There has been nothing unusual in our Government’s policies and directives aimed towards certain sectors/industries which create a lot of debates and differences of opinion.
This has been happening since long. In case of the pharma sector, earlier it was’ FDI in Indian Pharma sector’, now it is a directive to promote’ Generic Drugs against Branded ones’.
More since last year, we have been hearing a lot about the word ‘generic’. The Health Ministry’s directive to all doctors in the centre and state run hospitals, to prescribe henceforth only’ generic drugs’. The Medical Council of India (MCI) has issued a circular stating every physician shouldprescribe drugs with ‘Generic Names’
‘Brand’ is the thing
Let us look into the general fact. In India most people identify a product or commodity by a brand name. Even in the rural belt, people are aware of brand names than the commodity. The ‘brands’ have created a trust in us. Most of us ask for the brand name when it comes to buying, be it grocery or durables.
Certain brands ( names ) have created so much impact in the minds of people, that the brand and the product have become synonymous. When it comes to drugs (medicines) particularly the ‘Over the Counter’ (OTC), majority of patients ask for the’ Brand’. An average person asks for a Crocin, Combiflam, Amoxil, etc., In general, patients go by doctors’ prescriptions in case of scheduled drugs.
Also, the branded medicines are there in the market for many years before the generic medicines.
The governments’ reasoning:
To make healthcare cheaper and affordability of medicines to the majority of the population who cannot otherwise afford private hospitals, clinics and branded medicines.
More than 70 percent of India’s population lives in rural areas and nearly 40 percent of the population is either below the poverty line or hovering close to it. Public healthcare is the only option for millions of the rural poor who cannot afford the costly private healthcare in the country.
The Health Ministry’s directive is mainly to bring down the accelerating cost on healthcare. The majority of the people cannot afford costly branded medicines. Hence, the promotion of generic drugs which are no different from the branded ones. So, this directive will help reduce the cost of drugs considerably and benefit people at large.
But this is not the only reason. The government also wants to put to an end the unethical practices of the Pharma , who induce the doctors to prescribe their branded drugs over Generic drugs.
What the doctors feel
Most of the doctors are apprehensive about the quality of generic drugs. According to a doctor in AIIMS on condition of anonymity, “there are certain generic medicines that don’t work like the branded ones ,In fact, in AIIMS, for our own use and the staff’s use, certain generics are not prescribed, instead branded ones are preferred,” the doctor said.
LSW LifeScienceWorld approached some experts to seek their views on this hot topic and this is what they have expressed:
This is what they say:
Upon contacting IMA ((Indian Medical Association) for its views, Dr.Narendra Saini, Hon. Secretary Generalinformed of a meeting held on 6th of February, 2013 at the IMA H.Q, New Delhi on the feasibility of Generic Drugs that was attended by the office-bearers of IMA, Drug Controller of Delhi, Director Health Services, Eminent doctors of India, representatives from pharma industry and lawyers.
Dr. Saini mentioned some of the points that were discussed. “Govt. should control the MRP of drugs, generic or branded so that benefit reaches the common man. At least the price control of MRP of all essential drugs is of paramount importance and their list should be published and revised regularly. IMA members should maintain the rational use of drugs while choosing a drug and ensure it qualifies the criteria: quality safe drug and yet affordable.
Since in our country, patients have very limited access about the information of drugs and even persons employed in chemist shops are also not qualified, proper checks and balances are essential to ensure that patients get the best medicine on physician prescription.
The web site of Drug Controller of India should mention the names and addresses of manufacturing and marketing companies authorized by them to ensure the traceability of the product. It should also mention the MRP of drugs.”
The renowned Cardiothoracic Surgeon Dr.Ganesh Mani, of Indraprastha Apollo Hospitals has something novelistic to say:
“To my mind, the cost of healthcare as it appears, is to a large extent, exaggerated by “frills” of the pharmaceutical companies in:
1.Packaging & cartoning for retail use. 2. Brand promotion among physicians to get brand-loyalty for specific prescriptions.
