IPR Regimes: Early Stages

‘invention’ means any manner of new manufacture and includes an improvement and an alleged invention.

‘manufacture’ includes any art, process or manner of producing preparing or making an article, and also any article prepared or produced by manufacture.

Apart from the issue of product vs process patents, the representatives of the Pakistan pharmaceutical industry, especially those with the MNCs, complained about legal difficulties in getting injunction orders against the infringer and the threat of revocation of a patent through compulsory licensing. An application under Section 22 of the PDA 1911 could be filed in the high court claiming that the demand for a patented article in Pakistan is not being met to an adequate extent, and on reasonable terms and force, an issuance of a grant of compulsory licence. Similarly, under Section 23 of PDA 1911, the patent could be revoked if, even after a considerable lapse of time (four years after grant of patent) the patent was being worked outside Pakistan and not within the country. Both these clauses were similar to what the Indian patent law had till the 1990s. No estimate of the number of compulsory licences issued or patents revoked so far was available. Nonetheless, some sections of the pharmaceutical industry saw it as an important potential problem.5 Interestingly, despite the concerns raised above, about 1200 patents were granted in Pakistan every year during the 1990s, about 80 per cent of these related to pharmaceutical industry.

Trademark violations were rampant and in general, the trade mark law was used more widely than patent and designs law to take legal action against infringers. The manufacture and sale of counterfeit and spurious medicines was also a major cause of concern and many cases of imitative “packaging” have been found [Basant 2000 and Mirza 1998a for details]. It is not clear if these violations have had a dampening effect on pharmaceutical prices.

Market Structure and Competition

The industry can be broadly divided into the formulations production and the manufacturing of active ingredients, i e, raw materials, basic and intermediate chemicals used for the manufacture of pharmaceutical products. In what follows, I briefly summarise the structure of the pharmaceutical industry in Pakistan and then based on the data summarised in the table, compare it with the industry in India.

In general, the formulations market in India was more competitive than in Pakistan with a much larger number of registered manufacturers and even a larger number of active units.9 This seems to be true despite the fact that market concentration in therapeutic markets in India can be quite high (e g, a four-firm concentration ratio of 31 per cent for antibiotics and within some sub-groups of antibiotics even as high as 97 per cent) [Chaudhuri 1999]. The MNCs in Pakistan, however, claimed that the absence of patent protection for pharmaceutical molecules has led to the registration of many thousands of “me-too” brands from local firms in the country. On average, for every MNC brand, there are between 10 and 50 local copies, all generally cheaper, providing extremely powerful market forces to keep prices down. The production of pharmaceutical products was very unequally distributed across firms. Recent estimates are not available but in 1993 when the total number of registered units was 226, about 70 per cent of the total sales were accounted for by 32 firms. The remaining 194 shared the rest of the market [UNIDO 1993]. The top 15 firms, all MNCs, accounted for more than 50 per cent and top five more than 23 per cent of the market [Basant op cit: Table 4).

Having a subsidiary was the most preferred method of MNCs to operate in Pakistan in the late 1990s.10 Mehdi and Kiani (1996) clearly bring out the dominance of MNCs in the Pakistan pharmaceutical market through an analysis of the top 100 medicines in terms of sales volume and value of sales. The top 100 drugs in terms of sales of their units are characterised as the “prime volume market” and the 100 best selling drugs (i e, the drugs that have earned the firms more rupees than the rest) as the “prime value market”. Each of these two sets of drugs constituted about 41 per cent of the Pakistan pharmaceutical market in 1995. The MNCs have a monopoly over the prime volume/value markets with a market share of over 90 per cent. The distribution of market shares even among the MNCs was much skewed.11

Unlike Pakistan, the Indian market was not dominated by the MNCs. In fact, the share of MNCs declined from about 68 per cent in 1970 to less than 33 per cent in 1999 and was less than 23 per cent in 2004 [Chaudhuri 2005: 18]. Besides, the distribution of market shares among MNCs was not skewed. Unlike in the case of Pakistan, where all the top 15 pharmaceutical firms were MNCs, only three of the top 15 firms were MNCs in India and five of the top 20 firms were MNCs in 2004 [Chaudhuri 2005: 17]. Role of the public sector: Only one public sector unit is engaged in the production of formulations. The Fauji Foundation, Lahore run by Army Welfare is engaged in bulk drug production.

