Nasrullah Khan, a carpenter from Doddaballapur, who was prescribed a five-day antibiotic course for an infection by the State-run Bowring and Lady Curzon Hospital here, had to buy it from a private pharmacy as the hospital did not have stocks. He bought three days’ supply of antibiotics spending Rs. 120 as he could not afford to buy the entire course at Rs. 200, something that goes against the grain of medical advice.
He is not alone. Of the 600 patients that buy medicines from the private pharmacies on the premises of Bowring Hospital, more than 40 per cent cannot afford the entire course. Although free medicines are dispensed at government hospitals, it is only for those below the poverty line (if stocks are available) and for in-patients. While those from the affluent classes don’t come to government hospitals, it is the patients from the lower and lower middle classes who suffer.
A new hope
Now there is a chance that Nasrullah and those like him need not put their health and immunity at risk. With the State government venturing in dispensation of generic drugs — which cost a fraction of branded drugs — patients from the poorer sections of society can hope to stick to prescribed doses. The government opened such a store recently at Victoria Hospital and 20 more are in the pipeline across the State. If Nasrullah had bought his medicines from the generic store, the dosage would have cost him a mere Rs. 45. For, generic, or non-branded, drugs, are sold at this store at 80 per cent discount.
But… dissenting voices
On paper, generic drugs are the best thing that has happened to patients, particularly from the poorer sections of society. However, doctors express reservations. A senior consultant in Victoria Hospital, who didn’t want his name published, said that not all drugs are available in their generic form. “Some don’t have the active ingredient as in the original drug to take care of a particular ailment. And in life-saving situations, we cannot experiment with generic drugs,” he said.
“Generic drugs may be cost-effective, but branded drugs are always better because they come into the market after rigorous research and development. Although the efficacy of generic drugs would have been tested, yet there are chances of reactions,” said another doctor.
Pricing anomaly
If that is one argument, there is another concern raised by activists about the pricing of generic drugs. Ashok Kumar Bhargava, a Lucknow-based generic drugs activist, told The Hindu that manufacturers and dealers were raking in profits in the guise of maximum retail price (MRP) for generic as well as branded drugs.
“With the MRP printed on the generic drugs being the same as that on branded medicine or sometimes even more, the dealers fool the customers by convincing them to buy the generic drugs at a lesser cost. The dealer would have bought it from the manufacturer at a cheaper price. While the customer believes he has benefitted with the lesser price, the dealer makes profits,” he said.
Same source
The activist went on to add that generic drugs are actually manufactured by pharmaceutical companies to keep up with the competition. The government must come out with a policy to ensure that generic drugs are priced according to their actual priceand not as per the MRP of the branded medicine, he said.
Explaining, a member of the Karnataka Chemists and Distributors Association said that if the MRP of both the branded and generic drug was Rs. 120, the chemist could lure the customer into buying the generic drug saying he could buy it for Rs. 100. “The chemist would have got the generic medicine for not more than Rs. 20. The customer thinks he has saved Rs. 20 while chemist is happy with a profit of Rs. 80,” the member said.
Spurious drugs
So what about the backbone of the pharmaceutical industry, the medical representatives who directly liaise with doctors? Instances abound of companies baiting doctors to promote their products with anything from expensive gifts to foreign tours.
On the government’s move on generic drugs, sources in the Karnataka Medical and Sales Representatives Association said that they had their reservations as “there is a possibility of spurious drugs being passed off as generic drugs”.
“As generic drugs are manufactured by all pharmaceutical companies, spurious drugs can be dispensed by the dealers to customers. People need to be careful and check for the company’s name on the pack,” an office-bearer said.
For example, even if the packet of the particular drug is marketed by a noted pharmaceutical company, it may well have been manufactured by a local company, which buys the marketing rights from the pharmaceutical company. “People can again be fooled saying that it is a product by the noted pharmaceutical company,” the member said.
Regular inspections
However, Karnataka State Drugs Controller B.R. Jagashetty dismissed these fears saying that there was no room for the sale of spurious drugs as regular random checks were being conducted. “There are more than 6,000 pharmacies in the city and we regularly conduct inspections to check on the quality of the drugs,” he said.
Stating that a generic drug is produced and distributed without patent protection, Dr. Jagashetty said that it may still have a patent on the formulation but not on the active ingredient.
Price control
Of the 348 drugs in the National List of Essential Medicines (NLEM), 74 are under the Drug Prices Control Order (DPCO). Under the latter, the pharmaceutical company cannot have a profit margin of more than 100 per cent, including cost of manufacture, supply chain and promotion. The prices for the rest are fixed by the manufacturer and approved by the National Pharmaceutical Pricing Authority (NPPA). “Our role is only to check on the quality of the drugs,” he added.
