Senior Investigative Journalist
joshua.seemungal@guardian.co.tt
Amid growing concerns over restricted competition in the pharmaceutical industry, the Fair Trade Commission (FTC) has advised the Private Pharmacy Association of Trinidad and Tobago that there may be sufficient grounds for members to submit formal complaints regarding potential breaches of the Fair Trading Act.
Meanwhile, an official investigation by the Health Ministry into concerns about rising drug prices, supply shortages, and the concentration of contracts among a limited number of suppliers with respect to the Chronic Disease Assistance Programme (CDAP) is yet to begin.
Last Sunday, Guardian Media reported that Health Minister Lackram Bodoe ordered a comprehensive review of the programme. He also said the ministry will meet with pharmaceutical associations to address long-standing concerns within the industry.
In part one of a special investigation last week, Guardian Media revealed that a Freedom of Information Act (FOIA) request showed one company, Smith Robertson and Company Limited, received 42 per cent or $1.8 billion worth of CDAP contracts between 2015 and 2024, while Bryden Pi Limited received the second highest share at 17 per cent ($742 million).
A letter from FTC Executive Director Bevan Narinesingh last week stated, “The FTC acknowledges the Ministry of Health’s recent decision to undertake a comprehensive review of the CDAP, as reported in the Trinidad and Tobago Guardian Newspaper … The initiative (The Ministry of Health CDAP Review) is timely and aligns with our statutory mandate to promote and maintain fair competition, protect consumer welfare and ensure the efficient allocation of public resources.”
The FTC advised that “there may be sufficient grounds for members of the Private Pharmacy Retail Business Association to submit formal complaints to the commission regarding potential breaches of the Fair Trading Act”.
The association was asked to submit detailed records of any observed irregularities or anti-competitive conduct related to CDAP.
Additionally, the FTC advised that “the submission of a completed Complaints Form is required in order to formally initiate the commission’s complaints procedure”.
Narinesingh told Guardian Media no formal investigation was taking place, “The commission is aware of general public discourse concerning allegations of monopolistic practices within the local pharmaceutical industry. However, to date and despite encouraging the public to do so, no formal complaint or credible evidence naming any specific enterprise operating in Trinidad and Tobago has been submitted to the commission by affected parties.”
Retail pharmacies feel threatened
President of the Pharmacy Board of Trinidad and Tobago Ricardo Mohammed has alleged that retail pharmacies are under threat due to the practices of pharmaceutical conglomerates.
“Yes (it is threatening the survival of some of these retail pharmacies), in the sense that, one, it is alleged that some of these companies, when they apply for a product, they get it faster than the average pharmacy.”
Some stakeholders, Mohammed said, alleged that companies may be restricting competition through the drug registration process. However, Guardian Media could not verify these allegations independently.
“But what we are having issues with is that the increases in prices from pharma companies are sometimes being sent to us, sometimes weekly and monthly, and these price increases are sometimes upwards of five per cent, ten per cent, 18 per cent in some cases,” he said.
“Now that a new US tariff has come into effect, it is going to significantly affect pharmaceutical prices coming into the country,” he added.
Meanwhile, President of the Private Pharmacy Retail Business Association Glenwayne Suchit expressed a similar concern.
“I have a breakdown of all the legal notices over the last two years for all the drugs that have been approved ... We can’t get approvals,” added Suchit, a pharmacist and business owner with close to 40 years of experience.
Sixty-two per cent of the drugs, he alleged, are for one company.
These concerns are not new. In March 2021, former president of the Pharmacy Board Andrew Rahaman wrote a complaint to the FTC concerning Smith Robertson’s acquisition of two pharmaceutical companies–Oscar Francois Limited and Intersol Limited.
The Ministry of Trade and Industry advised that the merger received the go-ahead after a four-month review and approval process. The FTC stated that the commission was satisfied the merger would not adversely affect competition or be detrimental to consumers or to the economy.
In May 2021, former UNC Mayaro MP Rushton Paray asked the then People’s National Movement government to act against alleged ‘predatory price increases’.
After complaints, former trade minister Paula Gopee-Scoon said she instructed the Consumer Affairs Division to develop a tool to monitor and publish quarterly prices of the main essential pharmaceutical items.
It was never published and is unavailable on the Central Bank’s website.
Four years later, the issue remains unresolved, Mohammed added.
According to Mohammed, who was elected in 2024, the board is reviewing pharmaceutical laws to lobby Government to control prices.
