Free medicine scheme makes a big splash in Rajasthan

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Free medicine scheme makes a big splash in Rajasthan

The free medicine supply scheme launched in Rajasthan may act as a ‘game changer’ for chief minister Ashok Gehlot in the state and health care in the country. Following the success of the scheme in Rajasthan, the government of India is planning to introduce generic medicine under the National Rural Health Mission (NRHM) which may radically transform the health care system in the country.

The scheme could act as a panacea for many ills plaguing the country. As per WHO reports around 65 per cent of the population lacks regular access to essential medicines and the expenditure on health is considered as the second most common cause of rural indebtedness. Over 23 per cent of the sick do not seek treatment as it is beyond their reach; and expenditure on drug constitute about 50-80 per cent of the health care cost. Similarly expenditure on health is responsible for 2 per cent APL families fall to BPL every year. The paradox is all the more  startling as about 98,000 infants do not see their first birthday annually due to lack of medical care whereas India is the third largest producer of medicine both generic and branded with an estimated turnover of Rs 45,000 crore!

The Rajasthan scheme assumes importance as the health care cost is mainly borne by individuals as out of pocket expenditure. The breakup of health care cost shows that private out of pocket expenditure constitutes the bulk at 79 per cent, followed by the state government at 14 per cent, Central government at 4 per cent, private investment 3 per cent and the private insurance, barely 0.1 per cent, clearly indicating the burden on the affected individuals and families.

Rajasthan Medical Services Corporation Managing Director and the brain behind the scheme, Dr Samit Sharma says the scheme had so far benefited about 8.5 crore people in the state. After the scheme was introduced, the number of patients visiting the government hospitals and dispensaries has increased by almost 50 per cent from the previous 44 lakh every month to 62 lakh now. Everyday nearly 2 lakh patients get the benefit of the scheme.

Medicines with a market value of Rs 1,591 crore have so far been supplied to patients at a bulk cost of just Rs 270 crore ever since the scheme was launched in October, 2011 in the state.

“There should not be any doubt about the quality and effect of generic medicine just because it is cheap,” says Dr Sharma. He says generic manufacturers are able to sell their products at lower prices because they are not required to repeat the costly clinical trials of new drugs and generally do not incur expenditure on costly advertising, marketing, and promotion. In addition, multiple generic companies are often approved to market a single product which creates competition in the market place, often resulting in lower prices.

Various brand names

 For example if a doctor has to treat a patient of blood cancer, he may advice the salt Imatinib by various brand names. If he has prescribed brand Glivec, a month’s course will cost Rs1.24 lakh to the patient. Whereas, the same anti cancer drug, but with a different brand name ‘Veenat’ costs just Rs11,400. Cipla supplies the generic equivalent of this drug (@-imitib) at Rs 8,000 only whereas Gelnmark supplies it for Rs 5,720! All these brands contain the same salt Imatinib, in the same quantity, conform to the same quality standards and are equally effective.

The scheme has resulted in drastic reduction in the out of pocket expenditure of patients. The average cost per patient has come down to Rs 30 for the cost of drugs purchased from the market cost of Rs 300-500.
 
Dr Sharma pointed out that 95 per cent of diseases could be treated through 250 to 300 essential drugs and there was a difference of up to 40 per cent in the prices of several branded and generic medicines. Presently 325 essential drugs and 42 surgical items were distributed free of cost at government hospitals and plans are on to include 450 more drugs and 150 more surgical items from April this year.

The introduction of the scheme has not only broken the unholy alliance between the doctors and pharmaceutical companies but has also bring about a kind of revolution in health care which was unthinkable in the past.

The irony of the Indian pharmaceutical market is that the most commonly used medicines are sold at very high prices to maximize revenue to the companies. According to the industry statistics the highest selling medicines are non essential drugs, demonstrating an unholy alliance between the doctors and the pharmaceutical companies. Revital and Becasules are the top selling drugs as if they is a kind of food substitute!

 The tricks employed by pharmaceutical companies are that drugs which are similar to their predecessors are ‘invented’ just by making some minor changes in the original drug chemical and then patented and aggressively promoted. Similarly higher priced alternatives of a patented drug without any clear therapeutic advantage are introduced periodically. In contrast to ‘breakthrough drugs’ these drugs have no significant treatment benefits but are just created to continue to enjoy patent protection and thereby reap huge profits after convincing the doctors to prescribe them.

Unethical promotion and irrational use of drugs result in medicines become unaffordable. Besides inappropriate medication and risk of adverse effects, it is a huge drain on the families’ resources and the foreign exchange for the country.   
Experts point out that making medicine affordable is only one major part of the health care and the government has to invest substantially in health care infrastructure to cope with the pressure of population.

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