in perspective

Both doctors and the consumers live by the myth that the branded medicines are better.

It is not too well known that medicines constitute 50 per cent to 80 per cent of health care costs for the poor and health care is the second-most leading cause of rural indebtedness in India.

With most people having no health insurance and the public health care system crumbling, thanks to government apathy, there is an urgent need for policy changes in terms of public health intervention. In this context, Karnataka’s state medical education minister’s recent utterances that at all hospitals attached to government medical colleges, generic medicines will be made available at half price, need much greater attention than the one given by the media. 

Firstly, it is good to have clarity on what constitutes generic medicines. A generic drug is identical to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.

Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.

The branded medicines are generally overpriced and unaffordable for the poor. In the USA, according to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year.

When patent on a particular branded medicine terminates then generic medicines are manufactured. With generic medicines bringing in competition, the medicine prices come down. This is a global phenomenon and nothing new in the Indian context.

Education required

So it is important as a policy that only generic drugs are purchased, but unfortunately, both doctors who prescribe medicines and the consumers live by the myth that the branded medicines, that are invariably costly, are better.

This problem can only be tackled by educating them that generic medicines are of good quality equivalent to that of brands. For example ten capsules of Cephalaxin 500 mg, a life-saving antibiotic, in the market is available for Rs 116.95, where the same can be made available at Rs 31.50.

The second important policy intervention required is to purchase only the Essential Medicines (EMs). The EMs are those that satisfy the primary health care needs of the vast population.

The EM concept can be applied at various levels, national, district and taluk, it is especially valuable in poor-resource settings, as it allows one to get the most important medicines for the resources available.

According to a study at least 60 per cent of the top-selling 300 medicines are not in the EM list. Surprisingly this accounts for more than Rs 35,000 crore sales of medicines. By adopting the EM list, either at state or national level, with a stroke of pen all unessential medicines like tonics, cough-syrups, unwanted vitamin combinations and others can be removed.

By implementing the twin basic policies of having generic medicines and the EM list, it is possible to a great extent to make medicines affordable. Of course there are other policies level interventions like good governance, effective distribution systems, proper quality control, transparent procurement system, promoting rational drug use with prescription auditing and others.

In Tamil Nadu already such a system has been in operation for nearly 15 years. It has set up the Tamil Nadu Medical Services Corporation Ltd (TNMSC) which is an autonomous agency for procurement and logistics of medicines. The state also introduced the Tamil Nadu Transparency Act in Tenders 1998, which to a great extent regulated corrupt practices.

A similar idea was experimented with in Karnataka in 2003, with the establishment of Karnataka State Drug Warehousing and Logistic Society (KSDWLS). But there are significant differences in the functioning of these two organisations.

Unlike TNMSC, KSDWLS is not an autonomous body but it has a typical government set up. The state health minister acts as a chairman of KSDWLS and additional director who is a member of Karnataka State Administrative department acts as a manager.

A study comparing TNMSC and KSDWLS found that the managing director in Tamil Nadu had the power to  spent upto Rs 50 lakh, whereas in Karnataka it is just Rs 1 lakh.

Also according to an article in the Lancet, corruption was a major hurdle at KSDWLS. For example the Lokayukta estimates that “nearly 25 per cent of the health budget gets siphoned off due to corruption at various levels.”

Rajasthan has already taken steps to provide free medicines for all from October 2, 2011, while Gujarat is following suit. It’s time the Karnataka government also changed its policies to make medicines affordable for the poor consumers.

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