3.Salaries of drug representatives in large numbers to achieve personal friendships with physicians and thereby modulating their prescriptions!
4. Printing of large amount of promotion literature to act as education & reminders.
5.Organising expensive travel to physicians to exotic locations to win their favour of loyal prescriptions as a return for memorable experiences.
6.Gifts and souvenirs with personalized inscriptions !
If these companies sell their drugs without the additional cost of their promotion as detailed above, hospitals and patients could get the same drug at a fraction of the price. These are called ‘generic’ medicines and have to be guaranteed by the companies for their quality and efficacy as ‘equal’ to their branded retail products.
The cost to the healthcare provider would reduce considerably without any compromise of quality of healthcare delivery. The savings accrued could augment the profit of the hospitals even if a portion of the savings is passed on to the patient.
I strongly recommend the use of ‘generic’ drugs provided there is a guarantee of the quality of the product used on the patient. Needless to add, the defaulters who compromise quality or efficacy (for profiteering) must be severely dealt with as a dis-incentive to such practices.”
Below are some of the views expressed by the industry and association personnel:
Ranga Iyer, former Managing Director of Wyeth and immediate past president of OPPI
feels that by popularizing generic medicines, the branded medicines will not be affected. Multinational pharma companies who are producers of innovative drugs with established brands have their share of market, customers and patients.
Currently a leading pharma consultant, Ranga says, “India is a vast country with different strata of population with different demographic setup. The market is vast for all players of all class and categories.
Government wants to promote generic drugs mainly to make drugs and healthcare expenditure more affordable by a larger population who otherwise cannot afford private hospitals and branded drugs.
But the concern is that of quality. So long as the generic drug manufacturers maintain the standard of quality adhering to strict GMP rules, there should not be any worry. The government should see to it that the norms are followed to the core.
If the promotional policy of the government gathers momentum and if some of the multinationals wishes to venture into making generics, no one can stop them.
The ultimate purpose is to make healthcare cheap and affordable by all. After all medicine is a necessity and is taken with a purpose.”
Abhay Kumar, President-Indian Pharmacist Association
The Health Ministry’s directive asking the doctors to prescribe Generic medicines is a very positive and legitimate directive as a whole. As far as the Pharmacist is considered, he/she would be the most happy to see a prescription with the generic medicine, as he will be not bounded by the “Brands” which some Physician restrict for ‘not to be substitute’. This step of the GOI not only will lead to cheaper medicine to the under-deprived patients but will also encourage several other Pharmaceutical companies to market their product in Generic as well. As we all know that potency and pharmacological value of these generic drugs are as good as the branded one, there should any misconception among the common people about the “Generic medicine”. So, government should also launch some awareness campaign about the efficacy of the generic drugs in addition to issuing such directive to the Physician to prescribe generic medicine.
At the end we at the IPA welcome this step of Govt. of India and would request all those who stands on the other side in this regard to support this for the betterment of the common people of India, who needs this cost effective ‘Generic Medicine” the most.
Jatish Sheth, Vice chairman, Confederation of Indian Pharmaceutical Industry (CIPI), Committee Member Karnataka Drugs & Pharmaceutical Manufacturers Association and director, Srushti Pharmaceuticals.
“A story of Nobel Intentions but Misplaced Understanding of Realities” says Jatish Sheth,
According to him, there is a perception in the minds of the law makers (influenced by recent television programs and news items ) that if the doctors Rx generic drugs , the cost will be less .
The perception now is that there is a unholy nexus between Drs and Pharma companies to Rx a particular brand and hence if they take away this freedom from the Dr’s there will be a reduction in prices.
But there is no law to restrict the price of the end product and so in the future if the Dr Rx’s the product, it is the Chemist who will decide which company generic should be given , so the company who give the chemist the higher margin will be the one that the patient gets .
In these circumstances, the Dr or the Patient have no clue on who is the company manufacturing the product what he will be taking .
