§ 02 — Comparison

Compare regulatory pathways side-by-side

Benchmark MAHMAH, GMPGMP, HTAHTA and pathway requirements across up to three markets.

Country A

Country B

Country C

Highlight differences

Criterion	🇵🇰Pakistan	🇺🇸United States
Authority & dossier
Regulatory authority	DRAP	FDA
English submissions	Yes	Yes
CTD accepted	Yes	Yes
eCTD accepted	No	Yes
Reliance pathway	Available	None
Reference agencies	FDA (US), EMA, MHRA (UK), Health Canada +4	—
Lead pathway (timeline & fees) — Standard Registration (Form 5/5F) — Imported / Locally Manufactured · New Drug Application — 505(b)(1)
Pathway name	Standard Registration (Form 5/5F) — Imported / Locally Manufactured	New Drug Application — 505(b)(1)
Approval timeline	365–730 days	304–365 days
Application fee	PKR 500,000	USD 4,310,002
Annual renewal	PKR 50,000	USD 416,734
Local representative	Required	Not required
Local manufacturing	Not required	Not required
GMP inspection	Required	Required
MAH & local presence
Local entity required	Yes	No
Local responsible person	Yes	Yes
RP role	Registration certificate holders must designate a qualified person (typically a pharmacist registered with the Pharmacy Council of Pakistan) for technical / pharmacovigilance correspondence with DRAP.	US Agent: a person residing or maintaining a place of business in the US, designated to act on behalf of the foreign establishment for FDA communications, including notification of inspections.
Accelerated pathways
Designations available	1 designation	6 designations
Examples	Public Health Emergency / Critical Need Registration	Priority Review, Breakthrough Therapy Designation, Accelerated Approval — Subpart H/E +3
Post-approval lifecycle
Variations framework	Variations classified into major (require Registration Board approval — e.g., new indication, formulation change, new manufacturing site) and minor (notification). Pricing variations follow the Drug Pricing Policy and require separate Pricing Committee approval.	FDA classifies post-approval changes as: Annual Reportable, Changes Being Effected (CBE-0 immediate, CBE-30 with 30-day pre-implementation notice), and Prior Approval Supplements (PAS) — the most significant changes requiring FDA approval before implementation. Major manufacturing or labelling changes typically require a PAS.
Renewal cycle	Registration is valid for 5 years and must be renewed before expiry, with up-to-date CMC, safety and pricing information.	FDA does not require periodic renewal of NDAs or BLAs — approvals remain in effect indefinitely subject to compliance, payment of annual program fees, and post-marketing requirements. Annual reports are required.
Pharmacovigilance	DRAP's Pharmacovigilance Centre coordinates national ADR reporting (member of WHO Programme for International Drug Monitoring, Uppsala). Marketing authorisation holders must submit PSURs aligned to ICH E2C(R2), report serious ADRs within statutory timelines, and maintain a Risk Management Plan for new active substances.	Mandatory expedited reporting of serious unexpected ADRs within 15 calendar days; periodic safety reports (PADERs/PAERs) for the first 3 years post-approval, then annually. PSURs in ICH E2C(R2) format accepted in lieu of PADERs by agreement. FAERS database receives spontaneous reports. Post-Marketing Requirements (PMRs) and Commitments (PMCs) tracked publicly.
Unlicensed access
Named Patient Supply	Available	Available
Compassionate Use	Available	Available
Emergency Import	Available	Available
Parallel Import	Not permitted	Not permitted
Clinical trials
CTA approval	Required	Required
Ethics approval	Yes	Yes
CTA timeline	60–180 days	30–30 days
GCP standard	ICH E6(R2) GCP; DRAP Bio-Study Rules and Good Clinical Practice Guidelines	ICH E6(R3) (adopted via FDA guidance January 2025); 21 CFR 312, 314, 50, 56
Pricing & reimbursement
Price regulation	Regulated	Free pricing
Reference pricing	Yes	No
HTA required	No	No
HTA body	No formal national HTA body; DRAP Pricing Committee makes pricing decisions	ICER (Institute for Clinical and Economic Review) — independent, non-binding

Verdict colours indicate lower, moderate, or higher regulatory burden — they're not value judgements on a market.