Established with Chinese technological support, the firm is more or less defunct today making simple medicines like aspirin, etc. India has been quite different in this regard with the public sector, i e, production units and the public research and development (R&D) institutions playing a key role [Chaudhuri op cit, 2005]. Setting up of Indian Drugs and Pharmaceuticals (IDPL) and Hindustan Antibiotics (HAL) and subsequently, a few other public sector units by the state government has played an important role. IDPL and HAL were set up to produce antibiotics and synthetic drugs at a time when MNCs were not very enthusiastic about setting up basic manufacturing facilities, did not want to provide technology to others and the Indian private sector was not mature enough to undertake production of many of the bulk drugs. Overall, the Russian collaboration through the public sector units proved to be much more beneficial for India than the similar collaboration Pakistan had with China. There can be several reasons for the difference: better quality of Russian vis-à-vis Chinese technologies; relatively lower concentration of market power in the hands of small number of firms (especially MNCs) in India or simply the much larger size of the Indian market. Moreover, public R&D institutions also played an important role in India for deve loping drugs indigenously [Chaudhuri op cit 2005].

Although there is a relatively high degree of self-sufficiency in the formulation packing of finished pharmaceutical forms, the manufacture of active ingredients or basic production of pharmaceutical chemicals is negligible in Pakistan. This makes the economy virtually dependent on imports. While about 90-95 per cent of the active ingredients are imported, only about 35 pharmaceutical chemicals are produced in the country, either entirely or at a certain step of the chemical process. In 1999, 36 (24 domestic and 12 MNCs) firms were licensed to undertake “basic or semibasic manufacture”, but most of them were not very active.12 Some MNC representatives also complained about the nonviability of producing pharmaceutical chemicals in Pakistan. The reasons for non-viability essentially emanate from the small size of the Pakistan market. The industry representatives argued that economies of scale cannot be reaped by exporting the surplus raw material because the international markets are very competitive with the presence of low cost suppliers like China, India, Taiwan, Korea and eastern Europe. According to some respondents about seven basic manufacturers were active in Pakistan in the late 1990s. Since there was tariff protection for local manufacturers and since they specialised in specific active ingredients (basic chemicals) and do not compete with each other, local monopolies have developed. It was argued that since few firms will come forward to set up new units for basic chemical production, competition through imports is the only way to dislodge those monopolistic structures.

In India, about two-thirds of the domestic raw material requirement was satisfied internally (see the table). The absence of local capacities (and the associated technological capabilities) to produce raw materials for pharmaceutical products has adversely affected Pakistan in a variety of ways:

Drug Price Control

Till 1969-70, there was no statutory control over drug prices in Pakistan. A major cyclone in East Pakistan (now Bangladesh) in 1970 and the consequent pressures on the economy (including need for drugs) led to imposition of price controls on the pharmaceutical industry. These controls were eventually incorporated into the Drugs Act of 1976. During 1976-93, this act formed the basis for regulating prices by the federal health ministry (MoH), which used various cost plus formulae to arrive at the maximum retail price. These formulae were used to fix prices of all drugs till 1993, when the distinction between the controlled and decontrolled groups of drugs was made [Basant op cit for details].

Pricing has been a major issue between the pharmaceutical industry and the MoH in Paksitan. During 1976-91, while applications for price increase were dealt with on a case-by-case basis13, the industry representatives consistently argued that the implementation of the “cost-plus” formulae by the health ministry did not recognise adequately the impact of domestic inflation and rupee devaluation on the industry’s operational profit margins. Over time, different types of indexation formulae have been used but the concern of the industry that cost escalations are not fully compensated has remained.

