Red pill or queue pill: How the weak lira is disrupting drug markets in Turkey
In İstanbul's Fatih district – aka the “hospital neighborhood” thanks to its many medical facilities – a pharmacist looked at my prescription and said the medicine I needed was not in stock. He was the first pharmacist to deliver the news.
I would visit six more pharmacies before I tracked down medication for a simple intestinal problem. When I asked why it was so hard to find, another pharmacist told me: "The companies stopped selling drugs to us. Most drugs are not available on the market."
The combination of a weak currency, high inflation and state policies have disrupted prescription drug markets in Turkey, particularly for imported products, making it more difficult for citizens to find some medications and for pharmacies to carry them.
Many in Turkey’s $4 billion pharmaceutical sector claim the drug shortage is primarily caused by mismatched exchange rates for drug prices, which require pharmacies to sell some medications at unsustainable margins.
According to the Turkish Pharmacists Association, drug shortages became more prevalent after February, when the Turkish Medicines and Medical Devices Agency placed the 2022 exchange rate for medical products at 6.29 Turkish liras for 1 Euro.
Pharmaceutical companies use this exchange rate when selling imported products to warehouses and pharmacies. The problem: the Euro/Tl exchange rate has remained above 15 tl per euro throughout most of this year.
Due to the gap between the state agency's rate and the market rate, pharmaceutical companies have responded by cutting production, resulting in the current drug shortage. And while the government raised the rate to 7.86 in July, the move’s impacts were negligible as the Euro/Tl exchange rate had risen above 18 the same month.
Hatice Ersoy, a pharmacist with 20 years’ work experience in Fatih, said five out of 10 patients go home with empty hands when searching for medicine. The problem was visible at the pharmacy where Ersoy works, as many shelves were empty. On the few full shelves, vitamin bottles took the place of prescription drugs.
"I've never experienced something similar. Companies stopped production because of the lower profits," Ersoy said, adding that the real crisis is happening in drugs related to cancer and in vitro fertilization (IVF) treatments.
The situation is particularly difficult for Müge Karaoğlan, who suffers from cystinuria, a rare disease that causes kidney stones. Karaoğlan needs to use several medications, but she and other patients with similar conditions have been experiencing major obstacles in filling prescriptions.
The Turkish Social Security Institution has not regularly imported the three mandatory drugs needed to treat cystinuria since last year, according to Karaoğlan, and it is almost impossible to find the two other medications needed by the patients with the condition.
"At first, I searched all the pharmacies in İzmir," said Karaoğlan, who lives in the western coastal city of İzmir. "But now my search has expanded to the whole country. One of my friends found it in Konya, and my relatives sent it from Gümüşhane and Bursa. When I am lucky enough to find the drug, I buy it in bulk."
The scarcity of drugs affects both patients' health and pharmacists' income. The pharmacy where Ersoy works sells mostly imported drugs, which has impacted the store’s bottom line.
“Since the supply has been disrupted, our monthly turnover decreased by 300,000-400,000 TL," Ersoy told Turkey recap.
The turnover for another pharmacist, Şahin Aras, remained the same as last year because the store primarily sells domestic medicines. Still, in a country with official annual inflation above 85 percent, profit margins continue to shrink for pharmacies.
For the first time in 13 years, the government updated pharmacies' profit margins in 2022. They did so twice this year.
Under current regulations, the profit rate is 28 percent for drugs priced up to 200 TL, 18 percent for the drugs between 200-400 TL, and 13 percent for drugs over 400 TL. Pharmacies' margins decrease as the prices of drugs increase, and the most profitable bracket now contains only a few medications due to rising prices.
The head of the All Pharmacy Employer's Union, Nurten Saydan, said the latest update in October would increase pharmacies' profit by only 2 or 3 percent.
Though, according to the pharmacist Aras, whose store is located across from a neighborhood health center, another reason for decreasing profits is a recent rise in the number of pharmacies in Turkey, noting many new pharmacies had opened in his area.
"Our profits decrease as the number of people who get a share of the cake increases,” Aras said. “This makes it difficult for most pharmacists to make a living.”
Additionally, Turkey had only seven faculties of pharmacy at the university level in 2001. That number is now over 60.
The Health Ministry states in its "Human Resources in Health 2023 Vision" report that the public and private sectors need 32,887 pharmacists. However, according to the data from the Turkish Pharmacists Association, there were 37,442 pharmacists in Turkey in 2019. When new graduates from 2020 and 2021 are added, Turkey is likely to have more than 40,000 trained pharmacists at the moment.
In response to increasing pressure, a group of pharmacists is set to hold a protest at the end of this month (Nov. 27), with some claiming the government's attempts to aid ailing the sector have been "useless."
Ali Şeker, İstanbul deputy for the main opposition Republican People’s Party (CHP), told Turkey recap that pharmacists’ problems have become painful, especially with the extraordinary increase in inflation.
"While rent, electricity, and employee wages increased, the profits of pharmacists have remained the same," Şeker said.
Diego Cupolo, co-founder + editor @diegocupolo
Verda Uyar, freelance journalist @verdauyar
Ingrid Woudwijk, freelance journalist @deingrid
Gonca Tokyol, freelance journalist @goncatokyol
Batuhan Üsküp, editorial intern @batuskup