Guidelines on generic medicines welcome

The National Medical Commission (NMC) has done well to take steps to better enforce the use of generic medicines by issuing fresh guidelines on it. It has directed doctors to prescribe generic drugs as the norm, instead of branded drugs. This is not the first time that advice, guidelines and directives have been issued in the matter, but compliance has been poor. There were no penalties for non-compliance in the past, but the NMC has now warned that failure to follow the directives will invite penalties. Hopefully, this will make a difference. It has also directed that prescriptions should be written clearly and legibly, preferably in capital letters. Shoddily written prescriptions create confusion and have sometimes resulted in patients taking wrong medicines. The recommendation to write legible prescriptions has also been issued in the past but has not been followed. 

Doctors will now have to prescribe only generic medicines, except for cases where medicines have a narrow therapeutic index – drugs where a small difference in dosage may lead to adverse outcomes – and in other exceptional cases. The guidelines have also sought judicious use of fixed-dose combinations and asked doctors only to prescribe approved, rational combinations. Doctors have been told to educate people on generics being equivalent to branded medicines, urge pharmacies to stock them, and to encourage people to buy medicines from Jan Aushadhi Kendras and other generic drug outlets. Being the regulator of the medical profession, it is the responsibility of the NMC to ensure that its guidelines are followed. 

The enforcement of the guidelines will make a big difference to patients with respect to their out-of-pocket expenditure. Branded drugs are much more expensive than generic drugs and they are supported by large-scale commercial promotion by pharma companies. Generic drugs have the same composition, effects, side effects and usage as the branded drugs but are often ignored as there is a nexus between doctors, pharma companies and medical shops to promote branded drugs. There are motivated campaigns which try to create the impression that generic drugs are manufactured in facilities where the best standards are not maintained. There is also the claim all generic medicines are of uneven quality. Medical stores are reluctant to store them because their profit margin on them is lower than in the case of branded drugs. Even the Jan Aushadhi shops are not always well-stocked. India is a top producer of generic drugs, and their easy availability should be ensured all over the country. All the issues connected with implementation need to be addressed to ensure that patients, especially the poor, are not exploited in the matter of use of drugs.