Sickle Cell Disease access in Pakistan: the DRAP named-patient pathway

Creator: Reserve Meds
Published: 2026-05-18

How patients in the Islamic Republic of Pakistan with sickle cell disease legally obtain US-sourced FDA-labelled therapies when the locally registered indication, stocked presentation, or payer coverage does not match what the prescribing physician has written.

Last reviewed 2026-05-18 by Reserve Meds clinical and regulatory team.

Quick orientation

Patients in Pakistan with Sickle Cell Disease access US-sourced specialty therapies through the DRAP named-patient pathway, a Drug Regulatory Authority of Pakistan-administered mechanism that allows a Pakistani-licensed physician at a registered facility to import the FDA-labelled product for a specific named patient. This page details the global epidemiology of sickle cell disease, the treatment options that typically travel through the cross-border route, real-world timelines, and how your written quote is prepared.

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Epidemiology and clinical context of Sickle Cell Disease

Sickle cell disease is an autosomal-recessive hemoglobinopathy caused by the HBB gene mutation producing hemoglobin S. Clinical phenotypes include sickle cell anaemia (HbSS), HbSC, HbS-beta-thalassemia, and rarer combinations. Burden is high in regions of historical malaria endemicity; the WHO Model List of Essential Medicines includes hydroxyurea for chronic management. Disease-modifying advances include crizanlizumab and one-time gene therapies approved in 2023 (voxelotor was withdrawn worldwide in September 2024).

Global prevalence is in the range of approximately 300,000-400,000 affected live births globally per year; concentrated in sub-Saharan Africa, India, the Middle East, and the Mediterranean. Relevant therapies for sickle cell disease appear on the WHO Model List of Essential Medicines. ICD-10 classifies the condition under D57. The clinical picture in Pakistan reflects the same biological substrate, though referral patterns, age at diagnosis, and access to specialised diagnostic centres vary by region.

Why Pakistani families pursue the named-patient route for sickle cell disease

the Islamic Republic of Pakistan operates a structured pharmaceutical regulatory environment. Modern sickle cell disease therapy is regulated through DRAP channels, and a Pakistani family seeking cross-border supply is rarely asking for a treatment that does not exist locally. They are usually asking for a precise version of it that the local market has not caught up to.

Four converging patterns drive these cases. First, indication lag - newer FDA-approved indications and dosing expansions for sickle cell disease therapies often reach local registration later than the US label, if at all. Second, presentation gaps - the exact strength, weight-banded dose, pediatric vial size, or device format the prescriber requires may not be stocked at the local agent even when the medicine is registered. Third, payer denial - private insurers assess specialty therapies case by case, and step-therapy or formulary rules often produce denials even when the drug is on the local register; cash-pay families pursue cross-border supply rather than wait through appeals. Fourth, continuity of supply - when a US-stable patient relocates to Pakistan or visits family for an extended period, maintaining the original FDA-sourced regimen matters more than switching to a different local presentation.

In each pattern, the DRAP named-patient pathway is the mechanism that connects a Pakistani-licensed physician's clinical decision with US-sourced, FDA-labeled product for a specific patient.

The DRAP named-patient pathway in detail

The pathway for a Pakistani-licensed physician to obtain a medicine that is not registered or not stocked locally is the DRAP Special Permission / Non-Objection Certificate pathway, which allows a treating physician at a registered tertiary facility to apply for the import of an unregistered medicine for a specific named patient, filed through the DRAP OIES portal at dra.gov.pk and administered under the DRAP Act 2012. The framework allows registered healthcare facilities to import a specific medicine for a specific patient when the medicine is approved by a recognised reference authority (typically the US FDA, EMA, MHRA, PMDA Japan, or Health Canada) and a clinically equivalent locally registered alternative is not suitable.

For sickle cell disease, the clinical justification typically frames the case around vaso-occlusive crisis prevention; chronic anaemia management; eligibility for one-time gene therapy. A complete application includes a clinical justification letter from the treating physician (diagnosis with confirmatory genetic or biomarker testing where relevant, severity scores, prior therapies and their outcomes, why this specific drug, why the locally stocked option is not suitable), the treating physician's Pakistani medical license verification through the Pakistan Medical and Dental Council (PMDC) and DRAP, an anonymised patient identifier where the DRAP submission allows, full product details (brand name, generic name, manufacturer, strength, dosage form, pack size, quantity requested, intended treatment duration), the destination dispensing facility name, license number, and pharmacy in charge, and a chain-of-custody plan describing how the medicine will move from the US manufacturer through the importer to the dispensing pharmacy.

We give you a written timeline estimate for your case before you commit. DRAP retains discretion on timing, and we do not promise specific durations.

Treatment options that travel through the DRAP route for sickle cell disease

Modern disease-modifying or symptomatic therapy for sickle cell disease spans a small set of brand-name products, most of which originate from US-headquartered or US-licensed manufacturers and reach the FDA-approved label before equivalent registration in Pakistan. The list below captures the products most frequently requested by Pakistani specialists through the named-patient route. Each links to its drug-specific access page on Reserve Meds with regulatory, logistics, and cost detail.

