Yesterday, I got a long WhatsApp
message in which, our Prime Minister’s push for a law to make prescribing generic medcine mandatory for doctors, was
heavily criticized. The message appears to be circulated by a group of doctors
that alleges government’s move as irrational, biased and politically motivated.
Many such messages and posts are in circulation, since the time PM spoke about
prescribing generic in Surat. Few of my doctor friends whom I spoke to on this
matter, appeared to be highly agitated on this matter. Time of India conducted
a study where they found 73% doctors opposed to push for generic drugs. But on the other hand, government seems to
be firm on pushing this agenda ahead. There has been a letter issued from MCI to
doctors asking them to prescribe medicine with generic names, as far as
possible. The letter was amended later as Indian Medical Association (IMA) got
into semantics and issued a clarification that ‘as far as possible’ does not
mean compulsory and doctors are free to prescribe what they want. Even on
amended letter
there is subjective interpretations being made by IMA and bodies in healthcare
profession.
So what is this mess and why so
much hullabaloo is going around? I looked into the details of this issue and
spoke to few people who could be affected by this. It appears to be the clash
of interest of government, doctors and pharmaceutical organizations. To
understand this issue better, let me first start by explaining generic drugs,
which we all are conversant with but don’t fully understand what it means.
So what exactly are generic drugs?
US-FDA, defines generic drug as ‘an
identical- or bioequivalent- to a brand name
drug in dosage form, safety, strength, route of administration, quality,
performance characteristics and intended use.’ It also mentions that although
generic drugs are chemically identical to their branded counterpart, they are
sold at a much lower price (link). In India, most pharmaceutical companies
manufacture generic drugs along with their branded drugs. In technical terms, as
a product there is no difference between generic and its branded counterpart.
The difference lies in marketing of the product. Pharma companies spend enormous
amount on marketing of their branded drugs, which they don’t do for generics.
The marketing cost when incorporated in the price of drug can make them
costlier by about twice to ten times their actual cost. Due to the efforts companies
put towards branded medicines, they also keep a higher margin to earn out of
it.
Why government wants to push for generic medicine prescription?
Healthcare plays an important role in economic growth of country in long
run. As per our constitution and various international declarations, government
bears the responsibility for healthcare provision to its citizen. Nationally
and internationally, there is a move for ‘universal health coverage (UHC)’ and for
achieving UHC, cost of healthcare is a vital determinant. When patients find treatment
given by a qualified doctor un-affordable, they are very likely to discontinue
it and go back to their household remedies or to quacks. Cost of medicine is ‘the most’
significant portion of overall healthcare cost (upto 70%), and reducing
healthcare cost is not possible without reducing cost of medicine. Here, comes
the role of generic. As mentioned in above paragraph, generic drugs are a lot
cheaper than brands and have the potential of reducing the overall healthcare
cost significantly. Also, since generic drugs are, by definition, chemically
same to their branded counterpart, no negative effect on treatment is expected
with their use. Due to this, government is making effort to increase the use of
generic drugs and hence wants doctors to prescribe generic drug name as a
mandate. There are similar other moves such as ‘capping the price of cardiac
stent’, which is also in the direction of making healthcare affordable to all.
Why doctors are opposing this move?
Doctors are taking this move as an infringement to their professional
freedom and something which can drastically affect the way they have been practicing medicine till now. Their reasoning is that only a doctor knows, what
is the best medicine for his/her patient and doctors must be given freedom to
choose his/her line of treatment. Else they may not produce best result for
their treatment. Secondly, many doctors trust the branded medicine that they
have been prescribing for years and they may not trust its generic version. It’s
the doctor who take the responsibility for treatment outcome and should be the
one to decide without any unjustifiable restrictions.
Other factors that is making the issue complicated
While both governments and doctors’ objectives seems genuine there is
one more factor that makes this issue much complicated. This is the monetary
and material incentives linked to drug prescription. Pharmaceutical companies,
in their marketing efforts have often pleased the doctors with freebies with
expectation of getting more prescriptions of their products. Although there are
legal and ethical
codes to prevent incentivizing
of doctors, reality is a lot different. There is a generalized perception that many
times, doctor’s prescription of drugs is also influenced by material incentives
linked to it from the company. This could bring suspicion about the rationality
of medicines being prescribed. Most doctor would oppose to this, claiming the
nobility and beneficence with which doctors practice. How far are they being
difficult to ascertain.
What could be the resolution?
The resolution can be achieved, if the basic underlying reasons are
addressed. In country like India no easy or umbrella solution can work for any
challenge. Hence to expect that just by making generic mandatory, healthcare
can be made affordable is too far-fetched. Government must come up with a
policy that prevents irrational prescription or prescription influenced by incentives,
while protecting doctor’s freedom to prescribe. This is however, easier said
than done. Big pharmaceutical companies, who have a deep vested business interest
in this matter can be a significant influencer. Besides the doctor’s lobby is
also pretty powerful. Government must move cautiously, by taking interests of
doctors and pharma companies into consideration, but surely pushing this agenda
gradually. Creating awareness about generic drugs amongst people, having strict
legal measures to deal with unethical prescriptions, producing research
evidence for generic drugs effectiveness and incentivising production of
generic drugs are some of the measures that would go a long way in increasing
generic drug usage.
Disclaimer - This is my own view on the topic and doesn't intends to be biased towards any body
(Please leave your comments below)
