What North Korea’s Health App Reveals About Domestic and Imported Pharmaceuticals

A recent article published on 38 North introduced a health app developed in North Korea. Among its features, the article mentioned that the app included a database of over 3,000 different pharmaceuticals, traditional medicines and medical goods. This study examined the dataset in the context of disease-specific treatments, specifically medications listed for the treatment of tuberculosis, hypertension, and diabetes. The overall variation in drug prices suggests that they may be accessible to individuals across different economic statuses. A larger number of Koryo (traditional Korean) medicines are included compared to imported Western medicines, with most appearing to serve as adjunctive rather than primary treatments. This pattern illustrates the integration of Western and Koryo medicine within the North Korean healthcare system. 

Overview of the Data 

The dataset includes information on 3,319 substances, organized under various themes. This study sorted the data based on therapeutic uses of the various substances, first extracting drugs used to treat specific diseases, then analyzing what the resulting lists might signify. 

The list broadly includes Western medicine, Koryo medicine, and others including nutritional supplements and medical devices. (For clarity, this study uses the FDA’s definition of a drug—“a substance used in the diagnosis, treatment, or prevention of a disease or as a component of a medication”—to define what is considered Western medicine.)  

It is unclear whether the drugs listed in the app require a doctor’s prescription for purchase. However, it seems unlikely that the list only includes over-the-counter medications, as many of the substances in the dataset typically require a prescription in countries like the United States. 

Among all listed medications, including nutritional supplements, 59.1% were produced in foreign countries, with a total of 18 countries of origin. The major sources were China (32.8%), Japan (29.1%), Vietnam (13.8%), Russia (9.3%), and India (3.9%). 

Case Study 1: TB Treatments 

Tuberculosis (TB) remains one of the most serious infectious diseases in North Korea, which has long struggled with a high prevalence of the illness. According to the WHO’s 2024 Global Tuberculosis Report, the country had an estimated 135,000 TB cases in 2023. The estimated incidence rate stands at 513 per 100,000 people—a level exceeded by only a few other countries, including the Central African Republic, Gabon, Lesotho, Myanmar, and the Philippines. 

The dataset includes 108 substances used to treat TB. Among them, only nine (8%) are Western medicines—specifically, three listings for ciprofloxacin and six for dexamethasone, all from different sources. The rest are either Koryo medicines or unclassified others. 

Globally, first-line drugs for tuberculosis include isoniazid, rifampin, pyrazinamide, and ethambutol. However, none of these are available on the app. The absence of a drug from this list does not necessarily mean it is unavailable in North Korea. In fact, there is substantial documentation of these first-line TB drugs being delivered to North Korea through various international channels, including through the World Health Organization and multiple non-governmental organizations. The reason why these specific drugs are unavailable via this app service is unclear but should not be overinterpreted.  

Of the TB drugs that are available via the app, ciprofloxacin is sold in quantities of ten pills, with prices ranging from 45.1 to 110 foreign exchange won. According to earlier reporting in 38 North, a red price tag in the app denotes pricing in foreign exchange won, with an estimated exchange rate of 1 USD to 100 won. This converts to approximately $0.45–$1.10 per ten-pill pack. In the US, ciprofloxacin is typically sold at a wide range of prices, depending on insurance coverage or coupon use, but generally falls between $1 and $5 per tablet. This suggests that, at least nominally, ciprofloxacin is priced at less than one-tenth the US level. Given the lack of reliable data on domestic purchasing power and income levels in North Korea, it is difficult to assess how affordable these prices are for the average citizen. Nevertheless, the prices do not appear to be prohibitively high and may be within reach for a significant portion of the population. 

Dexamethasone is used as an adjunctive therapy in certain special cases, such as TB meningitis or pericarditis. It does not have bactericidal effects on Mycobacterium tuberculosis and must be administered alongside anti-TB drugs. The dataset includes both tablet and injectable forms of dexamethasone. The tablet form is priced at 24 to 30 foreign exchange won for a pack of 30 pills, which equates to approximately $0.01 per tablet. In the US, the same medication typically costs between $0.20 and $0.50 per tablet. The injectable form is priced at an equivalent of $0.06 to $0.20 per ampule. Direct comparisons are complicated by differences in quality, formulation, concentration, and packaging.  

