Your health shouldn’t break the bank, right? With the rising cost of medications, let’s find out!
By Adilah Adnee
As the cost of medications continues to rise, many people are feeling the pinch at the pharmacy counter. Gina Koay, a community pharmacist at City Wellness Pharmacy in Penang, has seen firsthand how these price hikes are impacting her patients.
From families struggling to manage prescriptions to seniors on fixed incomes, the financial burden is becoming harder to ignore. In this article, Gina shares her insights into the challenges local pharmacies face and offers practical advice for navigating the ever-increasing costs of healthcare.
1Twenty80:Has the rising cost of medications become a recurring issue?
Gina Koay: The price increases aren’t just happening now—they’ve been happening every year. Some imported medications go up by 5% to 10% annually. While generic drugs may not see price hikes every year, they do tend to increase every few years. So, it’s something we’ve come to expect, especially with inflation rates rising each year.
“The price increases aren’t just happening now—they’ve been happening every year.”
Gina Koay
1Twenty80: What are the key reasons behind the ongoing increase in drug prices?
Gina: Starting from 2025, there will be a minimum monthly ‘gaji’ (wage) of RM 1700, but that’s just one factor in the bigger picture. Taxes and other variables come into play as well. So, for me, it’s becoming a norm. People often think we’re selling expensive medications, but that’s not the case. The cost isn’t driven by us; we can’t just keep squeezing the margins. Instead, we need to look for alternative solutions.
1Twenty80: Have you seen any signs of patients avoiding or delaying their medications due to financial challenges?
Gina: Yes, it’s definitely something I see regularly. There are two main areas where people seek health care: one is government hospitals, where patients follow up with their treatments at clinics or public hospitals; the other is private hospitals, where they may go to a private pharmacy or a GP. For those in the government system, medications are typically provided for free or at a very low cost—around RM1.
So, they usually don’t face major issues with affordability. The problem, though, is compliance. With the overflow of medications, patients often don’t know how to take them properly, or they may even choose not to take them at all.
On the other hand, those who visit private hospitals often face a financial burden, as they have to pay for their medications out of their own pockets. Some will delay getting the medicine because they can’t afford it that month. I have one customer who told me, ‘I’ll work harder and then I’ll buy the medication I need. Until then, I’ll just use the medicine from the government hospital.’ They delay it but try to adjust.
I always suggest that they come in for follow-ups, especially for chronic conditions like high blood pressure, blood sugar, and cholesterol—things we can manage in the community pharmacy. For conditions we can’t handle, patients sometimes delay treatment due to cost, or they seek assistance from charitable organizations. Others may rely on government hospitals and their limited resources, which also means depending on the quota system.
1Twenty80: How do you think the increasing cost of medications impacts patients’ ability to access affordable treatment?
Gina: Yeah, health is definitely affected. Imagine everyone starts flocking to government hospitals for treatment. The government has limited funds, and there are just too many people in need of care. Then there’s the tier system where the government targets different income groups—B40, M20, T20. Ideally, they focus on funding B40, but the reality is that people from all income groups still head to government hospitals because the medications are free. And honestly, who wouldn’t want free medication? The problem is that this creates an imbalance. Those who can afford private care are crowding out those who truly need the help, so those in the most need sometimes can’t get the treatment they deserve.
It’s really unfortunate, especially considering the way our healthcare system works. Anyone who can stand in line and wait, gets access to treatment, regardless of whether they truly need it or not. But don’t forget, even the standard medications at government hospitals are seeing price hikes. This means the government faces higher costs, which forces them to tighten their budget. As a result, they might buy fewer supplies, and the quota for those who need it most gets smaller. Meanwhile, in private healthcare, you get seen without having to wait, but you’re paying a premium for that convenience.
“Those who can afford private care are crowding out those who truly need the help, so those in the most need sometimes can’t get the treatment they deserve.”
Gina Koay
1Twenty80: How often do patients ask for lower-cost alternatives or non-branded medicines for their medications?
Gina: As pharmacists, we’re always aware of generic medications and the options available. If there’s a generic alternative, I always make sure to let my patients know. For example, some patients come in asking for the brand-name medication. But I don’t carry that medication in my pharmacy, only the generic version. So I’ll tell them, “I have a locally made generic that’s bioequivalent—it works exactly the same”.
