Special Story: People's choice of generic medicines!
Generic medicines have been introduced in order to minimize the health expenditure of our people. But the awareness about generic medicines among the people is so pitiable that most of them not even know what they really are.
A drug is termed generic based on the chemical name of its active ingredient. A drug after its discovery, approved for marketing and reaches its expiry of its patent rights, becomes common to all. After that any company can manufacture and sell it without any legal issues. These kinds of drugs are called `generic drugs’.
A branded drug is termed not by its chemical active ingredient but by its branded name given by its maker company. For example, the most commonly used drug is `paracetamol’. It’s a generic name. It’s given various other names by its manufacturers such as `Calpol’, `Crocin’, `Dole’, `Metacin’, etc. Not by one or two names, `paracetamol’ has been sold with five hundred different names.
What are benefits of generic drugs?
If a company discovers a new drug it can sell the new drug for twenty years exclusively under its patent coverage. This can be called `patent period’. During that period, if any other company wishes to sell the same, it should pay royalty to the company that discovered the drug. Or one should wait till the product’s patent gets expired.
Jan Aushadhi Pharmacy
* Jan Aushadhi Pharmacy was first started on 25th November 2008, in Amritsar city, Punjab.
* There are 229 generic drug (Jan Aushadhi) pharmacies in Tamil Nadu and there are 13 that are going to start at the earliest.
* There are 3008 generic drug (Jan Aushadhi) pharmacies in India.
* Nearly about 60% of health expenditures are spend beyond one’s capacity.
* In Jan Aushadhi Pharmacies there are more than 600 drugs and also surgical implements that are available at the very low cost.
* If an individual or a nongovernmental organization wishes to start a Jan Aushadhi Pharmacy, government provides free space nearby government hospital premises.
* For those who sell up to Rs 10000 per month, the government provides an incentive of 15% and up to Rs 2.5 lakhs is provided.
* For those who are backward / tribes and differently-abled they are provided with Rs 50000 worth drugs. And 15% of the monthly sales will be provided as incentive (maximum of Rs 10000 per month). Likewise one can get up to Rs 2 lakhs as incentive.
* World Health Organization stated that `There will be a major change in health expenditure as India has made it mandatory to prescribe generic drugs’.
* In October 2016, Indian Medical Council had mandated that the doctors should prescribe generic drugs. But it has not been implemented till now.
A drug making company that discovers and manufactures the drug will consider the cost of the active ingredient and also add considerable amount based on the discovery expenditure of the drug while determining its price. The price of the new drug will be more because of that. A company that manufactures the generic version of the new drug after its patent expires, the price will be based on the cost of the raw material along with a considerable profit. Therefore the price will be very much lesser. As the generic makers bring down the price to a minimum the original drug maker also pushed to bring down the price to compete with other manufacturers. There will be small variations in their prices too.
Dr Pugazhenthi says,``In the month of October 2016, Indian Medical Council announced that the prescription made to the patients should not be in the name of brand names. Only their generic names should be prescribed. Even it is mentioned similarly in the Acts. But most of the clinicians do not follow the mandates. And the Indian Medical Council too does not monitor them”.
``Doctors do not prescribe a drug that costs lesser than the other companies. Our people too buy drugs that are prescribed by the doctors. Even when the pharmacists inform the commons that the same drug is available from other companies and at low price, people do not heed to them. They insist that they get the medicine prescribed by their doctors. Drugs are given free of cost by the government hospitals. `People’s Pharmacies’ (Makkal Marundhagam) with the support of central govt also sell drugs at lower prices. Nevertheless people tend to go to private hospitals and pharmacies. Dr Pugazhenthi provides the reason for the same.
``With government hospitals, most of the drugs are procured with poor quality and distributed to the public. This leads to prolonged use of drugs and also treatment gets delayed due to ineffective drugs. People get discouraged and therefore seek for private hospitals. But the government doctors complain that no one comes for follow up continuously.
There are complaints that the Central Government supported Jan Aushadhi Pharmacies do not have critical drugs. In order to protect the poor people from the exploitation of the drug companies, government should come forward to provide drugs free of cost to the people of below poverty line. At the same time, just because the drugs are provided free of cost, they should not be manufactured with poor quality. There is no truth in the general accusation by the doctors that all generic drugs are of poor quality. We cannot say that all generic drugs are of poor quality. If poor drugs are manufactured it is the responsibility of the government agencies to find those companies and ban them. Without doing that making the poor people poorer and make them scapegoats should be avoided”.
