Though bound by law, neither doctors nor pharmacies want to dispense generic medicines to patients as the profit margin is low

Laws in India specify that all medical prescriptions should give generic medicines and all pharmacies must make them available to patients.

But aggressive marketing by private pharma companies, cut-throat competition and ignorance of the customers coupled with weak enforcement of rules allow private manufactures of branded medicines to make a killing through your “friendly pharmacy”.

About 85% of total health expenditure in India is financed by household out-of-pocket expenditure (according to government figures) and medicines constitute 20% to 60% of total healthcare expenditure.

Understanding the strain medical expenditure has on the common man, the central government has been working on “aggressive” marketing of generic drugs by opening pharmacies that sell these medicines, and asking pharmacies to display availability of these medicines.

Missing display

Sadly almost no pharmacy in the Capital seems to be in the mood to cooperate with the government in advertising the availability of generic drugs. “We provide what doctor has prescribed” is the common refrain.

But just why are the pharmacies not displaying the availability of generic drugs?

“This is a profit-driven market. The margin on generic drugs is low when compared to the branded drugs which make a killing,” said a retailer at Khan Market.

“Additionally, a lot of customers aren’t happy when low-cost medicines are handed out to them. They feel that the quality of the medicine directly depends on the cost of it,” he said, but admitted that it isn’t the case always.

“Doctors can prescribe but we cannot ensure that generic medicines are dispensed. Of course, pharmacies get a commission on selling branded medicines. Besides, non-availability of these medicines is a huge issues,” said Dr. Anil Bansal from the Delhi Medical Association.

‘Mediflation’ concerns

High drug prices act as a strong barrier to seeking effective healthcare in India, as people lack purchasing power, noted a study “Drug Price Difference Between Different Retail Market Settings – An Analysis of 12 commonly used drugs”.

It said that there are instances when people go without drugs (by extension without treatment) or buy a small proportion of the required doses of drugs due to high prices.

“The situation gets increasingly worse as time progresses, as drug prices grow faster than the national or per capita income in India. Mediflation, although not clearly estimated, could be 3-5 times higher in India compared to general inflation (about 5-6%). Given 6-7% growth of GDP and 4-5% growth of per capita GDP, mediflation cuts into the household budget heavily,” noted the study.

“This is a heartbreaking reality in India,” said a senior Health Ministry official.

“The poor and the middle class are the worst hit, hence our drive to bring in and advertise about generic drugs. We have to pass on the benefits to the people,” he added.

The Board further recommended including a definition for generic medicine under Drugs and Cosmetic Rules, 1945, since it is currently not defined.

“I haven’t seen any pharmacy in Delhi display this. Those near the hospitals are so packed that we can’t even see the counter, leave aside spotting a separate rack for generic medicines or even this board on display. The customer is squeezed from every side. Even a common illness in Delhi means that you will need at least ₹10,000 to get back on your feet. This will include your consultation, diagnostics, medicines and follow-up. I wish generic drugs are marketed more aggressively so that people are aware of their rights and can make informed choices,” said Pradeep Suresh from east Delhi, a teacher by profession.

Non-availability of drugs

Since 1961, pharmaceuticals have been under price regulation in India.

But it isn’t just cost that the national Capital is grappling with. Non-availability of generic drugs is another problem.

According to a study “Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India”, published earlier this week, it was found that availability of essential anti-cancer drugs in both public and private sector pharmacies in the Capital is far below the World Health Organization’s prescribed standards.

The study was led by the George Institute for Global Health in collaboration with the University of Sydney, Cankids India, Max Super Speciality Hospital, and Boston University School of Public Health and published in the British Medical Journal Global Health.

Data was collected on availability and price of 33 strength-specific anti-cancer essential medicines and four non-cancer essential medicines. Seven hospitals – four public and three private – and 32 private-sector retail pharmacies were surveyed. The study further found that only three anti-cancer essential medicines were available on the government-run Jan Aushadhi website.

“Yes enforcement (sale of generic medicines) is a problem as we are facing a huge manpower crunch. Besides checking the quality of medicines, we also act on complaints etc. However, ensuring every pharmacy follows this rule is virtually impossible and making the consumer empowered and aware is the only way out, ” said a senior Delhi Health Department official.

 

As good as brand names

What are generic drugs?

* A generic drug is a medication created to be the same as an existing approved brand-name drug in dosage form, safety, strength, route of administration, quality, and performance characteristics.

*It works in the same way and provides the same clinical benefits as its brand-name version.

*Approved generic medicines are generally sold only after patents and exclusivities protecting the brand-name version end.

*Generic medicines tend to cost less than their brand-name counterparts because they do not have to repeat animal and clinical (human) studies that were required of the brand-name medicines to demonstrate safety and effectiveness.

*In addition, multiple applications for generic drugs are often approved to market a single product; this creates competition in the marketplace, typically resulting in lower prices.  Typically results in prices about 85% less than the brand-name.

*The reduction in upfront research costs means that, although generic medicines have the same therapeutic effect as their branded counterparts, they are typically sold at substantially lower costs.

 

Some examples

A generic drug is the one known by the name of its chemical component

* Generic drug Paracetamol 500 mg costs ₹10 for 10 tablets, while brand names like Crocin 500mg costs ₹30 for 15 tablets

* Antispectic Chloroxylenol 1 kg costs ₹110 while Savlon 500 ml cost ₹129 or Dettol 550 ml cost ₹152 at discounted price

*Generic Azithromycin: ₹67 for 3 tablets; Branded Azax: ₹112/for 5 tablets.

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