We do not have space here for a detailed comparison of drug price control systems in India and Pakistan. However, a broad comparison would suggest that somewhat similar systems were in place.14 Both countries used cost plus formulae that provided incentives to enhance costs. Such a method was particularly problematic for Pakistan where most of the raw materials had to be imported and provided opportunities for transfer pricing. There is evidence to show that after price decontrol of some drugs, the prices in Pakistan rose sharply after 1993.15 As a result, the federal government had to reduce and then freeze prices of several drugs in the second half of the 1990s thereby dampening price increases in the country during the late 1990s. The MoH also issued an ordinance indicating their intention to amend the Drug Act of 1976 to allow the government to fix the prices of imported raw material to solve the perceived problem of transfer pricing by the MNCs. The issue of transfer pricing: Linked to the issue of pricing and price increases is the alleged practice of transfer pricing by MNCs. Such practices become problematic for any price control mechanism that uses cost plus formulae as was the case both in India and Pakistan. The phenomenon of transfer pricing is also used to argue against price increases because the MNCs are already earning profits by over-invoicing their imports from either the parent firms or related companies.

The impact of transfer pricing can be quite significant in Pakistan as the imported material constitutes about 57 per cent of the total costs of locally manufactured goods sold by the 23 major MNCs operating in the country. The share of active ingredients alone was more than 46 per cent.16 Basant (2000: Appendix Table 1) provides invoice specific data on the cost of importing 69 different raw materials by various firms from different sources. Exceptions apart, prices of raw material imported by MNCs from their sister/ parent companies or from other sources in western countries were, in general, significantly higher than those paid by MNCs or domestic firms to suppliers from countries like India, China, Singapore and South Korea. Prima facie, therefore, there was circumstantial evidence to suggest that transfer pricing is taking place. However, before making any final judgment, several issues need to be considered.

The MNCs argued that they do not use a supply source, which does not meet their internal quality specifications that are very strict. The domestic firms use lower quality raw material the prices of which are low. Quality differences can be significant across suppliers and this certainly explains part of the price differential between MNC suppliers and others. However, there are cases where MNCs have bought raw material from other sources at a much cheaper rate.17 Apart from quality, another reason why MNCs may pay higher prices for raw material can be that the chemical is still under patent. Typically, MNCs do not violate patent laws and in countries honouring these patents, prices are likely to be higher. In countries like India and China, where the IPR regime is weak, the same raw material could have been available at a cheaper rate. We do not have patent related information for the 69 raw materials covered in Basant (2000). However, insofar as some MNCs are able to acquire the raw material at a cheaper rate from western countries than other MNCs, the

Table: Some Factors Affecting Pharmaceutical Prices in India and Pakistan

Notes: (1) $ = Rs 43.4 (Indian) and Rs 57.39 (Pakistani).

(4) QRs – Quantitative Restrictions. Source: Basant (2000); Mishra (2005); Chaudhuri (2005).

