Melissa has recently been diagnosed with high cholesterol, on top of an existing condition—hypertension. According to her pro-bono doctor, she now needs to take Atorvastatin and Aspirin in addition to her maintenance medicines, Losartan and Amlodipine. Altogether, her medications cost Php1,417.50 a month.
But she is not the only one in the family who is ill. Her husband also has hypertension and needs maintenance medication, while their son was diagnosed last year with hypothyroidism and deep-vein thrombosis (DVT). Managing hypothyroidism requires Levothyroxine, which costs Php330 a month. For her son’s DVT, the doctor prescribed Dabigatran to slow blood clotting, while the doctors continue to investigate its cause, an uncommon condition in children. This costs Php5,205 a month. The family’s medication costs now total Php7,680 per month.
Melissa and her husband are both minimum wage earners. Medicines already cover 26% of the family’s monthly income, further eating up their budget for other essentials.
Medicines in the Philippines are among the most expensive in Southeast Asia. But the key issue in healthcare is not just the price, but who pays. Out-of-pocket spending accounts for 44.7% of the country’s total health expenditure. The Philippine Health Insurance (PhilHealth) recently revealed that 40% of Filipinos’ out-of-pocket health expenses go to buying medicines. Despite laws intended to reduce medicine prices and improve access to essential drugs, the high cost of medicines continues to add to the growing burden of rising basic commodity prices.
Now, the Department of Health (DOH) is closely monitoring medicine prices as geopolitical tensions from the US-Israel war on Iran begin to ripple through global supply chains. According to industry sources, drug companies have only been holding off price hikes in the past weeks from rising logistics costs alone, and not yet counting the impacts of more expensive raw ingredients and tightening supply. Melissa and her family are bracing for even tougher and sicker times ahead.
Big Pharma is in control
Why are medicines expensive in the Philippines? The country is captive to the control of Big Pharma—a handful of multinational corporations that dominate the global pharmaceutical industry and shape pricing, supply, and access.
The US$4.7 trillion market capitalization of pharmaceuticals in 2024 was held by only 50 pharmaceutical companies with a majority based in the United States. Drugmakers from the US make up 56% of global market capitalization, followed by Europe at 34%, and Asia with a 10% market share.
As these companies pour large capitals on research and development, mergers and acquisitions, and outsourcing of critical production stages to countries with cutting-edge technologies but cheap labor, they have managed to seize control of production and supply of pharmaceutical products around the world.
Because of this control, Big Pharma can easily leverage patent applications, especially under the World Trade Organization (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPS). In 2023, innovators worldwide filed 3.55 million patent applications, and drugmakers filed an average of 140 patent applications per drug expiring after 20 years at a minimum. It will only be after the patent expires that the generic and cheap replications can be made.
This mechanism has given major drugmakers substantial leverage to keep generic and biosimilar competitors at bay. Patents strengthen their position in litigation and negotiations, allowing them to delay the entry of lower-cost alternatives and keep these out of the public’s reach. As a result, Big Pharma can freely set astronomical prices for medical products.
Currently, 14 of the world’s top 20 pharmaceutical companies have manufacturing facilities in the Philippines. Foreign entities in the country own up to 99% of the paid-up capital in pharmaceutical establishments that manufacture, import, and distribute medicines. They consolidate the production of pharmaceuticals in the country and create a nationwide manufacturing hub for their global business expanding locally. Thus, it is not surprising that medicines in the country are over-priced.
More profiteering by local traders
Foreign pharmaceutical companies set their prices differently in each country. Then, several mark-ups along the supply chain are added to the price before the medicine reaches the patient. The Philippines imports 62% of its medicine supply, which is half the answer to the question why medicines are expensive—they are already expensive to begin with.
The first mark-up occurs in the transactions between the foreign drug companies and the local Philippine offices, estimated at 4.5% to 12.5 percent. This is followed by an estimated mark-up of at least 20% from cost-insurance-freight cost, import tariffs, finance charges, quality control testing fees, national corporate taxes, and transport costs.
The distributors and wholesalers will mark this up further by 5-13 percent. Retailers will add another 13-20 percent.
Meanwhile, locally produced drugs, with imported ingredients nonetheless, have higher mark-ups—distributor by at most 355%, and again retailers by another 117%, making the drug retailers in the Philippines the richest in the supply chain.
Government adds to the burden
This is not the end of the patient’s burden. There is an additional 12% value-added tax (VAT) slapped on most of the medicine supply in the country.
The Food and Drug Administration (FDA) periodic updates of VAT-exempt list strictly focus on medicines for non-communicable diseases, such as diabetes, high cholesterol, hypertension, cancer, mental illness, tuberculosis, and kidney diseases. As of February 2026, there are 2,263 VAT-exempt medicines for such diseases. But this accounts for only 5% of the 50,000 recorded government-procured medicines as of 2019. Still, over-the-counter products like paracetamol, vitamins and mineral supplements, cough and cold medicines, antibiotics, antacids and many others remain taxable.
Public hospitals can ideally provide a variety of options for cheaper medicines than what private retailers sell. But aside from the fact that 79% of government-procured medicines are supplied by Big Pharma, the government has also given up its crucial role by devolving the health system and allocating insufficient health budget, which disrupt the procurement and distribution of essential medicines in public hospitals. Limited supply of medical products to none at all is a common scenario in public hospitals—often, doctors simply advise the patients to buy from private retailers that offer much more expensive drugs.
Out of the Php216 billion total market sales in 2024, 90% was supplied through the large drugstore chains and retail outlets owned by the local billionaires, while only 10% went through hospitals.
Fighting the illness called neoliberalism
Patients pay for consultation and diagnostic tests, preventive services, basic treatment, and expensive medicines. For an illness requiring multiple medicines or with comorbidity, or for a family with more than one ill family member, often the choice is to skip either consultation or taking the medicine.
The heavy burden of out-of-pocket spending and government neglect has made even the cheapest regimens unaffordable. Furthermore, 58% of Filipino families earn less than Php23,000 a month, and so treatments that appear affordable actually burden the poor families. Metabolic diseases appear catastrophic when health spending is put into account.
At face value, it may sound like a gentle reminder that prevention is better than cure, but it screams a hard truth: Filipino patients like Melissa and her family cannot afford to be sick. But the more unbearable truth is that Big Pharma and their local partners are at the intersection of health and profit, which is an utter violation of the people’s right to health. This collusion is bound to inflict a heavier blow on the Filipino families, as pharmaceutical companies are likely to raise prices to protect their profits amid the escalating global capitalist crisis and wars. The most insufferable truth is the Marcos Jr government’s collaboration with such profit-taking by continuing with neoliberal policies in the health sector. In the end, it is not illness alone that Filipinos are forced to fight, but a system that profits from their suffering.