Though the government’s recent move to withdraw customs duty exemption on 76 life saving drugs sought to help local manufacturing and consequent domestic demand, it would adversely affect the patients who are prescribed foreign versions of certain drugs against cancer, HIV, diabetes, renal disorders, among other ailments.

With cost expected to rise by 22 to 35 per cent, the tweak may be good for domestic
pharma companies and government kitty but fails to comply with the proclaimed objective of “health for all”. As manufacturing of such medicines is yet to take off under the much touted “Make in India” initiative, the action only perpetuates the vicious cycle of ill-health and impoverishment.

Despite progressive efforts like Drug Price Control Order which was meant to ensure affordability of some commonly used drugs, liberalisation of the pharmaceutical sector in 2002 sent prices spiralling upwards. When 90 per cent of the population has no medical coverage, rising prices have left a large number of people beyond the ambit of healthcare.

In a country with nearly 100 million living cancer patients and rising by a million a year, the decision is acerbic. Unlike TB, HIV/AIDS, there is no public procurement programme of cancer drugs. Barring few generic drugs, there are many patented cancer drugs which find in the list. Cancer accounts for 6.7 per cent deaths, warranting most expensive treatment.

India has the largest number of diabetics in the world. A study indicates low income group patients spend about 27 per cent of their annual income and those in rural India 34 per cent on diabetes care, most of which consumed by medicine costs.

While a country like India which is making its transition from a developing one to an em-erging power along with 1.25 billion population, with no reliable social security net and an ever-increasing out-of-pocket expenditure on health needs, the decision will directly hit the patient population and their families. 

The generic drugs which are made locally will also become dearer as the imported Active Pharmaceutical Ingredients (APIs) will become costly. The government, instead, must give tax sops to companies engaged in R&D to enable manufacture of cheap and quality drugs.

Also, cheap generic versions doesn’t always benefit the patient, as doctors often prescribe branded ones, a result of predatory marketing strategies and compromised work ethics. Caveat emptor (“Let the buyer beware”) is not applicable for a patient entrusting his organs and life to a doctor. Many doctors pander to such a belief by prescribing branded drugs, when cheaper alternatives are available. 

Although the Medical Council of India‘s code of ethics explicitly mentions that “every physician should, as far as possible, prescribe drugs with generic names…” this practice is rarely followed. Despite proliferation of India-made medicines, imported brands dominate the market. Already in private hospitals, the business targets conflict with the objectives of humane and effective medical use. Generic drugs are frowned upon. A segment of medical community is not strict adherents of the Oath of Hippocrates, is plain truth.

Affects poor most

Those below the poverty line, who are still not beneficiaries of schemes like Rashtriya Swasthya Bima Yojana, will have to bear more pain, as life threatening diseases does not discriminate between rich and poor. The number of deaths in case of chronic diseases will swell, as poor will opt out of medication.

Moreover, as the patent battles and IP infringement issues are under litigation, ‘Make-in-India’ drive may not be a reality anytime soon.  A market-driven economy is best left in the market place, which should not trespass the healing of the sick and care of the ill. In India, a silent crisis in access to essential medicines confronts most patients seeking treatment of acute and chronic diseases. According to the WHO, an estimated “650m in India has no regular access to essential medicines”. Patients are forced to buy medicines from the private market, a compulsion that often spells calamity for those who can ill-afford to bear the twin burden of sickness and healthcare costs.

The private sector now caters to 80 per cent of outpatient and 60 per cent of inpatient care.  Not only do public health syste-ms fail to provide essential drugs to patients, but the Indian pharmaceutical market is flooded wi-th expensive medicines that are inappropriate to public needs. In the US, “six out of every 10” prescriptions are filled with gen-eric medicines, and pharmacies are also allowed to replace br-anded drugs with generic ones.

By contrast, in India, home of one-fifth of the world’s production of generic medicines, a consumer finds it difficult to access low-cost generics. Physicians should prescribe both versions, option left to the patient.  Public health facilities must enforce this practice because unbranded medicines are procured and dispensed in these institutions.

Is it “acche din” for pharmaceutical lobby at the behest of those who can’t afford basic healthcare? The lack of access to essential medicines is the result of inadequate budgetary provision for healthcare, the absence of a comprehensive policy on medicine and a weak regulatory framework. The governm-ent should be more responsive to address the priorities.