The recent announcement by Prime Minister Narendra Modi in Surat that doctors would be mandated by law to prescribe medicines only by their generic chemical name is part of a well-thought policy to reduce the cost of drugs. This dovetails with the initiatives to slash the prices of several drugs and medical devices, such as stents and chimes, with the intent to increase domestic production of affordable generics. All of these measures will help to make medicines more affordable, reducing the high out of pocket expenditure on healthcare.
Prescription of drugs by their generic name will curtail the physician’s habit of prescribing a costly brand when a cheaper yet effective alternative is available. The unwary patient must not, however, be beguiled by a canny pharmacist who misuses the generic prescription to sell the brand which provides the highest profit margin, ignoring the cheaper alternatives. For this, public and patient education (generic drug literacy) must be promoted so that patients or their family members can easily refer to the manufacturer and price listings of the alternatives available under each generic name. Such a catalogue, periodically updated, must be displayed in a touch screen format (in English, Hindi and a regional language) in each pharmacy. Any purchaser should be able to choose from this menu and estimate the cost before purchasing. Computerised sales records must be randomly surveyed periodically to ensure that pharmacists are not preferentially favouring drugs in the higher price range.
Combination drugs, which mingle two or more generic medicines in a single tablet or capsule, must be closely scrutinised for rationale, pharmacokinetics and efficacy. Generic prescriptions will reduce the scope for their misuse.
This also imposes a responsibility on part of the government to ensure that only quality assured generics are sold. Substandard drugs need to be continually weeded out. The number and quality of drug testing and certification laboratories must increase. Domestic production of generics must be boosted, as indeed of the basic chemicals that are needed for pharmaceutical production.
A pooled procurement mechanism is best used for reducing drug prices when bulk purchase of drugs is needed for public sector use. Quality assured generics can, thereby, be obtained at low prices directly from the manufacturer, eliminating multiple layers of mark-up that lie on the road to retail. Tamil Nadu and Rajasthan have shown how this works well and why states should adopt. Private sector hospitals, too, can be encouraged to buy from autonomous central or state procurement agencies, which follow this method, and pass on the benefit to their patients.
There is also a need to engage with global trade regulations, both to protect our right to produce essential drugs and our ability to export generics. A recent report of the United Nations High Level Panel on Innovation and Access to Health Technologies called upon countries to safeguard and fully utilise the rights conferred by the TRIPS flexibilities as confirmed by the Doha Declaration of the WTO. It asks WTO members to resist and report any political or economic pressure exerted to subvert these rights. It cautions against the threat posed to the rights by free trade agreements which introduce provisions to steal it to resort to compulsory licencing for public health purposes or open the door to industry interference through insertion of Investor-State Dispute Settlement mechanisms.
Further, the UN report also urges member states of WTO to adopt a permanent revision of Paragraph 6 of the TRIPS agreement “to enable swift and expeditious export of pharmaceutical products produced under compulsory licence”. Will India, as the ‘pharmacy of the world’, take up the global leadership role in making this happen? By doing so, PM Modi will improve access and affordability of medicines across the whole world.
ksrinath.reddy@phfi.org