Despite the inclusion of 108 substances claimed to treat tuberculosis, the overwhelming majority are Koryo medicines or supplements. While some Koryo medicines may have direct antimicrobial effects and be used for bacterial infections, there are no known reports of any that are especially effective against Mycobacterium tuberculosis.  

However, Koryo medicines may be used as adjunct therapies for TB related symptoms. First, they can help restore energy in patients who experience significant weight loss, fatigue, and loss of appetite while taking anti-tuberculosis medications. Second, Koryo medicines may help alleviate side effects such as liver dysfunction or gastrointestinal discomfort caused by anti-tuberculosis drugs. Third, they may be used to relieve symptoms such as coughing, sputum production, and chest pain. 

Case Study 2: Hypertension Treatments 

Hypertension is a major non-communicable disease worldwide, typically managed with medication. North Korea is no exception; according to the WHO, the age-standardized prevalence of hypertension among adults aged 30 to 79 years in 2019 was 26.5%. 

The app includes 223 substances used to treat hypertension, of which 63 (28.3%) are western medicines. Except for three, all originate from Vietnam, India, Russia, Japan, and Egypt. Unlike in the TB case, most of the western drugs listed (57 out of 63, or 90%) are recognized internationally as first-line treatments. This makes the absence of first-line TB drugs all the more puzzling. 

Imported first-line hypertension drugs are priced between 44 and 1,948 foreign exchange won (roughly $0.44 to $19.50) per package unit. The cheapest among them is a combination of Losartan and Hydrochlorothiazide (HCTZ), with stated origin in India—a widely used two-drug regimen in hypertension management. Priced at $0.44 for 10 tablets, it is a fraction of the US retail price, where the same combination typically sells for $15–30 per 30-tablet supply. This suggests North Korean prices for some essential medicines can be as low as 1/10 to 1/20 of US prices. 

At the opposite end of the spectrum, the most expensive entry on the list is a combination tablet of Amlodipine and Atorvastatin, reported as originating from Japan. This medication targets both hypertension and cardiovascular risk reduction. Listed at 1,948 foreign exchange won for 10 tablets (roughly $2.00 per tablet), it aligns with US pricing, which ranges from $1 to $10 per tablet depending on the brand and pharmacy. This indicates that the list contains a mix of affordable generics as well as premium-priced drugs likely intended for those with greater purchasing power. 

As mentioned earlier, three of the drugs name a domestic North Korean manufacturer. Two of these are first-line antihypertensive agents. This includes Amlodipine besylate, a widely used calcium channel blocker, which is listed as being produced by Ryonghung Pharmaceutical Factory. Despite being domestically manufactured, the drug is priced in foreign exchange won, rather than local currency. A report by 38 North observed that Ryonghung and several other domestic pharmaceutical factories “appear to sell products exclusively in foreign exchange won,” possibly because the drugs are made from imported raw materials or as a means of maximizing profits. The listed price for Amlodipine besylate is 165 foreign exchange won for 100 tablets, or approximately $0.02 per tablet. By contrast, the average US price for the same drug is around $0.15 per tablet, suggesting that even with foreign currency pricing, the North Korean price is roughly one-tenth of the U.S. price. 

Another example is Losartan potassium, a first-line antihypertensive agent. It appears in the list with a price of 26,000 domestic won for 50 tablets, marked with a blue price tag in the app. Applying the exchange rate of 1 USD = 8,000 domestic won used in a prior 38 North report, this equates to approximately $3.25 per 50-tablet package, or $0.07 per tablet. Compared to the US unit price of around $0.20, this also places the North Korean price at roughly one-third the US level. The inclusion of this drug in the list suggests that North Korea possesses at least some domestic capacity to produce essential antihypertensive medications and to make them available to the population at relatively affordable prices. 

