Drug Pricing and Availability: Where Patient Risks Occur
Kazakhstan's pharmaceutical market faces a serious challenge: how to ensure the availability of essential medications amid rising logistics costs and inflation? A solution could be deregulation of prices for medications priced up to 1 MCI—this is the approach the Ministry of Health is considering starting in 2026. This initiative reflects a commitment to balancing the interests of patients, businesses, and the state. We spoke with Pavel Khegai, Chairman of the EUROBAK Healthcare Committee , about the importance of this measure .
Why is the issue of deregulating prescription drugs priced up to 1 MCI in the retail segment so pressing today? Drugs priced up to 1 MCI (4,325 tenge in 2026) are often basic therapy and the foundation of pharmacy offerings. These are the medications patients purchase most frequently. Today, with rising logistics costs and inflation, the lack of amendments to Order No. 247 deprives this segment of flexibility. The production and import of such drugs are becoming unprofitable, and they are the first to disappear from pharmacy shelves.
It's important to understand that the issue of deregulating pharmaceutical prices in the commercial segment directly aligns with the agenda of the Decree of the President of the Republic of Kazakhstan "On Measures to Liberalize the Economy." The head of state has clearly outlined a course toward reducing government intervention in market processes.
It's worth noting that Kazakhstan is indeed one of the few countries that strictly regulates drug prices. As the Ministry of Health previously noted, following dialogue with representatives of the pharmaceutical industry, the possibility of deregulating prices for drugs priced at less than one minimum monthly calculation index (MCI) starting in 2026 is being considered.
One of the goals of this decision is to prevent the erosion of low-price drugs while maintaining support for manufacturers. We fully support the Minister's position that the priority should be given to the category of drugs priced below one monthly calculation index (MCI). The market for drugs priced below one MCI typically has many players; competition between them is a better price regulator than government regulations. Furthermore, this segment is the most sensitive to inflation and rising production costs: with a fixed low price, production of such drugs often becomes unprofitable, forcing manufacturers to discontinue their production.
This phased approach is justified because we have successful experience from previous years: when a large number of drugs were previously deregulated, prices eventually stabilized thanks to market mechanisms and healthy competition.
How might this impact patients? Paradoxically, the lack of deregulation of the low-cost segment could lead not to a reduction, but rather to an actual increase in the population's treatment costs. If entry-level drugs are removed from the market, patients will have to buy medications from a higher price segment.
International practice confirms these concerns: the use of strict pricing models in other markets often led to the disappearance of hundreds of vitally important products, as the actual cost of drugs exceeded state-set price ceilings, making their production and import unprofitable. In such cases, the government was forced to urgently revise prices upwards simply to return the drugs to pharmacies and overcome the resulting affordability crisis.
The main risk is a threat to health and quality of life due to a shortage of affordable, essential, and high-quality medications. If high-quality medications become unavailable due to price pressure, they are inevitably replaced by "gray" imports, or there is a risk of drugs with questionable safety and efficacy profiles emerging.
What solutions do you consider the most rational in the current situation? First and foremost, it's necessary to deregulate prices for prescription drugs not included in the lists of the State Funded Medical Care and the Compulsory Health Insurance. It's important to understand that these lists serve the public procurement segment, where different economic laws apply. As a first step, deregulation should begin in the commercial sector with drugs priced up to 1 MCI. This will prevent shortages of the most in-demand medications. At the same time, it's crucial to ensure that the new version of Order No. 247 specifies that 1 MCI is the threshold for entry into the free pricing zone, not a new fixed price ceiling.
At the same time, it is important to improve the pricing methodology itself to ensure market predictability for all participants. It is advisable to consider a transition to a more transparent price review mechanism that eliminates the risk of unilateral decisions without prior approval. To establish fair prices in the commercial segment, we propose relying on data from similar retail sectors in reference countries and strictly comparable dosage forms. Direct dialogue with manufacturers can be particularly valuable in this process: incorporating their reliable data will allow the expert organization to obtain the most complete picture, especially in markets where external commercial platforms provide only limited information. Using data from the real commercial sector will make the methodology transparent and, most importantly, will guarantee the physical availability of the required medications on pharmacy shelves.
What other steps is business prepared to take? The pharmaceutical community advocates, first and foremost, for maintaining the country's drug safety. Our priority is not simply protecting business interests, but ensuring continuity of treatment for patients.
Deregulation of the segment up to 1 MCI is a modern and balanced decision that meets the interests of all parties: it maintains access to medicines for the population, creates conditions for sustainable business operations, and implements the state's policy of economic liberalization.
We understand that each figure in the methodology reflects the availability of a specific drug, so we advocate a balanced approach that will preserve a wide range of products and avoid shortages. We are open to constructive dialogue and collaborative work on solutions that will be sustainable for both the healthcare system and patients.