“In the last 50 or 60 years, nothing has been done in the Pharmaceutical Board Act to even control distributors, and one of the key things is to revamp that legislation, so we can regulate distributors ... ” he said.
Guardian Media reached out to Agostini Limited, which owns Smith Robertson and Co Ltd for comment on its market share, but the company declined to comment.
Requests for comment were also sent to the communications team at AS Bryden, but no response was received up to last week.
Price increases
Guardian Media viewed several letters sent by companies indicating price changes to pharmacies.
On December 8, 2024, one company, Smith Robertson, wrote saying it was increasing the prices of close to 40 drugs.
Pharmacies complained to Guardian Media of receiving many of the notices in recent years.
Smith Robertson: December 2024 Notice
A December 2024 notice from Smith Robertson states, “We would like to inform you of an upcoming price change on the GlaxoSmithKline Ethical line of products, effective Wednesday, 1 January 2025.”
There was no explanation for the increase.
The range of increases implemented ranged from $6 for a nasal spray to $3 for 5ml AMOXIL syrup to $38 for Valtrex 500mg tablets.
Bryden Pi Limited: January 2025 Adjustments
A January letter indicating increases from Bryden Pi Limited signalled that price changes were due to a supplier price increase.
Of 41 listed drugs, 38 were increased, with three prices decreasing.
The price increases ranged from $85.90 for Acasta 100ml to $6 for Enoxaparin 80 mg to $34 for Zinnat 250 mg tabs.
AP Scott: Limited Increases
Comparatively, another competitor, AP Scott, in a January letter, listed four products with increased prices.
Orofer Syrup 150ml and Orofer 40 capsules were listed as price adjustments, while the two other medications were listed as supplier price increases.
Vulnerable patients, small pharmacies struggle
As prices climb and availability fluctuates, vulnerable patients and small pharmacies continue to struggle.
Some elderly patients described the growing difficulty of accessing affordable medication. Many rely on CDAP out of necessity, and while others skip doses or abandon treatments, others are forced to dig deeper into their pockets.
Pharmacists said they are doing their best to shield customers from rising costs—but admit it’s becoming unsustainable.
“They are trying to pressure us and shut us down. They are trying to shrink the market,” an Arima pharmacy owner, who requested anonymity due to fear of backlash, alleged. The owner did not name the individuals or companies allegedly responsible.
“I have no comment, but you take a look around any pharmacy and tell me what you see,” said a female pharmacy owner in Diego Martin.
It’s 9:30 on a St James morning, and 74-year-old Carol and her son are getting into their car after purchasing medication from Kappa Drugs.
“I get CDAP. Sometimes, I don’t get the medication because sometimes they don’t have it. If I need five boxes, sometimes I get three or four. When I can’t get everything from CDAP, I have to go somewhere else and buy it. I don’t even know if the price went up because I need it. I don’t watch the price,” she said before heading to the nearby St James Pharmacy.
Over at the St James Pharmacy’s carpark, customer Tardius Lewis spoke highly of the business.
“They tell you what is good for you. They are not trying to upsell me. Who is not going there, don’t know there,” he said.
Other customers also praised the pharmacy’s service and its efforts to keep prices down.
Inside of the pharmacy bottles of medication are stacked from waist height to the ceiling. Most products had two stickers—one showing the old price, the other the current price.
“It is a challenge to maintain the good prices we have. He (the boss) will want to raise the price, but he will think about the customers. He will be like, we will leave it at that price for now. The average businessman will not be willing to do that,” said manager Michelle Ramirez.
Further west in Diego Martin, outside WestBees Supermarket, a few customers filtered in and out of a nearby pharmacy.
“I find it high, yes. Look, I now pay $1,600 for something there. They tell me I get a little discount,” said a man in his early 70s.
A woman in her 70s, inching toward the entrance, added, “Oh, God. Don’t even talk about the prices going up. Yes, I have noticed. Look, my cholesterol, the other day I decided to stop taking it, because when I take it, it’s generic, and my feet start to swell.”
Another woman, also in her 70s, had just exited a vehicle.
“I’ve stopped buying my medication and went on CDAP because every month there was a different figure for the drug prices. I know it tends to have more generic drugs, but that’s why I am trying it. I’m giving it a go because I can’t afford to buy them. I’m a retiree. Every time I go, it goes up by $5 or $10, but it adds up.”