Medicine shortages in Barbados: arrears, queues and a fragile supply

How Barbados buys its medicines

Barbados runs one of the Caribbean's most generous public drug programmes. Drugs on the Barbados National Drug Formulary are free for people aged 16 or under, 65 or over, and anyone diagnosed with asthma, cancer, diabetes, epilepsy, glaucoma or hypertension¹², and private pharmacies dispense them on the state's behalf, then bill the Barbados Drug Service⁴. "Nowhere else in the world do private pharmacies act almost like a polyclinic," Pharmaceutical Society president Marlon Ward-Rogers said in 2024⁴.

The supply side is thin. A pharmaceutical country profile, published by the Ministry of Health with PAHO/WHO in September 2011, found that public procurement was partly centralised under the Barbados Drug Service through national competitive tenders, that 97.25% of pharmaceuticals were supplied by foreign companies registered with the Drug Service, and that there was no central medical store: suppliers stored and distributed medicines as part of the service, for a charge over the procurement price (then 20%)¹. The formulary then listed 700 medicines¹.

Four years of shortages

• May 2022. Then Pharmaceutical Society president Yolan Pantin said shortages were not yet at crisis stage but shipping and supply chain problems were pushing up prices; she did not want to see "somebody has to decide whether they eat or whether they get the medication that they need". A pharmacist added: "We are just a small fish in the ocean"².
• June 2023. Barbados Drug Service Director Maryam Karga-Hinds reported delays on prednisolone (a second supplier was contracted), rationing of Androcur (cyproterone) because of raw-material shortages, limited Epilim (valproate) supplies with the 300 mg strength due to be discontinued ("not a product which can be easily interchanged"), and limited ibuprofen³.
• April 2024. The Drug Service cut the insulin pens it pays for to two per client per month, to maintain "the viability of the programme", with exemptions for visually impaired people and those 18 or under¹¹.
• October 2025. Ward-Rogers blamed intermittent shortages on overseas geopolitical problems, from COVID-19 and the war in Ukraine to shipping disruptions and tariffs, and said brand-name drugs may be missing while generics exist⁶.

When the Drug Service stops paying

The most serious threat came from inside the system. On 1 February 2024, Ward-Rogers said the Barbados Drug Service had not paid pharmacies for formulary drugs for three months and that pharmacies had used up most of the formulary stock they had been reimbursed for; the result, he warned, "is that the cost of medication may rise in the interim", and "you can't give them what they can't pay for"⁴. One pharmacy owner said he would rather suspend participation in the formulary than raise prices⁴. The next day, after talks with the authorities, Ward-Rogers said payment was expected the following week and a price increase had been averted⁵.

Queues at the Queen Elizabeth Hospital pharmacy

In June 2026, during the debate on the Barbados Medical Products Bill, Deputy Prime Minister Santia Bradshaw described elderly patients waiting hours to collect medicines at the Queen Elizabeth Hospital: "when I come downstairs, the number has moved but one or two"⁷. She said Androcur was no longer available in the public system and had been replaced with cyproterone, which "I am told that it is coming with some side effects", and asked whether pandemic-era home delivery could return⁷. Health Minister Senator Lisa Cummins replied that the hospital has run separately from the public pharmacy network, that "the Drug Service is currently in extended discussions with the Queen Elizabeth Hospital", and that discharged patients may be able to fill prescriptions at the polyclinic nearest them⁷. Opening the same debate, Cummins called global supply-chain disruption "a perfect storm" but also "the perfect opportunity" for Barbados⁸.

What could change, and what it means for prescribers

Regionally, PAHO and the Organisation of Eastern Caribbean States' Pharmaceutical Procurement Service agreed to set up a technical working group in 2026; PAHO's representative for Barbados and the Eastern Caribbean said their collaboration could address supply chain vulnerabilities, and Grenada's health minister linked "limited market leverage, fragile supply chains" and climate shocks to recurrent stockouts and elevated prices⁹. A 2021 review of drug shortages found the causes are multifactorial (manufacturing problems, raw materials, logistics, just-in-time inventory and regulation) and that WHO's mitigation strategy includes early warning and training health professionals to manage shortages¹⁰. For physicians in Barbados, the practical lessons from these episodes are to prescribe by generic name where possible, to know which formulary alternatives exist when a brand disappears⁶, and to remember that a switch, as with cyproterone, is a clinical event worth monitoring⁷.