The Centre is reported to be in favour of moving a bill requiring doctors to prescribe generic medicines in place of costly, branded ones. This progressive step, which will reform the way essential medicines are distributed to patients, was recommended by the Planning Commission’s High Level Expert Group on Universal Health Coverage five years ago. Among its suggestions is a system of bulk procurement of important drugs from quality generics manufacturers through Central and State-level supply logistics corporations and their distribution through Jan Aushadhi outlets. Given the large size of India’s
pharmaceuticals market, and the vested interests in favour of the
status quo on price and distribution, it has taken inordinately long to move to low-cost generic medicines on a large scale. There is also a lack of awareness on the availability of affordable alternatives to expensive brands. A recent assessment of India’s expenditure on health published by
The Lancet showed that out-of-pocket spending comprises 58 per cent of the total; two-thirds of this is on drugs. What makes the situation difficult even for relatively better-off patients who can afford commercial health insurance is that risk cover is generally confined to part payment of hospitalisation bills, but not prescription medicines. The poor are impoverished further by drug costs. It is vital, therefore, that governments act on multiple fronts — making listed essential medicines available free or nearly free to all in hospitals through higher public spending, widening access to generics through Jan Aushadhi outlets, and closely monitoring professional practice to eliminate prescription of irrational, non-essential drugs that have no curative effect.
Famed as it is for leading in the production of generic medicines and catering to the needs of other developing countries, Indian pharmaceutical manufacturing has also faced censure over quality. The episode of Ranbaxy pleading guilty to felony charges in the U.S. three years ago for adulteration of its products and failure to meet standard manufacturing practices highlights the need for close regulatory oversight. Only with a guarantee of efficacy can the plan for mandatory prescription of generics succeed. To achieve this, the government should proactively help all manufacturers — public and private — to meet the internationally recognised Good Manufacturing Practice standards. Scaling up the number of Jan Aushadhi outlets quickly to a few thousand poses a challenge; moreover, the performance so far has been uninspiring. Barring a few States like Tamil Nadu, Rajasthan and Kerala that have a creditable record of public provision through hospitals, the target for opening generic drug pharmacies, first announced in 2008, has never been met. Co-opting private pharmacists is one way ahead. Again, one of the persistent problems with low-cost access systems is non-availability of specific drugs. A transparent supply chain managed by state-run procurement agencies can help overcome such bottlenecks.
