Bringing patients to centre of pharmaceutical business

Medicines account for nearly 70% of total out-of-pocket expenditure (OOPE) in India, due to which a rise in prices of branded medicine burns bigger holes in the pockets of patients and their families. The availability of quality generic medicine is a pragmatic solution to address the issue only if doctors prescribe generic medicines. The Jan Aushadhi Kendras (JAKs) opened across the country under the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) provide medicines at 50%-80% cheaper rates than branded medicines. The JAK product baskets include about 2,000 medicines covering all major therapeutic groups, such as cardiovascular drugs, anti-cancers, anti-diabetics, anti-infectives, anti-allergics, and gastro-intestinal, and 300 surgical/medical devices. Official data shows that on average 10-12 lakh consumers buy medicines from more than 14,300 JAKs daily, which is reflective of the growing preference for generic medicines. India’s pharmaceutical market has grown to the size of 50 billion US dollars, which is the world’s third-largest market by volume and 14th largest by value of production. The doctors not complying with the regulatory norms that require them to prescribe only generic medicines is explained by the huge influence of pharmaceutical companies producing branded medicines. Although the National Accounts Statistics 2024, published by the Ministry of Statistics and Programme Implementation, did not make production data of generic medicines separately, official estimates show that over the past ten years, the purchase of generic medicines has led to savings of Rs 30,000 crore for people compared to branded medicines of the same compositions. The National Medical Commission (NMC) notified new regulations on prescription writing last year, making it mandatory for the doctors to prescribe only generic medicines or face penalties, but the NMC put on hold the regulation following strong objection to it by the Indian Medical Association (IMA). The IMA demanded that the regulation be withdrawn until the quality of all generic medicines can be assured. Prescription of branded medicines compels poor patients to go to a pharmacy to purchase those, but many of them discontinue treatment after finding that they can afford to buy such costly medicines to complete the course. The IMA flagged a genuine concern that if branded medicines are allowed to be sold in pharmacies, then the responsibility of exercising the choice of preferred brand goes to the pharmacist, who is not trained to take care of a patient’s health. The issue cannot be kept hanging if poor people are to be protected from coughing up high expenditure for healthcare, which erodes their household savings. The country having more JAKs is also not going to solve the problem if doctors keep prescribing branded medicines that are available only in pharmacies. The government claims that medicines available at JAK are procured only from World Health Organisation Good Manufacturing Practices-certified suppliers for ensuring the quality of the products, and each batch of drugs is tested at laboratories accredited by the National Accreditation Board for Testing and Calibration Laboratories. The IMA, however, alleged that less than 0.1% of medicines manufactured in India are tested. Strengthening medicine testing facilities through the establishment of more testing laboratories and increasing the percentage of medicines tested is the only way out to find a workable solution on the prescription of generic medicines and ensure the availability of quality generic medicines. Transparency of drug testing is crucial to build confidence about the quality of generic medicines available in the JAKs. Bringing patients to the centre of the healthcare ecosystem is easier said than done with some powerful doctors’ lobby accused of promoting the interests of pharmaceutical companies in lieu of benefits. The government has claimed to have taken several measures to encourage domestic manufacturing in the pharmaceutical sector to reduce import dependence. The mere increase in domestic production is not going to change the overall situation for poor patients if licensed manufacturing of medicines is not linked to the prescription of generic medicines and problems of patients not being adequately informed about various brands and pricing to make an informed choice. An increasing number of JAKs cannot make much difference if they continue to exist along with pharmacies that primarily sell branded products and doctors continue to prescribe branded medicines. The problem requires a holistic approach through stakeholder consultation in which activists raising voices on behalf of poor patients get the opportunity to present their views and come up with workable solutions. The measures must go beyond optics of pro-poor patient-friendly measures. A viable solution to the persisting problem can be bringing uniformity in pricing of medicines of the same formulations produced under various brands so that the quality of medicine is ensured and, at the same time, patients have a wide range of choices to buy preferred brands. Such a solution can be possible only if the healthcare industry is freed from the approach of pharmaceutical companies to put profit above patients. Only regulations that put patients’ interests at the centre of pharmaceutical business can ensure affordable healthcare for all.