Authority & dossier

Regulatory authority

PakistanDRAP
United StatesFDA

English submissions

PakistanYes
United StatesYes

CTD accepted

PakistanYes
United StatesYes

eCTD accepted

PakistanNo
United StatesYes

Reliance pathway

PakistanAvailable
United StatesNone

Reference agencies

PakistanFDA (US), EMA, MHRA (UK), Health Canada +4
United States—

Lead pathway (timeline & fees) — Standard Registration (Form 5/5F) — Imported / Locally Manufactured · New Drug Application — 505(b)(1)

Pathway name

PakistanStandard Registration (Form 5/5F) — Imported / Locally Manufactured
United StatesNew Drug Application — 505(b)(1)

Approval timeline

Pakistan365–730 days
United States304–365 days

Application fee

PakistanPKR 500,000
United StatesUSD 4,310,002

Annual renewal

PakistanPKR 50,000
United StatesUSD 416,734

Local representative

PakistanRequired
United StatesNot required

Local manufacturing

PakistanNot required
United StatesNot required

GMP inspection

PakistanRequired
United StatesRequired

MAH & local presence

Local entity required

PakistanYes
United StatesNo

Local responsible person

PakistanYes
United StatesYes

RP role

PakistanRegistration certificate holders must designate a qualified person (typically a pharmacist registered with the Pharmacy Council of Pakistan) for technical / pharmacovigilance correspondence with DRAP.
United StatesUS Agent: a person residing or maintaining a place of business in the US, designated to act on behalf of the foreign establishment for FDA communications, including notification of inspections.

Accelerated pathways

Designations available

Pakistan1 designation
United States6 designations

Examples

PakistanPublic Health Emergency / Critical Need Registration
United StatesPriority Review, Breakthrough Therapy Designation, Accelerated Approval — Subpart H/E +3

Post-approval lifecycle

Variations framework

PakistanVariations classified into major (require Registration Board approval — e.g., new indication, formulation change, new manufacturing site) and minor (notification). Pricing variations follow the Drug Pricing Policy and require separate Pricing Committee approval.
United StatesFDA classifies post-approval changes as: Annual Reportable, Changes Being Effected (CBE-0 immediate, CBE-30 with 30-day pre-implementation notice), and Prior Approval Supplements (PAS) — the most significant changes requiring FDA approval before implementation. Major manufacturing or labelling changes typically require a PAS.

Renewal cycle

PakistanRegistration is valid for 5 years and must be renewed before expiry, with up-to-date CMC, safety and pricing information.
United StatesFDA does not require periodic renewal of NDAs or BLAs — approvals remain in effect indefinitely subject to compliance, payment of annual program fees, and post-marketing requirements. Annual reports are required.

Pharmacovigilance

PakistanDRAP's Pharmacovigilance Centre coordinates national ADR reporting (member of WHO Programme for International Drug Monitoring, Uppsala). Marketing authorisation holders must submit PSURs aligned to ICH E2C(R2), report serious ADRs within statutory timelines, and maintain a Risk Management Plan for new active substances.
United StatesMandatory expedited reporting of serious unexpected ADRs within 15 calendar days; periodic safety reports (PADERs/PAERs) for the first 3 years post-approval, then annually. PSURs in ICH E2C(R2) format accepted in lieu of PADERs by agreement. FAERS database receives spontaneous reports. Post-Marketing Requirements (PMRs) and Commitments (PMCs) tracked publicly.

Unlicensed access

Named Patient Supply

PakistanAvailable
United StatesAvailable

Compassionate Use

PakistanAvailable
United StatesAvailable

Emergency Import

PakistanAvailable
United StatesAvailable

Parallel Import

PakistanNot permitted
United StatesNot permitted

Clinical trials

CTA approval

PakistanRequired
United StatesRequired

Ethics approval

PakistanYes
United StatesYes

CTA timeline

Pakistan60–180 days
United States30–30 days

GCP standard

PakistanICH E6(R2) GCP; DRAP Bio-Study Rules and Good Clinical Practice Guidelines
United StatesICH E6(R3) (adopted via FDA guidance January 2025); 21 CFR 312, 314, 50, 56

Pricing & reimbursement

Price regulation

PakistanRegulated
United StatesFree pricing

Reference pricing

PakistanYes
United StatesNo

HTA required

PakistanNo
United StatesNo

HTA body

PakistanNo formal national HTA body; DRAP Pricing Committee makes pricing decisions
United StatesICER (Institute for Clinical and Economic Review) — independent, non-binding