A Peek at Pharmacy Practice in Cuba

Like many pharmacists who travel abroad, getting a glimpse of the local pharmacy scene is always on my itinerary.

My recent visit to Cuba under a people-to-people educational exchange visa gave me (and now all US citizens) the opportunity to travel legally to the country without all the paperwork needed just 2 years ago. Given the photos and souvenirs from my parent’s trip to Cuba in 1952, I’ve always been curious about this once-forbidden country.

My 6-day visit was filled with talks and tours focusing on the art, architecture, agriculture, and history of Havana and beyond. Two other pharmacists were part of the group, and the 3 of us often focused our questions and observations on pharmacy and health care in Cuba.

Here’s what I learned:

Medical care is free, but medication isn’t.

Although preventive medical care, diagnostic tests, and medication for hospitalized patients are free, Cubans pay out-of-pocket for outpatient medications. Our typical OTC meds like aspirin and acetaminophen require a prescription from a physician or clinic. Antibiotics and insulin are very expensive, but many generics are affordable when they’re available at the government-run pharmacies.

There’s no CVS or Walgreens.

With a population of 11 million, and more than 2 million in Havana, I found only 2 of the nearly 2100 pharmacies presumably located on the island.

The first was situated in a residential neighborhood in Havana. It was large yet incredibility rundown, just like its surrounding area. The narrow shelves lining the pharmacy were bare bones, giving the impression that the store was going out of business. The space focused strictly on pharmaceuticals; there were no cosmetic, greeting card, health and wellness, or candy aisles.

In comparison, the second farmacia I visited with my pharmacist colleagues near the Ciengage de Zapata Biosphere Reserve—a 3-hour bus ride from Havana—was no larger than a backyard storage shed. Dressed in a white lab jacket, a female pharmacist manned the Dutch-door prescription window, counseling a patient who stood on the sidewalk. Her female assistant sat at a card table with a cardboard box containing filled prescriptions.

One section of the back wall was lined with colorfully packaged liquid antibiotics, ophthalmics, and topicals. The other section contained small screwcap amber glass bottles pre-filled with generic tablets and capsules with glued-on labels used for patient instructions. No computers or typewriters were onsite; handwritten, pre-printed, or verbal instructions were the communication of choice.

There are 2 sets of pharmacies.

Besides the government-run pharmacies for Cuban citizens, another set of pharmacies is designated for international travelers. According to Servimedcuba.com, Cuba has some 46 international pharmacies, most of which are in hotels, and a dozen of them are located in Havana.

The foreigners-only pharmacies are fully stocked with imported drugs, though none are from the United States because of the embargo. Medications and assorted sundries are expensive and can only be bought with the tourist currency, the Cuban convertible peso (CUC).

Cubans can make drug purchases in the international drugstores only using the CUC, which is more than 25 times the value of their Cuba peso that’s used on a daily basis. This makes the price of medication very high compared to workers’ wages.

Pharmacists are well-educated.

All colleges and schools of pharmacy are public in Cuba. The entry-level degree offered by Cuban universities is a 5-year bachelor of pharmacy degree.

The curriculum consists of core science courses and factors in social pharmacy with coursework in psychology, sociology, political science, and economics. All university pharmacy schools are also formally involved in the continuing professional development of Cuba’s 3000 pharmacists.

Like the United States, the Cuban pharmacy profession has moved from a product orientation (dispensing medications) to a patient focus. Given the public nature of the health care system in Cuba, pharmaceutical care is outcome-orientated and requires the pharmacist to work with both patients and their health care providers to promote health and prevent disease.

The pharmaceutical industry is alive.

Despite the economic consequences of a half-century embargo by the United States, Cuba has created a strong presence in the medical research and biotechnology industry. Besides manufacturing and developing generic medications, Cuba currently has a total of 28 drugs registered or at various states of testing for the treatment of cancer, according to Cuba Business Report.

Clinical trials in Cuba have been in existence for years under collaboration with Canada, the United Kingdom, and China. Soon, the United States will be collaborating with Cuba on CimaVax-EGF, an oncology vaccine developed in Cuba for the treatment of small cell lung cancer. In the near future, the vaccine will undergo clinical testing at the Roswell Park Cancer Institute in New York.