Prime minister Narendra Modi’s clarion call for prescription of generic medicines by doctors has been welcomed by many. People feel this will dramatically reduce the price of filling out their prescriptions and end the perceived nexus between the industry and the physicians to promote branded medicines with sometimes much higher price.
India’s healthcare system is disjointed. Most customers have no purchasing preference and even if a branded medicine is prescribed, there is no assurance that the patient gets the same medicine because there is no system to track prescriptions. It is usually the chemist who decides what the patient gets and with this new move, the chemist is king, being in a position to choose the generic offering him the highest return.
For a patient there is also this confusion of what really is a generic—most people perceive it is a local preparation, loosely packed with scant quality parameters and very often this is true. Prescribing a generic would, therefore, leave the patient even more hapless and at the mercy of the dispenser as there is no way to understand which of the numerous generics is being given to him and why.
You may also like to watch:
It is very important to understand generics especially in the Indian context, where there is a distinction between a generic that is branded and one that just has a chemical name. The patient, for whose benefit this measure is being rolled out, needs to be educated to understand that generic medicines are as good as branded products; more important, our regulator needs to ensure that this is so. Otherwise people who can pay will continue to buy branded medicines at a premium, leading to the creation of a grey market.
According to the article “Quality of Health Care In India: Challenges, Priorities, And The Road Ahead” (Health Aff (Millwood), October 2016, (25(10):1783–90), 77% of healthcare visits were to providers with no formal training. These providers prescribe allopathic medicines, usually dispensed from their own clinics. A recent report from the World Health Organisation (WHO), based on 2001 census data, states that 31 % of those who claimed to be allopathic doctors in MP were educated only up to the secondary school level. Fifty seven percent had no medical qualification. All these providers write allopathic medicines and there are no checks or mechanism to monitor their prescription behaviour.
Besides, many patients in India self-medicate, using an old prescription for years without visiting a doctor. Dispensing medicines in the country is a large and profitable business.
The entire ecosystem thrives on commissions and kickbacks. Moreover, pharmacies generally don’t have qualified pharmacists and dispensers may be confused with this new directive. Upending an existing system, without a robust mechanism to implement a new one, will put patients at risk.
The government’s attempt to promote generics in the public health system, through its Pradhan Mantri Jan Aushadhi programme, already faces several challenges. At present, Jan Aushadhi centres stock only a small percentage of the complete formulary and only a portion of essential medicines.
We need to better understand efficacy, supply chain issues, storage and stocking. India is facing multiple challenges of poor quality generics, antimicrobial resistance, low public healthcare and high out-of-pocket expenses.
Under these circumstances, calling for mandatory prescription of generic medicines without laying the foundation for a change could result in further deterioration of the already overburdened system in the country. Patients could face sudden shortages of lifesaving drugs and life-threatening situations due to poor quality generics; and end up paying more due to prolonged illness.
While generic prescriptions could be a way to increase healthcare access, our challenges need to be thought-through and a long-term plan created that involves all stakeholders in planning, implementation and monitoring.
Without this essential foundation, the intent will be diluted and the benefits remain a dream for the patient that it is meant to serve.