Wanted: Affordable Medicines

UN Panel calls for new global accords to make drugs cheaper. But nobody is listening. Not the drugs multinational! Pneumonia, an acute infection of the lungs, is the biggest killer of children worldwide even though it is treatable and easily preventable with vaccines.

The disease remains prevalent in some of the poorest regions in South Asia and sub-Saharan Africa in part because of the high price of the vaccines necessary to prevent it. One-dose of-pneumonia vaccine costs about $68, and it is $204 for the three doses needed to vaccinate one child, although humanitarian organisations may get the vaccines at a lower price.

In 2015 the disease killed nearly 1 million children under the age of five, accounting for 15% of all worldwide deaths of children of that age group, according to the World Health Organisation (WHO).

Health care providers and other groups, such as Mèdecins sans Frontiéres (MSF) or Doctors Without Borders, an international medical group that provides assistance to populations in emergency situations, have long complained about what they claim are “artificially high prices” of pneumonia vaccines, among other medicines. They are concerned about not being able to afford these drugs to help prevent the disease in poor countries.

Sky-high prices of medicine and health technologies are of grave concern to developing countries, a situation that gained global attention at the height of the HIV/AIDS epidemic.

Currently the cost of a year’s supply of first-line HIV drugs in Africa is less than $100 per person compared to $10,000 in the year 2000, according to UNAIDS.

Back in 2000, only patent-holding drug companies could manufacture antiretroviral (ARV) drugs, but prices started falling when developing countries started producing generic versions and exporting them to other developing countries exempt from the patents.

But there lies a lot of misconception about generic and brand varieties of medicine.

The proposal, as announced by the Prime Minister Narandra Modi, to make generic prescription writing mandatory for doctors, would be a useless counterproductive step as a standalone measure. This is because in India no manufacturer markets medicines in the retail market under generic names and hence medicines are not available under generic names in the Indian retail pharmacy shops. Unless manufacturers (except those who are marketing medicines still under patent protection) are made to market medicines under generic name for the retail market, consumers will not get the benefit of ‘generic medicines’. In the absence of universal availability of good quality generic name medicines in retail pharmacy shops, merely getting doctors to start prescribing medicines under generic name will end up in shifting the discretion to pharmacists who are likely to dispense brands that give them more commission.

If the current government really wants to make available generic-medicines to people it has to take some concept steps.

It should implement the Hathi Committee’s recommendations made in 1975 to phase out brand-names in a step wise manner. And quality of all medicines whether generic or otherwise must be ensured by implementing the Mashelkar Committee recommendations made in 2003 regarding adequate increase in the number of drug inspectors and strengthening the quality control infrastructure.

Also, there has to be a mandatory, verifiable mechanism which will ensure that a particular batch of medicines found to be substandard, is withdrawn throughout India. Currently the manufacturer can sell such medicines in other states because State Drugs Controllers are independent entities!

What is more the Janaushadhi scheme to open generic medicine shops needs to be overhauled and has to take a quantum jump. This scheme started in 2008, is merely a tokenish measure which now aims to set up 3000 Janaushadhi shops by the end of 2017 when there are more than 5 lac chemists in India.

Finally ifthe government really wants to make medicines affordable, all essential and life saving medicines including their chemical analogues and therapeutic equivalents must be brought under price control which would mean significantly expanding the current list of price-controlled medicines. Prices of these medicines should be fixed by restoring the cost-based formula which was employed since 1979. However, from 2013 the price-control is based on ‘market based’ formula. This led to reduction of prices only by 10-20% on an average. Instead there is need to restore ‘cost based’ formula, with a margin of say 100% on standard cost of production. This would lead to slashing of drug-prices to one-third or one-fourth of current levels, without jeopardising legitimate profits!

In short this stand alone step announced by the PM of making generic prescriptions mandatory for doctors would only mean that pharmacists will be free to sell any brand, of the generic name prescribed by the doctor. Unless political parties take the isssue of affordable medicines for all as part of their regular political agitation, nothing will change for the better. Modi’s cosmetic sergery won’t help.

Frontier
Vol. 49, No.46, May 21 - 27, 2017