Medicine in Malaysia a cost saving for some Singaporeans. Are they trading safety for price?

JOHOR BAHRU: For almost a decade, estate agent and content creator Ryan Khoo has made videos comparing life on both sides of the Causeway, such as videos about all things cheaper in Malaysia.

Indeed, many Singaporeans travel to Johor for cheap groceries and fuel. For some, however, it is something else that is driving them there: prescription drugs.

“Lots of people don’t know that … prescription medicines are a lot cheaper as well,” said Khoo, who cited cholesterol medicine, blood pressure medication and “even the humble Panadol” as examples.

“And you can buy up to three months’ worth of medicines. … The pharmacists don’t require you to provide any form of prescription.”

He found this out after being asked to buy medicine in Johor Bahru for a friend’s father. “Later on, I realised quite a lot of people do it. Either they buy it for themselves or for their parents,” said Khoo.

Talking Point viewers, too, wrote in saying they not only get cheaper medicines in Malaysia, but also can buy those that require a prescription without proffering a doctor’s note. There are risks, however, as host Steven Chia discovers.

WHICH MEDICINES AND HOW CHEAP?

In Singapore, medicines that require a prescription or a pharmacist consultation include Lipitor for high cholesterol and Ozempic, a diabetic medicine that people also use to lose weight.

Most of the pharmacies Chia went to in Johor — from independent ones to large chains — were willing to sell him these and other medications, including painkillers, with no questions asked.

In Singapore, a steroid cream such as Elomet would ordinarily be sold one tube at a time to prevent side effects from overuse. But in Johor, there was no limit.

It was harder to get antibiotics without a prescription — for example Augmentin — but Chia got some in the end.

One pharmacist said most of the Singaporeans who come to her pharmacy are “searching for sleeping pills”, which would include Valium.

And one Singaporean whom Chia ran into at a pharmacy was stocking up on Twynsta, which is for hypertension. Back home, a box costs more than S$100, compared to RM66 (S$19) in Johor, said the customer.

“When I realised it, I was so agitated because that’s (a big) difference,” he added. “I stopped buying (the drug) from my clinic.”

WATCH: Is it safe to buy cheap medicine from Malaysia — without a prescription? (22:02)

There is a chance that some common drugs are still cheaper in Malaysia than their subsidised prices in Singapore’s hospitals, according to Nikki Ng, managing editor of MIMS Healthcare Data, which publishes medical and drug-related reports.

A box of 40-milligramme Micardis tablets, for high blood pressure, costs RM62 in Johor and about S$53 in Singapore, she cited. A box of 10-mg Lipitor tablets, meanwhile, costs RM108 and about S$76 respectively.

Asthma puffer Ventolin costs RM24 compared to S$21, while Elomet sells at RM29 compared to S$18. Essentially, the medications Ng cited were more than 50 per cent cheaper in Johor than in Singapore.

One of the main reasons for the lower prices, besides the exchange rate, is “stiff competition”.

“Sometimes in the same street, you’ll have at least three to four pharmacies,” said Ng. “They can be from the large chains (or) could be individual pharmacies.

“When there’s so much competition, the pharmacies would … drop the price just to make sure the customers come back.”

Also, in a smaller market like Singapore, “pharma companies sometimes might decide to price (medication) higher”, she added, whereas selling to Malaysia’s larger population means economies of scale and thus lower prices.

GENERIC DRUGS

Medicines can be even cheaper if they are generic drugs, which are produced after the patent on the original drug has expired. The brand Rotaqor, cited Ng, is equivalent to Lipitor but sells at RM13 per box, instead of RM108.

While medicines are often referred to by their brand name, what defines a drug is its active ingredient — the substance with an effect on the body. And generics are supposed to have the same active ingredients as branded drugs.

Paracetamol is an example of a generic medicine referred to by its active ingredient, instead of the famous brand name, Panadol. It is among hundreds of drugs produced by YSP Southeast Asia Holding, one of Malaysia’s largest manufacturers of generics.

“We’re local, … so certainly, (our products are) much cheaper than other imported items,” said company president Lee Fang Hsin. And they are effective because of the “testing rules and regulations”, he added, which “everybody must follow”.

Chia sent some of the generics he bought in Johor, such as flu, cholesterol and blood pressure medicines, to a laboratory for tests to see if they were as effective and safe as medicines in Singapore.

And they passed the test, with potency ranging from 101 per cent to 136.4 per cent. “That means these generic ones are safe to use,” said principal clinical pharmacist Golda Wang at Alexandra Hospital.

Potency refers to the amount of medication needed to produce an effect, and “minimally you do expect a 90 per cent potency”, she added.

WATCH: We test how effective cheaper and generic medicines from Malaysia are (3:44)

‘VERY BAD PRACTICE’

Efficacy aside, the ease with which Singaporeans can get prescription drugs and medication controlled by dispensing pharmacists in Johor is “very bad practice”, said professor of health economics Kenneth Lee at Taylor’s University.

“Every single prescription medicine that a pharmacist dispenses will need to have an entry,” he said, showing Chia a prescription book containing the quantities supplied, the dates and patients’ details, countersigned by the pharmacist.

The laws in Malaysia and Singapore are similar, he said. But he was not surprised to see that Chia could buy medicines in Johor without a prescription or without leaving his particulars.

“These so-called illegal sales are very common,” Lee noted. “Because if you don’t sell the medicine to the patients, they’d simply (go) next door. So you lose business — you may not be able to survive.”

Talking Point reached out to Malaysian health authorities to find out about their enforcement efforts but did not get a response.

Even without crossing the Causeway, however, Singaporeans can get medication from Malaysia through websites that promise home delivery anywhere in Singapore.

Chia ordered the steroid cream Tri-Luma — used for treating skin discoloration, itching and swelling — from an online store at almost half the price in Singapore. It is a prescription medication, but he still managed to have it delivered.

When he sent it to the laboratory for analysis, however, it failed the potency test: The results showed 63.3 per cent.

One reason that it was less potent than expected and thus “less useful”, said Wang, might have been that it was not kept cool — between 2 and 8 degrees Celsius — “to maintain the stability of the medication”.

“This extends to other medications that require cold storage,” she added, citing insulin as another example of medication that would be less effective if not stored properly. “And that’s one of the risks with online shopping.”

Chia’s item arrived in a normal box, and it turned out that the website he found did have this disclaimer: “We do not offer cold chain delivery for this item.”

But even with physical purchases in stores in Malaysia, buyers from Singapore bear some risks, Wang cautioned.

“These are prescription medicines for a good reason. You do require a doctor to follow up … to make sure that the medicines are appropriate for you,” she said.

“Bypassing the doctor’s follow-up, you’d miss … the monitoring that’s usually required for prescription medicine for its safe use.

“When you get a refill (of) cholesterol-lowering medication, for instance, you don’t really sense whether your cholesterol is high or low. And it’s not possible for you to sort of tell on your own whether it’s working or not.”

Watch this episode of Talking Point here. The programme airs on Channel 5 every Thursday at 9.30pm.