Pharmaceutical policy reforms and healthcare sustainability through value-based pricing in Bahrain

Abstract Bahrain’s healthcare system has developed through a series of government-led reforms and investments to establish primary and tertiary healthcare services, including free healthcare under the Health for All initiative. This perspective explores pharmaceutical regulations, pricing strategies and frameworks, the pharmaceutical market and expenditure, breast cancer, and diabetes mellitus as case studies, along with key challenges and future policy priorities, including value-based pricing and healthcare. Between 2015 and 2022, the average health spending as a percentage of GDP was estimated at 4.44% (range: 3.84% to 4.98%), with the lowest at 3.84% in 2022. Most of the pharmaceutical budget is allocated to importing pharmaceuticals due to limited local manufacturing capacity. Pharmaceutical imports amounted to US$464.26 million in 2024, and health spending per capita was approximately US$1,175.82 in 2023. Price review policies have helped reduce costs through measures such as a track-and-trace system and regulations governing licensed agents. Currently, two major diseases challenge the healthcare system: breast cancer, where Bahrain is among the highest incidence rates in the Gulf Cooperation Council (GCC) region (44.2 per 100,000 in 2020), and diabetes, with a prevalence of 22.1% in 2024, leading to substantial direct costs and increased budget pressures. To improve access and affordability, key initiatives include integrating Health Technology Assessment (HTA) into decision-making and price negotiations, promoting local manufacturing, and implementing value-based pricing alongside data-driven policies.