Imagine the consequences
It is a well-known fact that companies are very possessive of their Brand Names and Brand Image , Most will go out of their way to nurture and protect their brand names and hence will always ensure Quality of the product , packing etc. , Once we take away the Brand from the Rx , What is the motivation to have high quality , Companies will simply meet basic requirements and sell the product .
There is also a matter of confusion and Risk involved.
Say a Dr Rx’s Asprin 250 to a patient … Should the Chemist give Buffered Asprin , Enteric Coated Asprin or Dispersible Asprin .. ? All 3 are different in their form and use , While a Dispersible asprin is generally used for instant relief from pain , a enteric coated is usually used by long term users for blood thinning .
Imagine the consequences if one is dispensed to the other .
The same goes for Sustained release vs Instant Release products , or Capsules vs tablets , or Syrup vs Suspensions. The fact is that within the same Generic Molecule , there are various forms.
Then there is the question of the survival of the Industry and the Medical Reps who form the threads of the fabric of the Pharma Industry … Know this …
Anjarakandy, , Gaddi, Sakaldiha Chahaniya, Bhadar, Doharighat Amila, Bargadwa, Bannur, Bazarbad, Sidartha, Udayagiri, Kondapalli, , Repallie, Most of us will not recognize these names, or maybe mistake them for some mythical area seen in movies.
These actually are small towns in some remote parts of India which have 10 doctors or more and I think each of these sees 100’s or 1000’s patients in a month.
Today, doctors in these areas are able to treat their patients with the latest and the best medicines available only because the Medical Representative of different Pharma companies go to these towns, meet the doctors, detail the product, hand over samples for them and follow-up on their visits every month. The doctors thus , can then compare the quality of different companies , prices , availability and prescribe appropriate prescriptions to his patients when required .
The patients of these towns get same treatment for severe infections , diabetes , or any other ailment as someone who is treated in AIIMS and for that matter, any other prestigious Institutes in India.
It was the Small Companies in India who’s reps first started meeting these doctors and we called it “ Micro Interior Working “ before recently , when the potential was seen by the larger companies and multinationals who followed and launch special “ Rapid Rural Penetration Task Force. “
If the government moves to a Generic system of Rx , all the reps will become redundant as then it will only be a matter of Selling at the lowest price .
No company will be able to afford any investment in Marketing and this will lead to the total collapse of the Industry ( At least those who have a marketing team )
Imagine the consequences of lacs of medical reps. and the teams that go with them losing their jobs.
Having said this , there is no doubt that the intentions of the Government in wanting to make available quality medicines at affordable price is commendable, but this requires some sustainable plans that will benefit all .
Already there is a National List of Essential Medicines that meet covers most of the common diseases , the government would do well to put a cap on the prices of these medicines and make them available across the country , May be companies by way of a social commitment , are made to manufacture all Essential Medicines of at least 5% of their turnover and sell to the government or market at cost , this will bring great relief to all those who need them .
As a country we hardly have brands known the world over . Brand gives visibility to a nation. USA has been able to capture the imagination of mothers all over the world with Johnson Baby Powder or Band Aid The pharmaceutical sector in India is on the verge of doing it. Omez, Nice gel are popular brands here and abroad. We need to create more brands and with this directive of prescribing only by generic name we are losing a big opportunity as any brand has to be home grown first
Rajesh Gandhi, CEO, Royal Chemist:, India’s one of the oldest chemist shop in Mumbai.
If all the medicines are marketed only by generic name then one medicine will be available made by so many small as well as big companies. the customer will not be in a position to differentiate between them and although he might get them at cheaper rate but he will not be able to be confident about the manufacturing quality of the same. As big and multinational companies usually do not compromise with the quality but which also increases the cost. So they might lose the incentive to maintain the quality and go for the price reduction only. In short customer will benefit in price but suffer in quality.
This is our opinion and we feel that there should be a balance between the quality and the price.
The ultimate purpose is to make healthcare cheap and affordable by all. After all medicine is a necessity and is taken with a purpose.”