Expanding access to generic medicines in NE

Rising healthcare expenses from a sharp increase in branded prescription drug prices drain household  budgets. Jan Aushadhi Kendras (JAKs) opened across the country under Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) to provide medicines at rates that are about 50% to 80% cheaper than those of equivalent branded alternatives, which is a viable solution to address the issue. In Assam and other Northeastern states, apart from the issue of lack of trust in the quality of generic medicines as elsewhere, a low number of JAKs remains a challenge in the availability of cheaper alternatives to branded medicines. As of January 31, of the total 18,255 JAKs opened across the country, only 394 are in the region. In Assam, which accounts for the highest number of JAKs in the region, there are only 179 such outlets, while the state has 26,395 villages and 214 towns. The preference for branded medicines is not a choice of patients, as they are handed out prescriptions by medical practitioners in which only branded drugs are prescribed. The Medical Council of India Circular issued in 2017 made it mandatory under the Code of Medical Ethics in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, for all registered medical practitioners to prescribe drugs with generic names legibly and preferably in capital letters. The National Medical Commission Act, 2019, empowers the appropriate State Medical Councils or the Ethics and Medical Registration Board (EMRB) of the National Medical Commission to take disciplinary action against a doctor for violation of the provision of the aforesaid regulations. Further, the central government advised the states to ensure the prescription of generic drugs and conduct regular prescription audits in public health facilities. But who will bell the cat? The central government setting a target of opening 25,000 JAKs by March 2027 by inviting applications from individual entrepreneurs, non-governmental organisations, societies, trusts, firms, private companies, etc., across the country, including the Northeastern States, brings an opportunity to increase more JAKs in the region. Building awareness on the provision of a one-time incentive of Rs. 2 lakh, by way of reimbursement towards meeting expenditure incurred on furniture, computers, refrigerators and other fixtures provided to JAKs opened in the North-Eastern States, can be expected to motivate more entrepreneurs to avail it. For any business, profitability plays the crucial role in its sustainability, and it also applies to the pharmacy business. The government has proposed to increase the sales margin of JAKs from 20% at present to 27.5%, while reducing the margin generated at the level of the Pharmaceuticals & Medical Devices Bureau of India, which implements the PMBJP scheme, which is good news. The observation by the Parliamentary Committee on Chemicals and Fertilisers that the general public is not very much assured about the quality and effectiveness of the medicines provided at JAKs, though according to the Department the medicines available for sale at JAKs go through stringent quality checking, unpacks the core challenge in popularising generic medicines and attracting patients to buy cheaper medicines from JAKs. The government, however, insists that concrete mechanisms are in place to ensure the quality of medicines available at JAKs. These include allowing supply only from WHO Good Manufacturing Practices (GMP) certified plants; allowing distribution only after 100% pre-testing of all medicine batches: samples are drawn from 100% of batches supplied at PMBI’s warehouses for anonymised testing, and medicines are dispatched for supply to JAKs only after the quality test is passed. Besides, testing is done only at laboratories accredited and periodically inspected by the National Accreditation Board for Testing and Calibration Laboratories and, in addition, assessed by PMBI for Good Laboratory Practices compliance. The government also claims that awareness campaigns are conducted regularly on the quality of medicines to increase the acceptability of these medicines available at JAKs, but it is important to explore innovative approaches, as these routine campaigns have not been proven effective in convincing the majority of patients to visit the JAKs even though medicines are cheaper. The parliamentary panel’s recommendation that a prescription/certificate from a government doctor or a local reputed doctor to the effect that generic medicines available at JAKs are therapeutically equivalent to branded medicines and displaying such certification prominently in the local or regional language is a pragmatic solution, and expeditious implementation of this recommendation will go a long way in increasing trust among the people. The operationalisation of JAKs in government hospitals and even some private hospitals, encouraging doctors to prescribe medicines available under the Jan Aushadhi scheme regardless of the purchasing capacity of the patients, as recommended by the Committee, is equally important. Strong political commitment is necessary to resist pressure from pharmaceutical companies that attempt to promote branded medicines through prescriptions written by government doctors, which undermines the prescription of generic medicines and raises doubts about the quality of affordable medicines available at JAKs.