I make it clear that I’m not changing the medication, just offering a more affordable option. I’ll also let them know that the generic costs, say, RM6, while the brand-name version might be higher. Some patients are open to it and say, ‘Okay, I don’t mind trying it.’ Others, however, are less convinced. About 20% of customers will say, ‘I don’t like generics, I don’t think they work for me,’ and they’ll walk out to find a pharmacy that carries the brand name.
1Twenty80: So, some people still prefer the branded ones rather than locally made products?
Gina: Yeah, some prefer the branded ones. Maybe they feel that it works for them. Some people say, “I want a good one; I don’t mind paying.” Yeah, you have people like that. Or some have already tried the so-called generics and experienced side effects. Then they will just condemn the generics, saying, “It doesn’t work. I don’t want it.”
1Twenty80: In what ways do the rising costs of medications influence the long-term health impacts of your patients?
Gina: When it comes to the rising cost of medication, for example, diabetes drugs, there are generics and patented drugs, and some patented ones don’t have generic alternatives. There is one, it’s quite popular nowadays and costs over 100 ringgit. Those who can afford it will say, “Okay, I’ll just get it.” But those who cannot afford it this month might say, “I can’t afford it. I won’t buy it, but I’ll just go back to the government hospital.”
To me, I don’t know how they’re going to manage it properly. Even though we try to explain to them, “If you’re going to follow up with the government hospital, then do it regularly. If you want to follow up privately, then stick to that.” But sometimes, they have this misconception that expensive medicine works better, even if they can’t afford it. So, at the end of the day, it still comes back to the pharmacist’s role in handling adherence and compliance. We need to explain how to take the medication properly. That’s where medication reviews come in.
Unfortunately, some people don’t care, and that’s how they mismanage their health. They feel they can wait and see. They don’t realise the importance of preventing complications early to avoid suffering in the future. Some people want a faster recovery but don’t consider the risks until it’s too late.
Take, for example, obese individuals with very high diabetes levels—those with high HBA1c readings. Even when you tell them they’re at risk of stroke and other complications, they still say, “I’m okay. I’m cool. I don’t care,” until something happens.
Imagine someone unlucky enough to have a stroke immediately. The type of stroke matters too—some die instantly, while others survive but suffer. They could end up unconscious, in a vegetative state, or half-paralyzed. They might need extensive rehab and a lot of medication.
If they had focused on preventive care earlier, they wouldn’t have to deal with these severe outcomes of diabetes. That’s my take. Our role as pharmacists is to advise them to prioritize compliance and adherence to their medication regimen before their condition worsens. You don’t want to face the complications or side effects of poorly managed diabetes.
Unfortunately, some people don’t care, and that’s how they mismanage their health. They feel they can wait and see. They don’t realise the importance of preventing complications early to avoid suffering in the future.
Gina Koay
1Twenty80: What are some common difficulties patients encounter when attempting to manage the high costs of prescriptions?
Gina: Yeah, they feel lost. They just don’t care sometimes. Let me give you an example using diabetes because I’ve encountered cases like this. For instance, when diabetes levels get too high, it can cause changes in facial structure. Although the patient might not have had a stroke, there’s a condition called Bell’s palsy.
One of my patients, an e-hailing driver, was working extremely hard—from 7:00 AM to 11:00 PM—without proper rest or meals. He wasn’t eating or taking his medications properly. He just kept driving to earn money. He thought, “I don’t have money to buy medicine, so I’ll put it on hold until I can afford it.”
He struggled, and then one day, he developed Bell’s palsy. He became worried, thinking it was a stroke. He ended up spending even more money on treatments like physiotherapy, Traditional Chinese Medicine (TCM), acupuncture, and more to rehabilitate his facial muscles. Then he came to me asking what supplements he could take, so I suggested B complexes.
He also mentioned that he didn’t want to monitor his diabetes closely because he couldn’t afford to test every day—the tests are expensive too. These are the common difficulties patients face: they delay treatment because of costs, which often leads to more expensive complications down the line.
1Twenty80: Are there specific patient groups (such as the elderly or uninsured) that are prone to the impact of increasing drug prices?