Government Policies Relating to Pharmaceutical Production

Till recently, Pakistan custom’s tariff rates were very favourable for local pharmaceutical production. In 1985, through a government order all raw materials and packaging materials used for the manufacture of pharmaceutical products were exempted form duties and taxes. This exemption was extended in 1989 to all plant and machinery and equipment imported for the manufacture of pharmaceutical products. The tariff policies under went some changes in the 1990s leading to protests from the industry. Since petroleum-based industry does not exist in Pakistan, tariff policies were changed in 1997 to create incentives to set up raw material production facilities in the country. A customs duty of 25 per cent was instituted on the imports of semi-basic chemicals, while a duty of 35 per cent was imposed on the imports of basic chemicals. In 1995-96 sales tax at 10 per cent was imposed not only on raw material and packaging material, but also at the rate of 5 per cent on the sale of finished products that was supposed to be absorbed by the manufacturers. However, this sales tax on finished products was withdrawn in October 1996, but in 1997 a 10 per cent customs duty was imposed on the imported raw materials and finished medicines. All this added to the costs of production in Pakistan. Besides, the high financing costs of importing pharmaceutical machinery in Pakistan, despite the fact that there were no customs duties on such imports, added to the cost disadvantages emanating from the absence of domestic raw material manufacturing capabilities. High customs duties and quantitative restrictions were prevalent in India till the late 1980s. But unlike in Pakistan, 1990s was the period when quantitative restrictions were removed, tariff rates declined continuously19 and towards the end interest rates had also started to decline reducing the financing costs and the overall costs of production.

An important aspect of government policies to encourage local production has been the incentives to foreign investors. Some key dimensions of policies implemented to attract MNCs for local production in Pakistan included:

MNCs can own 100 per cent equity; they can independently negotiate terms and conditions of foreign currency loans; capital invested, appreciation thereof and profit on it is freely repatriable; MNCs can decide the mode and level of technology transfer; no upper ceiling on payment of royalty (such a ceiling existed earlier, but has been removed); no requirement of work permit for expatriate managerial and technical staff; enlarged access to domestic borrowing;20 national treatment of MNCs in terms of taxes on income.

The FDI related policies in Pakistan have been significantly more liberal than those in India. Prior to 1994, Indian policies were very stringent vis-à-vis foreign investment. The key policy initiative was the introduction of the 1973 Foreign Exchange Regulation Act (FERA) and the drug policies in late 1970s which changed the earlier policy environment favouring MNCs to that which worked against them. The basic effect of FERA was to make a distinction between firms of foreign equity of more than 40 per cent (FERA companies) and those with foreign equity less than equal to 40 per cent and to restrict the activities of the former to specific areas. The new drug policy (NDP) announced in 1978 imposed restrictions on the FERA companies in pharmaceuticals that were not applicable to other sectors. Chaudhuri (1999) summarises these changes succinctly:

Comparing Prices of Pharmaceutical Products between India and Pakistan

There are several reasons why comparing pharmaceutical prices in Pakistan and India and ascertaining factors that contribute to these price differences is likely to be a complex task. Some of these reasons have already been summarised in the table and discussed in the earlier sections. It is evident that market size (impinging among other things on opportunity to reap economies of scale), several dimensions of market structure, policy initiatives and costs are significantly different in the two countries. In what follows, we highlight some more issues that can make price comparisons difficult.

Most Indian scholars have undertaken a selective comparison of drug prices in the two countries. Prices of a few drugs have been compared to show that the prices in Pakistan are higher than in India and this in turn has been attributed to the alleged differences in IPR regimes [see, for example, Chaudhuri 1999]. No comprehensive comparison of prices between the two countries has been undertaken. The main reason has been the nonavailability of relevant data.

Apart from the well-known issues of quality differences, pack size etc., one should explicitly recognise that several types of comparisons can be made: (a) between price of brands of the same MNC in the two countries; (b) between prices of the leading brand in one country with that of the leading brand in another country; (c) between prices of the leading brand in one country and prices of non-leading or generic brands (or their average) in the other country; (d) between prices of the non-leading or generic brands in the two countries; (d) between average (of all brands) prices for the same drug in the two countries.

The results of cross-country comparisons will differ depending on which type comparisons are made. Typically, the nature of price comparisons is not made explicit.

