The medical fraternity has voiced opposition to Prime Minister Narendra Modi government’s directive to the doctors asking them to prescribe generic medicines to patients. This has been done as an effort to provide affordable healthcare to all, especially the poor. There are two reasons to oppose the move - non-availability of generic medicines and questionable efficacy of such medicines.
The Indian Medical Association (IMA) has expressed its stand on the recent circular by the Medical Council of India's (MCI), statutory body that regulates medical education and registers doctors, on generic drugs. The IMA has said that MCI’s notice doesn’t prohibit doctors from writing the name of a brand or company while prescribing the medicines.
IMA, an umbrella body that represents doctors, said that the circular only asks doctors to write generic names and name of the salt on the prescription but they are not prohibited from writing the brand name.
"Nobody can stop you choosing the company for quality assurance," said the IMA statement. IMA advised doctors to choose drugs from the National List of Essential Medicines (NLEM) as they are cheaper and of assured quality. "When writing non-NLEM, take consent. When prescribing, write the cheapest available medicine and that will always be the generic version of that company," advised IMA.
"The medical practitioner, ultimately, has the right to choose the drug and brand. But along the brand, they must mention the generic name. They must also justify why a Rs 90 drug has been prescribed when a Re 1 drug is also available in the market," said KK Agarwal, President, IMA.
Last week, MCI had issued a public circular for all physicians in India to prescribe drugs using generic names. The notice had also warned disciplinary action against doctors for violating the code.
The clause 1.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 was amended by the MCI in September 2016. The amendment made it mandatory for all physicians to "prescribe drugs with generic names legibly and preferably in capital letters".
If found guilty of professional misconduct, the appropriate Medical Council will remove the medical practitioner's name from Indian Medical Registry, rendering him ineligible to practice.
The Modi government has been pushing hard to make drug prices affordable and accessible in the country. It has been promoting generic drugs through the Jan Aushadhi programme. Recently, the Modi government said that it is contemplating a law to make generic names mandatory in prescription.
As per officials, majority of the government-run hospitals do not have the medicines as such medicines are procured in accordance with the preference policy through the Central Public Sector Enterprises (CPSEs). Thus, the medicines procured from CPSEs are branded not generic. These medicines are then sold at discounted prices for patients at Jan Aushadhi Centres.
Currently, there are more than 1,200 Jan Aushadhi Stores across India. Out of these, 31 are located in Punjab, 22 in Haryana, 16 in Delhi, four in Chandigarh and 17 in Himachal Pradesh. Patients who get treatment at government-run hospitals, health centres and dispensaries are advised to buy medicines from these stores only.
"We purchase the medicines as per the policy only from CPSEs and are branded medicines. If the government is willing to provide us with the generic medicines under the policy, we will be more than happy to offer the same to our patients. The problem is that presently there is no provision to buy generic medicines under the policy," a senior health department official in Chandigarh on conditions of anonymity said.
"Generic medicines are the name of salts which constitute a medicine instead of the branded names. However, one of the biggest drawback of prescribing a generic medicine is that unlike the branded medicines which have a higher bioavailability, the generic medicine have very low bioavailability which makes them less effective. Bioavailability of any medicine is the absorption proportion of a drug in the body so as to have an active effect. So if a patient is taking a generic medicine, the percentage of absorption may be less than 60-70 per cent", a senior doctor working in the premier tertiary care institute, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, said, as he explained the difference between a branded and a generic medicine.
Explaining further, the doctor said, "Another drawback of these generic medicines is that these are procured from third party manufactures and are stamped by the brands under the garb of generic as their own . So if a brand X is manufacturing a branded medicine for fever for a price of Rs 100 per strip, the same brand will also sell a strip of generic medicine at Rs 60 without its name or logo.”
"A patient who buys the generic medicine at Rs 60 per strip may feel he saved money but in reality, he ended up buying a less effective medicine that too at Rs 60 which actually costs the pharmacist Rs 10 from the manufacturer".