Gina: Yes, I feel that many of the customers I serve are people who don’t have company support or insurance coverage. When they need it most, they have to pay out of pocket. For example, if they need a stent or bypass surgery, they often realize too late that they don’t have insurance to cover it. They can’t afford the surgery, so they either wait for the government to provide it for free or at minimal cost, or they simply have to wait a long time.
In the meantime, they take certain medications just to delay the issue. But to me, this is like a time bomb. For instance, if a patient has an 80% blockage in their heart, the doctor might say they can still wait. But in reality, some patients can’t wait and end up dying—maybe from a heart attack—before the treatment can happen.
I know of one case where the government hospital gave a patient a date for a stent procedure, scheduled for June of the following year. Unfortunately, the person died before that date because they couldn’t wait. They had no money to go for private treatment, which led to a massive heart attack.
The same situation applies to medication prices. If they’re on medication to thin their blood or manage their condition, they might go to a private hospital, but the costs are high. On the other hand, the government sector provides medications for free or at minimal cost.
For those who can’t afford to wait in line at a government hospital or don’t access government services, they end up facing the high costs of private medication. They often say, “I don’t have money to buy it,” and end up not buying the medicine at all. This leaves them in a situation where they’re essentially waiting for their condition to worsen.
Monitoring and modifying our lifestyle can make a big difference—things like more exercise, less oily food, and more fruits and vegetables. If you do this part well, you can avoid issues like heart attacks, strokes, or obesity, which in turn saves a lot of money.
Gina Koay
1Twenty80: What changes or approaches do you believe could help make medications more affordable for patients?
Gina: If the government could reduce taxes? Especially on imported medications, that would help. Although, nowadays, there are many generics available, and they’re often more affordable. But, of course, the quality and safety of these generics must still be guaranteed. That’s why we really need to focus on preventive care, especially here in Malaysia. Right now, our healthcare system is very reactive. It’s like, if you don’t have a heart attack, you don’t go to the hospital. If you don’t see ants in your toilet bowl, you don’t think diabetes is serious enough to get checked.
But if we could encourage more regular screenings—like wellness checks on a monthly or yearly basis—it could make a huge difference. People should be aware that as they age, regular check-ups are important. They need to understand that prevention is key, and being proactive about your health can save you from serious issues down the line
1Twenty80: So, more awareness and screening tests should be done for early prevention?
Ms. Gina: Yes, definitely. More awareness about screenings is important, and people need to be informed about the signs and symptoms of chronic diseases we’ve discussed. These are the areas where we can focus on prevention. For rare diseases like leukemia, for instance, people can die young from it. If the government could make medications for such conditions more accessible and affordable, more people could be saved.
If not, we really have to rely on the research and development efforts of our scientists. Most of the important medications for rare diseases come from overseas, and we can’t do much to prevent that. There’s not much choice in those cases.
But for conditions we can prevent, we do have a choice. We can focus on preventive care. Monitoring and modifying our lifestyle can make a big difference—things like more exercise, less oily food, and more fruits and vegetables. If you do this part well, you can avoid issues like heart attacks, strokes, or obesity, which in turn saves a lot of money. If you’re thinking about supplements, sure, you can consider them, but you need to make sure you’re getting the right ones for your specific needs.
The challenge is that many people are easily swayed by the overwhelming amount of information, especially when it comes to medical matters online. Social media is flooded with health advice, and people often buy whatever is marketed as “good” without considering if it’s safe, of high quality, or even approved by the Ministry of Health. They just want a quick fix. Unfortunately, they don’t always realise that some of these things could be harmful in the long run.
That’s why I hope pharmacists can play a bigger role in improving health literacy. By guiding people toward the right supplements, medications, and lifestyle changes, we can help them become more aware of their health conditions. This can help prevent future problems and ultimately reduce health statistics in a positive way.
I know the government is focusing more on prevention and wellness, which is great because that’s what developed countries are doing. But we also need to emphasise the importance of lifestyle changes so people can live longer, healthier lives.
Starting now is key—2025 just arrived, and it’s a good time for New Year’s resolutions. We really need to make it a point to take action now, not wait until it’s too late or say ‘nanti nanti’ (hold on). If you keep putting it off, you might end up suffering from heart disease, stroke, or obesity later on.
For me, I want to focus on doing medication reviews with people who are interested, advocating for preventive care, and helping people become more aware of their health. This way, they can make positive changes before they face serious health issues.