Basant (2007: Appendix Table 1) compares prices in the year 1998 of 182 representations of various medicines from 14 MNCs operating both in India and Pakistan. Interestingly, 128 of these representations (i e, about 70 per cent) are cheaper in Pakistan than in India. Thus, prices of MNC products in Pakistan were, on average, lower than in India during the late 1990s. One would have expected the Indian prices to be lower. We might get the expected result if we compare the MNC prices in Pakistan with generic prices in India.21

One issue, which needs some exploration relates to the differences in pack sizes in the two countries. For example, Erythrocin 250 and 500 mg tablets are sold in pack sizes of 100 only in Pakistan, while they are available in pack sizes of 10 and 6 respectively in India. If there are economies of scale in packaging, marketing and distribution, conversion of prices of smaller packs (10 and 6 tables in this case) to prices of larger packs (100 tablets) can be problematic. Indeed, the price differential for Erythrocin 100mg is much lower than for 250/500 mg tablets; the pack size is 12 for Pakistan and 10 for India.22

As discussed above, raw material prices can contribute to price differences. While data on these prices is not available, typically raw material prices are used to explain higher prices in Pakistan and not in India. For example, it was mentioned during a discussion that prices of Ibuprofen in Pakistan is much higher than the price of the same locally sourced compound in India. This explained higher prices of Brufen in Pakistan than India [see for price estimates, Basant 2007, Appendix Table 1, item 50]. Similarly, it was argued that ICI India is able to sell Tenormin (item 48 in the same table) at a cheaper price in India because unlike in Pakistan, it manufactures its own raw material for the drug (atenolol and Inderal) in India.

Apart from differences in raw material prices one may have to analyse differences in competitive pressures (e g, the number of alternatives available), market size and the ability to pay in the two countries. Detailed data on these variables is not available. However, in general, competitive pressures were lower in Pakistan than in India. Detailed data analysed in Basant (2000) shows that among the top 100 best selling products in Pakistan, except in the case of five formulations, domestic firms had entered in the market only after 1996 and import competition also increased in the late 1990s. Moreover, significant price increases in the late 1990s were in cases where the concerned firm had a virtual monopoly in Pakistan.23 More detailed data of this kind is not available for India and Pakistan but most respondents in Pakistan agreed that domestic companies are increasingly becoming competitive in Pakistan and may provide competition to the MNCs in the near future.

Another interesting fact is that of the top 120 branded products sold by MNCs in Pakistan in 1996, only 44 of them were also sold by these firms in India. Pharma Bureau had compared prices of these 44 products in Pakistan and India. Prices prevailing in September-October 1996 were compared and for 19 out of the 44 products, prices were found to be lower in Pakistan. Once again, it is not clear which prices were compared in the Pharma Bureau study, but it was claimed that Indian prices do not include between 4 and 8 per cent of sales tax applied by the Indian states. Inclusion of these taxes would have made Indian prices higher.24

Some Concluding Remarks

A Postscript

The Indian pharmaceutical market remains much larger than that of Pakistan at about $ 5 billion in 2005. The share of MNCs continues to be much lower at about 23 per cent. While domestic firms are more dominant in India than in Pakistan, levels of concentration are still high; the top 20 firms have a market share of more than 50 per cent [Chaudhuri 2005: 16-17]. The dependence of India on imported raw material is significantly lower than in Pakistan. Moreover, levels of competition in the raw material market in India are much higher than in the Indian formulations market. However, MNCs are increasingly resorting to imports rather than local manufacturing [Chaudhuri 2005: Chapter 8] which may be adding to price increases of formulations. Drug price control: The deregulation of drug price control in Pakistan was initiated in 1993 and has been gradual with the recent price rise affected significantly by price increases introduced by domestic firms [Parab 2005]. Price control mechanism in India has been liberalised in a big way after 1995 and, as mentioned, prices have been on the rise though not uniformly for all drugs. Available evidence suggests that the prices of drugs under price control have seen lower increases than those outside price control [Chaudhuri 2005: Chapter 8; Srinivasan 2006]. The removal of control on prices of a large number of drugs has, therefore, contributed to price rise with competitive pressures not always able to keep prices under check. Pharmaceutical prices became a political issue with the industry offering to reduce prices of about 886 drugs and there was a furore when this was not implemented speedily. The implications of the recent Supreme Court directive that essential drugs should not be out of price control are still being discussed [Srinivasan 2006]. Thus, drug price decontrol seems to have increased pharmaceutical prices in both countries.

