CDAP drug shortages in Trinidad and Tobago: metformin to losartan

A free programme with empty shelves

The Chronic Disease Assistance Programme (CDAP) of the Ministry of Health of Trinidad and Tobago gives citizens free prescription drugs for chronic conditions such as diabetes, high blood pressure, heart disease, asthma, high cholesterol, glaucoma and depression; any citizen can use it, with a CDAP prescription and ID, at more than 250 participating pharmacies⁵. It began in February 2003 with 20 drugs for four conditions and became universal in November 2004³. Over the past decade it has cost taxpayers more than TT$4.4 billion, and it had over 87,000 active patients in 2023⁶.

In 2026 the shelves started to empty. On 30 July the Trinidad and Tobago Guardian reported that pharmacists were being told to phone neighbouring health centres and pharmacies when a prescribed drug was out of stock. The Health Minister, Dr Lackram Bodoe, accepted there might be "shortages here and there" and said: "It might be a distribution issue, and it's really a supply chain issue as well, which we are addressing"¹.

Which drugs, and why

Justin Seelal, president of the Association of Pharmacist Owned Pharmacies, said shortages of rosuvastatin, losartan, amlodipine and metformin had lasted since late 2025, with patients pushed to buy privately: "The logistics are so bad from NIPDEC that we cannot get medication delivered from Chaguaramas to parts of the country"¹. His own pharmacy serves an estimated 300 to 400 CDAP patients a month, and about 20 pharmacies in the association face the same problem¹.

Glenwayne Suchit, president of the Private Pharmacy Retail Business Association, put the blame further up the chain. Government tenders were awarded only recently after months of uncertainty, two CDAP drugs were unavailable in May and June, and metformin ran out in July¹. "The tenders have been put into the companies, but the distributors are the primary reason for some of the shortages," he said, adding that distributors "use the supply as leverage to get payment" after debts the current administration inherited; payments resumed in April¹. As of 31 May 2024, pharmaceutical suppliers were owed more than TT$352 million⁶.

On 28 August the minister went further. NIPDEC, the National Insurance Property Development Company, buys drugs for the Ministry, and "I recognised that there are several issues with that procurement process," he said. CDAP has 52 medications, and he could not give the number in short supply: "I know it's a small number, and we're dealing with that"². The North Central Regional Health Authority added that shortages also hit the breast cancer drugs exemestane, anastrozole and letrozole and some psychiatric drugs; regional authorities can buy directly from companies when NIPDEC cannot supply².

Not everyone sees a crisis

The Trinidad and Tobago Association of Retired Persons said its members had not reported problems. "We have not received any reports from our members about medication shortages," said its first vice-president, Reynold Cooper, and members of the public the Guardian spoke to reported no difficulty filling CDAP prescriptions⁴. The Guardian's editorial board disagreed, calling CDAP "one of the most important and consequential social programmes implemented in post-Independence Trinidad and Tobago" and noting that "many of the patients who access CDAP simply cannot afford to purchase drugs they need from private pharmacies"³.

The monopoly question

Behind the shortages is a fight over market power. Freedom of Information documents show that 16 companies received TT$4.4 billion in CDAP contracts between 2015 and 2024; Smith Robertson & Co Ltd received about 42 % (TT$1.8 billion) and Bryden Pi Limited 17 %⁶. In June 2025 the Fair Trading Commission told pharmacy owners they might have grounds for a formal complaint but said no investigation was open⁷. In January 2026 the private pharmacy association said one entity controls more than 70 % of distribution; the Agostini Group said in a public notice that distribution is "regulated and competitive" and that more than 70 registered distributors supply the country, and the Commission's executive director, Bevan Narinesingh, said: "Having a monopoly itself is not illegal; it's the abuse of monopoly"⁸. These market-share claims have not been verified by regulators⁶.

Why shortages matter clinically

Metformin, losartan, amlodipine and rosuvastatin are first-line drugs for the conditions that dominate the national burden: the 2024 STEPS survey found 61.2 % of adults overweight or obese¹⁰, described in March 2026 as nearly two-thirds of adults overweight and almost one-third obese, "a sharp increase since 2011"¹¹. Reviews describe shortages as "increasingly common" and "disruptive to the optimal delivery of health care", best handled when prescribers, pharmacists and nurses work together with patients on a plan for each shortage¹². Many countries now ask companies to notify national registers of upcoming shortages: 34 of 38 countries in one policy review did so¹³. In 2024 NIPDEC's chairman, Nigel Romano, said expired drugs were 0.6 % to 0.8 % of its total purchases of pharmaceuticals and non-pharmaceuticals, with a supply benchmark of at least 18 months from the expiry date⁹.