The Competition Commission has referred Adcock Ingram Critical Care to the Competition Tribunal for allegedly overpricing dialysis products crucial for kidney treatment. (Photo: iStock) The Competition Commission said the complaint relates to peritoneal dialysis and continuous renal replacement therapy products supplied by Adcock Ingram Critical Care. The alleged conduct took place between July 2019 and June 2024.
The products in question are used in renal replacement therapy, which steps in when a patient’s kidneys are no longer able to do their job. Peritoneal dialysis can be done at home, while continuous renal replacement therapy is mainly used in intensive care units.
The commission stressed that the complaint concerns the products required to provide these treatments, rather than the dialysis treatment itself.
Adcock Ingram Critical Care’s activities include the manufacture and distribution of intravenous fluids and renal dialysis systems. The commission said it found that the company was dominant in the market for renal replacement therapy products in SA.
It also found that Adcock Ingram Critical Care’s prices for peritoneal dialysis and continuous renal replacement therapy products during the period under investigation were excessive, as they “significantly exceeded” the economic costs attributable to those products.
Economic costs include operating costs and costs of capital. The commission said this was a prima facie indication of an abuse of dominance under the Competition Act.
The case cuts into one of the most sensitive corners of the healthcare system. The commission said an estimated 6% to 17% of South Africans are living with chronic kidney disease, with that number likely to rise because of high rates of diabetes, hypertension and HIV.
Pressure
Expensive renal replacement therapies can restrict access to treatment and add pressure on the government, renal facilities, medical schemes and patients.
The commission said the alleged excessive pricing contributed to the increase or escalation in the costs of making dialysis treatment available to patients.
“The pricing of essential healthcare products has important implications for healthcare costs, access to treatment, and the efficient functioning of healthcare markets,” said Competition Commissioner Doris Tshepe.
“The commission’s intervention in this matter reflects its commitment to ensuring that firms do not use market power to charge excessive prices for products that are critical to patient care.”
The commission is asking the tribunal to declare that Adcock Ingram Critical Care contravened the Competition Act and that it is liable for an administrative penalty of up to 10% of its annual turnover. Adcock Ingram reported group turnover of R9.8-billion in its 2025 financial year, which means the upper ceiling on the administrative penalty would be R980-million.
Adcock Ingram’s most recent annual financial statements provide some context, although they do not break out revenue from the specific renal products named in the commission’s referral.
The group’s hospital division is described as the supplier of hospital and critical care products, including intravenous solutions, blood collection products and renal dialysis systems. That division reported revenue of R2.19-billion for the year ended 30 June 2025, up from R2.05-billion in the previous year.
Trading profit
However, trading profit in the hospital division slipped slightly to R125.3-million from R128.4-million. The division also reported R558.1-million in revenue from the South African government, down from R570.2-million in the prior year.
The published numbers do not show how much of the hospital division’s revenue or profit came from renal dialysis systems, peritoneal dialysis products or continuous renal replacement therapy products.
The company is also the subject of a proposed transaction with Natco Pharma. Under the deal, Natco will acquire all shares in Adcock Ingram not already owned by Bidvest through a scheme of arrangement. If approved, Adcock Ingram will delist from the JSE and operate as a privately held company, with Bidvest as the controlling shareholder.
Daily Maverick approached both Adcock Ingram and Bidvest for comment, but no response was received from Adcock Ingram and Bidvest was not available for comment.
The tribunal case now adds a separate and more uncomfortable test: whether one of Adcock Ingram’s critical-care businesses used market power to overcharge for products used by patients whose kidneys were failing.
For patients, medical schemes and the state, the case is about the price of staying alive. For Adcock Ingram, it is about defending both its pricing and its reputation in a part of healthcare where every rand carries weight. DM