The app also contains many Koryo medicines that are said to help with hypertension. In fact, some Koryo medicines are believed to contain ingredients that may help lower blood pressure and could therefore be considered therapeutic. However, by modern medical standards, the direct blood pressure-lowering effect of such medicines is limited, so they are generally regarded as supplements or complementary therapies. When used as supplements, Koryo medicines may help stabilize blood pressure by improving overall health through stress reduction, better sleep, and increased energy, or by alleviating side effects of conventional antihypertensive drugs, such as gastrointestinal discomfort or fatigue. 

Case Study 3: Diabetes Treatments 

Diabetes is another major non-communicable disease managed primarily through medication. Lin et al. (2020) reported that an estimated one to five million people in North Korea are living with diabetes. 

The app includes 183 substances used in diabetes treatments, of which 19 (10.4%) are Western medicines. All but two of these are internationally recognized first-line drugs. Of the 19, 18 are listed with countries of origin including Japan, Vietnam, Russia, and Egypt. The most affordable among them is metformin—a globally recommended first-line oral medication for type 2 diabetes—with a listed country of origin as Vietnam. The price in the database is 220 foreign exchange won for 50 tablets, or approximately $0.04 per tablet. In the US, the same medication typically costs about $0.10 per tablet. 

At the opposite end of the price spectrum is empagliflozin, an oral SGLT2 inhibitor used either alone or in combination with other first-line therapies such as metformin. The listing, marked as originating from Japan, indicates a price of 7,491 foreign exchange won for 10 tablets—about $7.50 USD per tablet. In the US, the same drug sells for approximately $20 per tablet. 

The only domestically produced diabetes drug listed is glibenclamide, a sulfonylurea made by Namsong Pharmaceutical Company. It is an older oral antidiabetic agent used in type 2 diabetes treatment. While still considered an effective agent in some cases, glibenclamide carries a higher risk of hypoglycemia compared to newer medications and is generally not recommended for patients with impaired kidney function. It may also be associated with increased long-term cardiovascular risk, which is why it is no longer considered a preferred first-line treatment in many guidelines. The listed price is 9,000 domestic won for 100 tablets, or approximately $0.01 USD per tablet, compared to a US price of around $0.04 per tablet. 

Of particular note is the absence of Chinese-origin insulin products. A 2022 study reported that North Korea imported large quantities of insulin through Chinese customs, amounting to $1,015,158 in 2021. A follow-up review of Chinese customs data indicates that in 2022, North Korea imported an additional $936,102 worth of insulin through the same channel. Despite these substantial imports, no Chinese-manufactured insulin products appear in the app’s database. Instead, the list includes an insulin product noted as originating from Egypt. While it is possible that the insulin imported via China was not of Chinese origin, it seems unlikely that all the imported insulin came from Egypt. These discrepancies suggest that while the database includes several drugs, it may not provide a comprehensive inventory of all medications currently available in North Korea. 

Again, the list includes many Koryo medicines said to assist with diabetes management, although Koryo medicines have only limited direct blood sugar-lowering effects and instead focus on symptom relief and overall health improvement. Their potential roles include helping manage symptoms such as appetite regulation, fatigue reduction, and thirst relief, as well as preventing or alleviating chronic diabetes complications by improving peripheral circulation and supporting liver and kidney function. 

Implications 

Based on the findings above, several conclusions can be drawn. A wide variety of drugs are both available in country and used for the treatment of different diseases in North Korea. The range of listed prices suggests that some medications may be broadly affordable and accessible, while others appear to be priced for individuals with greater purchasing power. Numerous Koryo medicines are included, but their role appears to be largely supportive rather than curative. While some may aid symptom relief or general health, there is little evidence that they are effective as primary treatments for serious conditions like tuberculosis, hypertension, or diabetes. Finally, since it is unclear who the intended users of this app are and how it is used in practice, it is unclear whether drugs not included in the list are also available or commonly used. 

Overall, the fact that North Korean phones have such an app does suggest North Korea is at least trying to make medicines more accessible to the general public. How effective that service is or how well-stocked the country is, however, is largely unknown. If an opportunity arises to observe the app in actual operation, the findings presented in this analysis could change accordingly.