We discussed about this with Dr Jeevanandam, a pioneer in cooperative hospitals. He said, ``With the help of Russia, government itself manufactured drugs in the name of Hindustan Antibiotics Limited. Most of the drugs and treatment implements were sold at low prices. But because of improper management and unwanted protests by labor unions the company was shut down. Our government also deviously facilitates the American companies to profit by banning local drugs. The primary reason for this is the signature made by India with the World Trade Organization.
Drugs that are sold for Rs 3000 in the outside market are available for just Rs 400 with the `People’s Pharmacy’. But critical drugs are not enlisted under the generic drugs. If we go to private pharmacies to buy those drugs unavailable, they would push us out by stating ‘you can get all other drugs too at the people’s pharmacies’. Therefore people get inclined to go to private pharmacies for all their needs instead of government agencies. For the past twenty years, in Bangladesh, the country that is far behind us, all basic drugs are available in the form of generic drugs. In our country too, all basic drugs should be made to be available in the form of generic drugs by the intervention of our government”.
When it was announced that, `Doctors should prescribe the names of generic drugs only; not the branded names’, Tamil Nadu Drug Manufacturing Association protested strongly against it. There was also an accusation that due to this announcement, pharmacists would sell the drugs where there is lot of concession for them. We approached Sethuraman, Chairman, Tamil Nadu Drug Manufacturing Association and he stated that, ``When a clinician prescribes a drug it will be based on the conditions of the patients and recommended accordingly. But pharmacists will only sell those products that are profitable to them. If there is a problem between the drug manufacturer and the pharmacist, they will not sell those products even if the doctors prescribe those generic drugs. Likewise there are many concerns with regard to this announcement”.
Anandan, Chairman, Tamil Nadu Pharmacists and Pharmacies Association, stated that, ``Some doctors prescribe both the generic and brand names of a drug. But, at the same time, they would mention on the prescription that ‘they are not responsible for the drugs bought in that manner’. Therefore, we sell only those drugs prescribed by the doctors”.
With the help of the Central Government, there are 3000 pharmacies that sell generic drugs, throughout the country in the name of Jan Aushadhi. For those who are interested to have a shop, there are subsidies by the government. There are 227 generic pharmacies in Tamil Nadu. In Tamil Nadu, for the first time, such a generic drug shop was founded with the help of Sahayam, IAS, in Sivagangai district, in the name of `People’s Pharmacy’.
We spoke to Kannan, owner of `People’s Pharmacy’ in Sivagangai. “Through this scheme, we sell generic drugs at the lowest price, from drugs for common illness such as fever, headache to all kinds of pain relief drugs, drugs against worst diseases like cancer and HIV.
Many drugs are going to be enlisted under this scheme at the earliest. But there are rumors about these pharmacies being spread among the people. There is a notion that if it is a generic drug it will have a poor quality. That is why many reject generic drugs.
Many initiated this with commercial intent and gradually tend not to operate it properly. They don’t even stock essential drugs. This is also the reason for people developing a kind of dissatisfaction towards these pharmacies”.
The price of the drugs that are used most by the people and the price of drugs to treat terminal illnesses should be determined by the Drug Price Control Authority. Government had brought out a list of 348 `Essential drugs’ used by the people commonly. But there are some critical drugs that are not in the list. For example, there is a drug used against fever in 500 mg dose but the same in 650 mg is not available in the list. Above all these concerns doctors are still treated equal to god by the common people because they still trust them.
Monthly sales by `People’s Pharmacy’
* In metro cities: Rs 5,00,000 – 10,00, 000
* In cities: Rs 1,00,000 – 1,50,000
* Semi-urban: Rs 50,000 – 1,00,000
Those who wish to establish a `People’s Pharmacy’ can contact the regional officers whose details are given below:
* Chennai: Sakiswarsingh – 90953 06167
* Madurai: Rajasekar – 94864 01773
* Coimbatore: Arunkumar – 94895 38779
For applications use the website: janaushadhi.gov.in
(This article written in Tamil by R Senthilkumar for Doctor Vikatan magazine dt 16/1/18 has been reproduced in English by V Amalan Stanley)