The price rise of pharmaceutical products in Pakistan and India in recent years is not due to changes in IPR regimes. Excess dependence on imported raw materials and MNC dominance in Pakistan, and reduction in price control along with significant market concentration in both countries seem to have contributed to recent price changes. There is all the more reason to look at the impact of IPR policies in the context of other policy initiatives. For example, the competition policy – price policy interface can directly mediate the impact of IPR policies on prices. On the issue of controlling pharmaceutical prices, in India the Pranob Sen Committee had suggested debranding of selected prescription drugs when there is evidence of clear market dominance and creating countervailing forces to keep prices low. As has been suggested, the public healthcare system as a “monopsonist” can potentially be an important countervailing force.31

Finally, in order to make the story more complete, it may be useful to add another dimension to the analysis of pharmaceutical prices – income inequalities. There is evidence to show that ceteris paribus, countries with high income inequalities observe higher drug prices than countries where income is more evenly distributed. In fact, a 1 per cent rise in the measure of income inequality tends to raise average drug prices by 0.7 per cent which is quite significant [Maskus 2003]. Unfortunately this paper has not been able to address this dimension of the analysis but it is likely to be an important determinant of drug price differences in Pakistan and India.

EPW

Email: basantrakesh@yahoo.com

Notes

[This is a slightly revised and abridged version of a paper presented at the Jenny Lanjouw Memorial Conference held at the University of California, Berkeley on March 31, 2007. Comments of the conference participants are gratefully acknowledged. Several people helped me during the course of my fieldwork in Pakistan. Officials of the Ministry of Health and the two pharmaceutical industry associations, PPMA and the Pharma Bureau were extremely helpful. Kieth Watson (Ely Lilly), Zulfiqar Khan (patent attorney) and Zafar Mirza (The Network) shared data and many insights. Simi Kamal and her extended family made my stay unforgettable. I am thankful to all of them. The usual disclaimers apply.]

1 This was a common refrain in a large body of literature on the subject. See Chaudhury (1999) for references.

2 However, in case the patent has not been “sufficiently remunerative” during currency of the patent period, the patentee could apply to the federal government for patent extension, at least six months before the expiry of the patent period. The government could either take a decision itself or refer it to the high court. The high court or the government could grant an extension of up to five years (Section 15, PDA-1911). With an extension, therefore, patent protection was available for a maximum period of 21 years.

3 Thanks are due to Zulfiqar Khan, a leading Karachi based patent and trademark lawyer to clarify these issues.

4 According to estimates provided by Zulfiqar Khan, only two to three MNC patents in pharmaceutical industry were “active” in Pakistan in 1999, in the sense that the owners/licensees of these patents take action whenever infringement takes place. Moreover, only three patent infringement cases in pharmaceutical industry had been decided till that year by the high courts, and there was no case pending in the courts!

5 These statements are based on interviews with representatives of the pharmaceutical industry in Pakistan, mainly those of MNCs.

6 The share of imports in Pakistan might go up to about 25 per cent if one includes drugs imported in semi-finished form. But such details are not available. Some respondents argued that “packaging firms” dominate the Pakistan pharmaceutical market! This was strongly denied by the MNC representatives. Sale of imported drugs was quite significant even for the MNCs operating in the country. In 1997, the sale of imported drugs constituted about 9.3 per cent of the total sales of the Pharma Bureau members, i e, 23 major MNCs operating in Pakistan [Pharma Bureau 1998: 24].

7 The UNIDO (1993) estimates put the share of institutional sales at 20 per cent, much higher than that estimated by Pharma Bureau, unless the purchases by government and semi-government have declined in recent years. Most respondents, however, estimated institutional (government and semi-government) sales to be between 10 and 14 per cent. The exchange rate used in UNIDO (1993) to convert estimates in Pakistan rupees to US $ is not clearly mentioned. Some estimates in the text suggest that the implicit exchange rate was US $ 1 = Rs 24.4.

