• Demands for local brands, generic alternatives rise

Despite the federal government’s recent implementation of zero import duty on pharmaceuticals and active pharmaceutical ingredients (APIs), the cost of essential medicines has remained at an all-time high, pushing life-saving treatments further out of reach for millions.

The policy, aimed at easing the financial burden on pharmaceutical companies and reducing drug prices for consumers, has been undermined by worsening inflation, persistent forex instability, and structural failures within the country’s healthcare and economic systems.

Health experts said the country’s reliance on imported medical products and raw materials makes drug prices highly sensitive to fluctuations in the naira-dollar exchange rates.

They also noted that local manufacturers are not insulated from cost pressures, as epileptic electricity supply and rising cost of diesel for generators continue to drive up production costs.

For patients, the result is a drug market where prices are unstable but consistently high. Antibiotics like cefuroxime now cost between N2,500 and N4,000 per pack, while injectable medications such as Rocephin go for as high as N9,500 per vial. Anti-malaria drugs, which ranged from N1,400 to N3,500 two years ago, now cost between N2,400 and N8,200, depending on the brand. Also, IV fluids like normal saline, once priced at N3,500 per carton, now retail for up to N9,500.

These increases are particularly devastating for Nigerians managing chronic illnesses such as asthma, diabetes, hypertension, arthritis, and heart disease, many of whom now face an impossible choice: treat their condition or afford their next meal.

As in the case of a 62-year-old Nwaanyiaku Udenna, a resident of Umuopara community in Abia State, who lamented that managing her hypertension has become a financial nightmare. What used to be a N3,500 monthly prescription now costs more than N12,000.

“To make the medicine last, I only take one pill every other day,” she said. “I used to buy a full pack and still feed myself. Now, I must choose, do I eat or do I take my drugs?”

Udenna, who has lived with the condition for over eight years, recalled nearly collapsing while cooking. Her children, she added, are barely coping with their own financial struggles and are unable to help consistently.

“If not for prayer, I don’t know how I’m still alive,” she said. In Benue State, 17-year-old David Tersoo, diagnosed with Type 1 diabetes at age 10, now faces a bigger threat than the disease itself: access to insulin.

His mother, a public-school teacher, said the price of one vial has more than doubled in recent months, from N8,000 to nearly N18,000. With each vial lasting only 10 days, she frequently borrows or negotiates part payments with pharmacies to keep her son alive. “I’m afraid every day. If I skip a dose, I don’t know what will happen to my son,” she said tearfully.

Earlier in March of this year, David collapsed during a school assembly after going four days without insulin due to a funding delay. The emergency hospital visit drained the family’s rent savings. “It’s not the sickness that will kill him,” his mother said, “It’s the cost of the drug.”

The impact is just as dire for 37-year-old Tunde Salami, who lives in Isolo, Lagos. He told The Guardian that the cost of drugs has made caring for his diabetic mother both emotionally and financially draining. Though they rely on a public hospital where consultation fees are low, sustaining her treatment each month has become overwhelming.

“When her blood sugar spikes, treatment can cost up to N100,000 in a month. Even in normal months, we spend N40,000 to N50,000 on drugs. Glucose test strips alone now go for N22,000.”

For Salami, the most difficult part is following the diet plan recommended by the hospital dietician. “Eating healthy is expensive. When we can’t follow the plan, her condition deteriorates. I’ve watched her health decline just because I couldn’t afford the food or drugs she needed.”

With no quick fix in sight, families across Nigeria are bracing for more difficult choices. For people like Udenna and Salami, the question remains painfully simple: how much longer can they survive when the very medicine that keeps them alive slips further out of reach?

Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Lagos branch, Tolulope Ajayi, said the Federal Government’s import duty waiver on Active Pharmaceutical Ingredients (APIs) is commendable, but has delivered limited results because of deeper, unresolved economic issues.

Ajayi told The Guardian that the executive order is a step in the right direction, but stressed that its impact depends on whether systemic bottlenecks such as corruption, forex instability, and operational inefficiencies are addressed.

“A waiving import duty on one hand, while power costs and production inputs continue to rise, simply cancels out the benefit. Only manufacturers and importers can say if those waivers actually offset what they’re losing to inflation,” he said

Ajayi noted that while the waivers may have prevented drug prices from rising, most medicines have only seen marginal adjustments. He added that the overall cost of importing or producing drugs is shaped by complex interdependent factors that go beyond tariffs.

One silver lining, Ajayi observed, is a shift in patients’ behaviour. As drug prices rise, more Nigerians are embracing generic alternatives, often guided by advice from community pharmacists.

“In the past, patients would insist on specific foreign brands, but now, more people are open to equally effective generic options, sometimes at a fraction of the cost,” he added.

He said some patients now buy drugs with the same active ingredients for as low as N4,000 to N5,000 instead of N30,000 for foreign equivalents, leading to a shift in market demand.

Still, he emphasised that true reform must be comprehensive, targeting every cost driver in the supply chain. He urged the government to improve health insurance coverage as a sustainable way to reduce out-of-pocket spending.

“Duty waivers alone won’t solve the problem. We need broader reform. And more Nigerians need to enrol in health insurance to shield themselves from the financial shock of rising drug prices,” he said.

A Public health analyst and Fellow of the Postgraduate College of Pharmacists, Dr Charles Nwako, warned that the continued high cost of medicine is pushing many Nigerians toward unsafe alternatives that threaten the country’s fragile health outcomes.

Nwako told The Guardian that without a broader strategy to curb inflation, regulate open drug markets, and strengthen local production, the impact of the current import policy would remain minimal.

He explained that more Nigerians are now turning to unregulated treatment options, traditional remedies, or half-finished prescriptions simply because they can no longer afford standard care. “The rise in liver and kidney failures is not unconnected to this trend,” he said. “People are buying what they can afford, not necessarily what is safe.”

Nwako added that without affordable access to medicines, patients are abandoning their treatments midway or relying on unqualified providers, worsening drug resistance, treatment failure, and mortality.

Unless urgent steps are taken, Nwako warned, standardised healthcare will remain the privilege of the few, while most Nigerians spiral further into health and economic hardship.

“If nothing is done, preventable deaths will rise, therapy failures will increase, and our already fragile health indicators will keep deteriorating,” he concluded.