When a newer, more potent version of an essential drug — the kind that keeps your heart beating robustly or your diabetes levels placid — hits the market, doctors will slowly but surely begin to like it.
It’s an inevitable process that reaches down from the most corporate of super-speciality hospitals to the tiniest of clinics. The only thing that impedes this progression is if the drug comes with a patent belonging to a pharma major.
Corporate healthcare may have no qualms passing the buck on to their bankable patients, but charitable hospitals are often caught between a rock and a hard place.
In fact, more than the infrastructure, it’s often the drug cost that is the most contentious issue for such organisations. “It’s very significant when a patented drug that is essential becomes the preferred option for a particular condition, because absorbing a larger drug cost can be difficult even for the largest of charitable organisations,” says Dr Bimal Charles, General Secretary of the Christian Medical Association of India, a body that has over 300 members who work in various mission-oriented hospitals across the country.
Heart drugs, diabetes pills and cancer essentials are three areas where pharma companies have backed up their R&D with unassailable patents for a good many years.
With patent-expired drugs generally costing around 90 per cent more than their generic counterparts, it’s often a question of availability and access over simple choice.
“Most charitable organisations and bodies still have to buy drugs through distributors of pharma products and that is where the price tends to go up,” adds the doctor who used to head the APAC project with VHS and USAid. “The patients will also have certain expectations, which we need to manage,” he explains.
So when a newer, more expensive drug hits the market, the cheaper alternative begins arriving ‘late’ or is perennially unavailable or does not seem to be accessible within reasonable means. “These are some of the tactics that pharma companies use to ensure their drugs do well. We are also involved at some level but that’s the cost of doing business,” points out an office bearer of a medical representatives trade union.
With no foreseeable option but to purchase and disburse the drug, hospitals often resort to various strategies to try not to pass them on to economically backward patients. Dr V Shanta, Chairperson of The Cancer Institute, Adyar says that patented drug prices have always been a major challenge to the institution from their early days. “Unacceptable high prices are a burden to everyone and though a few pharmaceutical companies come forward and give concessions and even a few drugs for free, its been always a major challenge,” she said.
Dr Shanta further observes that the institution has coped with the price increases of drugs by following certain norms. “Our institution does not prescribe unnecessary drugs to the patients. Careful use of drugs and also use of drugs at the right time is what we follow. When we are sure that the chemotherapy is not going to enhance the quality of life of the patient, we do recommend palliative care, rather than putting them on medicine. We also use generic medicine widely. We have been using generic medicine from the early days. From experience, we have learned that generic medicine is as effective as patented drugs. Patented drugs are prescribed only for selective patients who insist on it. This is how we manage with the price spike, she added.
Some hospitals have deep purses, allowing them to absorb the drug cost, but that is obviously not a solution. Dr J V Peter, Head of pharmacy Services, Christian Medical College Hospital, Vellore said, every time there is an increase of the price. It was they who bear the burden.
“We give 25 to 40 per cent discount to our patients. We don’t want to pass the burden on them as we are rending service to the poor and needy. Price increase affects all of us. Some companies come and offer discounts understanding our service to the poor. They give us subsidy. But still, not many do it. If it wasn’t for the philanthropists who help us, we wouldn’t be able to do anything,” he remarks.
This state of affairs exists despite the aggressive working of civil society in tandem with the Chemicals and Fertiliser Ministry, which sets the all-important Drug Prices Control Order, after the recommendations from the National Pharmaceuticals Pricing Authority (NPPA). “Pharma companies put a lot of pressure on these statutory bodies to ensure that their drugs don’t get pushed on to the essential commodities list, because then price caps will automatically come into place. If this happens, then they push for flooding the market with the product to make up for the margins lost,” says pharma activist and researcher J Surendran.
Is there a way out? Generic drugs have been screaming for attention ever since the centre announced the Jan Audhadhi programme in 2008 — to distribute generic drugs to institutions and hospitals at a subsidised rate, across the spectrum. With little manpower, resources or execution, the project has been meandering till it picked up steam last year.
“Things are gradually improving, which is one of the major reasons why we are looking at signing an MoU with them — such that they can provide quality, generic drugs to all our member hospitals that are involved in charitable work. If this happens, it will be a vast and welcome change,” says Dr Charles.