June 18, 2025
THIMPHU – Limited pharmacy services in several remote districts, including Zhemgang, Gasa, and Samdrupjongkhar, are restricting access to essential medicines and pushing residents to obtain drugs from across the border, raising concerns about safety and regulatory compliance, according to the Competition and Consumer Affairs Authority (CCAA).
A study, conducted by the CCAA on private sector participation in the pharmacy services in the country, found that a shortage of retail and wholesale pharmacies is exacerbating disparities in access to medicines.
As of this year, there are 83 registered retail pharmacies and 35 wholesale outlets in the country, with nearly half of the retail pharmacies located in the capital, Thimphu.
Six of the 20 dzongkhags have no retail pharmacies, while four have only one. In these areas, residents rely heavily on Basic Health Units and hospitals for medication.
When these facilities face stock shortages, consumers are often forced to travel to other districts or purchase medicines from across the Indian border, where drug quality is not regulated by Bhutanese authorities. The CCAA study surveyed 10 wholesalers, 20 retail pharmacies and 70 consumers across seven dzongkhags with limited pharmacy presence. Results show that 80 percent of wholesalers identified high transportation costs as the main challenge, followed by low demand (70 percent) and difficulty recruiting certified pharmacists (30 percent).
Another challenge is the difficulty in recruiting Certified Pharmacists (CPs), reported by 30 percent of wholesalers. This is notable given the availability of around 162 certified professionals nationwide.
The issue appears to stem from a general reluctance among qualified individuals to join or remain in the pharmaceutical sector, which subsequently hinders the expansion of wholesale operations into rural dzongkhags.
Despite these challenges, 30 percent of wholesalers expressed a willingness to expand their operations if fiscal incentives, such as tax breaks or subsidised loans, were made available.
Retailers cited similar challenges. Eighty-five percent of surveyed pharmacies reported limited supplier availability due to long delivery timelines. High transportation costs were identified as a barrier by 75 percent of retailers. Fifty-five percent said they struggle to hire qualified staff. Despite these issues, 85 percent of retailer reported satisfaction with the current pricing structure, indicating acceptance of regulated profit margins.
Around 69 percent of pharmacies identified the shortage of certified pharmacists as the biggest barrier to expansion. Around 46 percent cited low medicine demand in rural areas, while 23 percent pointed to high rental costs and 15 percent said they lacked access to financing for inventory.
Consumer feedback underscored the impact of limited pharmacy presence. Among those living in districts with only one pharmacy, 55 percent said they were satisfied with the service, while 28 percent expressed concern about monopolistic pricing and frequent stock-outs. Around 80 percent said more pharmacies are needed to improve access and reduce costs.
The study recommends a series of policy measures to address the gaps, including offering low-interest loans through the Economic Stimulus Plan, granting location-specific tax holidays, and allowing dzongkhag administrations to repurpose unused government buildings as pharmacy outlets with subsidised rents, especially in areas like Trongsa and Samdrupjongkhar where lack of affordable space is a challenge.
The report also suggests expanding the intake capacity at the Khesar Gyalpo University of Medical Sciences of Bhutan to increase the supply of certified pharmacists. It recommends exploring sponsorship programmes in which pharmacy firms fund candidates for training.
To expand reach, the study proposes piloting e-pharmacy services to allow licensed urban pharmacies to deliver to rural areas through a regulated platform. It also recommends exploring the use of drone technology for medicine delivery, citing successful examples in African countries.
The Bhutan Food and Drug Authority regulates the pharmaceutical sector, including pricing and distribution. However, the report indicates that regulatory oversight alone is insufficient to address the structural barriers limiting access to medicine in remote parts of the country.