the bas­ket. But you see the rate of change of health­care costs in Trinidad, of course, that’s not just phar­ma­ceu­ti­cal prod­ucts, that’s the cost of go­ing to the doc­tor, get­ting the X-ray. It’s the in­pa­tient and out­pa­tient plus Phar­ma. It’s the full pack­age of health.

“But I think that’s im­por­tant to ap­pre­ci­ate as a very rel­e­vant con­cern peo­ple have around their health­care costs, es­pe­cial­ly if their salaries are be­ing squeezed or they have oth­er pres­sures,” said Walk­er, but he could not say if con­sumer pat­terns had changed as Aven­ta is a sep­a­rate en­ti­ty from Agos­ti­ni’s phar­ma­ceu­ti­cal re­tail op­er­a­tion, which op­er­ates Su­per­pharm and MPharm.

He added that sup­ply chain is­sues and for­eign ex­change chal­lenges were still ob­sta­cles the group had to man­age.

“Most of the prod­ucts are im­port­ed. We don’t set the price in that re­gard,” he said, “You hear it in the US. You hear Don­ald Trump say­ing, the cost is too high, and we need to bring man­u­fac­tur­ing back to Amer­i­ca so that we could re­duce the cost. And that’s Amer­i­ca say­ing they need to bring back man­u­fac­tur­ing, and much less the sit­u­a­tion that we would face as a small­er ter­ri­to­ry. We don’t nec­es­sar­i­ly have that ne­go­ti­at­ing lever­age, per­haps any vol­ume that oth­er big­ger ter­ri­to­ries might have, and we’re not pro­duc­ing a lot of it lo­cal­ly. So that’s some­thing that def­i­nite­ly im­pacts us,”

He ex­plained that in many cas­es the com­pa­ny had been at­tempt­ing to ab­sorb these im­port shocks to keep prices rea­son­able on the lo­cal mar­ket.

“When you get a price in­crease from a sup­pli­er of one of these med­ica­tions, it will have an im­pact, ul­ti­mate­ly, on the price in the shop. Why? Well, first of all, why do sup­pli­ers in­crease price so you could ask that first. So sup­pli­ers might in­crease the price be­cause they have their own in­fla­tion in their own coun­tries, and their labour costs are go­ing up, and the sup­ply chain costs to de­liv­er and ship it to Trinidad might be go­ing up,” he ex­plained.

He said while the com­pa­ny had ex­pand­ed its reach, with T&T still ac­count­ing for 40 per cent of its busi­ness, the for­eign ex­change con­straints were a con­sis­tent chal­lenge.