Casgevy (exagamglogene autotemcel) is a CRISPR-edited autologous CD34+ cell therapy approved in 2023 for sickle cell disease with recurrent vaso-occlusive crises.
Lyfgenia (lovotibeglogene autotemcel) is a lentiviral autologous CD34+ gene therapy approved in 2023 for sickle cell disease.
Oxbryta (voxelotor) is a hemoglobin-S polymerisation inhibitor; Pfizer voluntarily withdrew the global product in September 2024 over safety findings.
Adakveo (crizanlizumab) is a P-selectin inhibitor previously approved for vaso-occlusive crisis prevention; the EU marketing authorisation was withdrawn in 2023 after SPARTAN missed primary endpoints.

Choice of therapy depends on the patient's full phenotype, genotype where relevant, prior therapy, and the prescriber's judgment. Reserve Meds coordinates whichever medicine the physician has prescribed; we do not substitute, advise on substitution, or promote one brand over another.

Cost and quotes for sickle cell disease in Pakistan

Medicine price: quote on request. Every case gets a written custom quote before you commit.

Medicine price: quote on request. You get a written quote for your case before you commit. Reserve Meds' coordination fee is itemised separately on every firm quote.

On the insurance side, private insurers assess named-patient imports case by case. Some reimburse fully when the medicine is on their formulary even if not stocked, some reimburse a percentage subject to copay, and many require pre-authorisation. We do not promise coverage from any insurer. US manufacturer copay cards and patient assistance programs do not extend internationally; cross-border patients pay cash or rely on local payer coverage.

Where sickle cell disease therapies get dispensed in Pakistan

A small group of Pakistani institutions handle named-patient imports for rare and specialty conditions as established workflow, with in-house import pharmacy infrastructure and physicians experienced with the application set. Each maintains pharmacy infrastructure appropriate to the relevant presentation (2 to 8 degrees Celsius cold-chain for biologics, ultra-cold or specialised handling for cell and gene therapies, ambient storage for oral therapies).

For physicians at smaller hospitals without internal import infrastructure, the common pattern is to route through a specialty importer that holds a pharmaceutical establishment license and files the DRAP application on the prescribing physician's behalf. The medicine then moves into the prescribing hospital's outpatient or specialty pharmacy under chain-of-custody documentation. For one-time cell and gene therapies in particular, the dispensing facility must demonstrate qualified storage, documented temperature monitoring, infusion or apheresis capability where applicable, and a chain-of-custody record that meets the manufacturer's risk-evaluation-and-mitigation expectations.

Common questions about sickle cell disease access in Pakistan

Is sickle cell disease treated through the DRAP named-patient pathway in Pakistan?

Yes. When the prescribing Pakistani specialist documents that a specific sickle cell disease therapy is not registered or not stocked in Pakistan, the DRAP pathway provides the regulatory mechanism to import the FDA-approved product for a specific named patient. the DRAP Special Permission / Non-Objection Certificate pathway.

How long does DRAP approval typically take?

We give you a written timeline estimate for your case before you commit. DRAP retains discretion on timing; Reserve Meds does not promise specific durations.

What does sickle cell disease treatment cost in Pakistan?

Medicine price: quote on request. You get a written quote for your case before you commit. The Reserve Meds coordination fee is itemised separately on every firm quote.

Each insurer assesses named-patient imports case by case. Some private insurers reimburse fully when the medicine is on the formulary even if not stocked, some reimburse a percentage subject to copay, and many require pre-authorisation. We supply the documentation set that lets your insurer assess the case; the claim sits with you or your hospital.

Which Pakistani hospitals dispense Casgevy and similar specialty therapies?

Hospitals that handle named-patient imports operate pharmacy storage appropriate to the relevant presentation (2 to 8 degrees Celsius cold-chain for biologics, ultra-cold for select cell and gene therapies, ambient storage for oral therapies).

Where Reserve Meds fits in sickle cell disease cases in Pakistan

Reserve Meds is a US-based digital health company. We do not replace your treating physician, we do not replace DRAP, and we do not replace your dispensing pharmacy. For sickle cell disease cases specifically, we orchestrate supply through a US-licensed pharmaceutical wholesale partner, build the documentation packet your physician submits, coordinate validated logistics (cold-chain with continuous temperature logging where the FDA label requires it, ultra-cold handling for relevant cell and gene therapies) into Pakistan, and give you one point of contact through the case. Standard named-patient coordination under our specialty playbook applies.

A typical sickle cell disease case runs across four parallel tracks. The clinical track is the physician's: justification letter, dosing or administration plan, monitoring schedule, and the next patient-facing follow-up. The regulatory track is the DRAP application packaged by the importer; we provide the documentation template, the dispensing facility license check, and the chain-of-custody attestation. The logistics track is the US-side sourcing and the validated international shipment with continuous temperature logging and customs broker coordination. The patient-experience track is the case coordinator who keeps everyone aligned on dates, addresses dispensing-pharmacy questions, and confirms the medicine has been received and stored correctly. The four tracks run in parallel, not in series; that is the operational difference between a 3-week and a 9-week case.

Next step

If your Pakistani physician is treating sickle cell disease and is weighing the cross-border route for a specific FDA-approved therapy, the next step is a short intake. We reply within one business day, then send a documentation checklist to your doctor.

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