8 This is based on the interviews of the secretary and director general MoH and the PPMA chairman published in the April 12, 1996 issue of the newspaper, The News on Friday.

9 According to some estimates, the number of active units is more than 20,000 [Lalitha 2002].

10 Earlier there were some tax advantages for firms listed in the local stock exchange and local listing was based on the number of local shareholders. Such a tax advantage encouraged firms to enter into JV arrangements earlier but now since these advantages have been withdrawn, a subsidiary has become the most preferred organisational form for the MNCs.

11 In fact, six MNCs Glaxo-Wellcome, Parke Davis, Beecham, Abbott, Rhone Poulanc Rover and Sandoz had about 53 per cent share of the prime volume market. The share of Glaxo-Wellcome in this market was as high as 23.9 per cent; Parke Davis with a share of 6.6 per cent was a distant second. Similarly, seven firms, Glaxo-Wellcome, Beecham, Hoechst, Squibb, Abbott, Pfizer and Merck Sharp and Dohme had more than 50 per cent of the prime value market in 1995. These seven top MNCs achieved this market share by selling 43 medicines of which 23 were antibiotics. About two-thirds of their prime market turnover was contributed by these antibiotics. The total share of all the local firms was less than the shares of Glaxo-Wellcome (11.5 per cent) and Beecham (10 per cent).

30 No new evidence is available of transfer pricing in Pakistan but duties on imported raw material add upward pressure on prices. For example, raw material imports from India have been on the rise in recent years but the import duty was increased from 10 to 35 per cent increasing the costs of production (www.in-pharmatechnologist.com/news, March 16, 2005).

31 See editorial comments on these lines in two issues of the Economic and Political Weekly (December 2, 2006, pp 4927-28 and October 8, 2005, pp 4391-92).

Ahmed, S J (2006): ‘Winds of Change Sweep Pharma Marketing in Pak’, www.phrmabiz.com/article, January 12.

Anonymous (2006): ‘Pak Law Includes New and Useful Improvements as Well’, www.pharmabiz.com/article, January 12.

Basant, Rakesh (2000): ‘Pharmaceutical Industry in Pakistan’, mimeo, Indian Institute of Management, Ahmedabad, India.

Maskus, K (2003), ‘Observations on the Structure of International Brand Name Pharmaceutical Prices’ www.researchinnovation.org/ tiiparchive/2003_3_d.html

Mehdi, Tahir and Ayyaz Kiani (1996): ‘Pakistan’s Prime Pharmaceutical Market: Essentially Non-Essential’, The Network’s Quarterly Newsletter, 5(3), September 5-9.

Mirza, Zafar (1998a): ‘The Task That Lies Ahead’, The Network’s Drug Bulletin, 7(3), May-August 8-9.

Mishra, Pulak (2005): ‘Mergers and Acquisitions in the Indian Corporate Sector in the Post-Liberalisation Era: An Analysis’, PhD Dissertation, Vidyasagar University.

Parab, K (2005), ‘Pakistan Pharm – Is It on the Right Path?’ www. pharmabiz.com/article/detnews, May 26.

Pharma Bureau (1998): The Pakistan Pharmaceutical Industry, 1998: Fact Book, Pharma Bureau of Information and Statistics, Overseas Investors’ Chamber of Commerce and Industry, Karachi, Pakistan.

Srinivasan, S (2006): ‘The Draft National Pharmaceutical Policy: Concerns Relating to Data Exclusivity and Price Control’, Indian Journal of Medical Ethics, III (4), October-December, 118-19.

UNIDO (1993): Pharmaceutical Sector Study of Pakistan, Technical Report, Findings and Recommendations, Vienna.