[Fx14]

Originally Posted by Piyush_DT

I have worked at pharmacies in UK and the doctors only write generic name of medicine. It's pharmacist which gives the medicine and they have all the brands.

The local scenario is quite different.

Many times I have noticed that the pharmacist stocks only some brands (probably offering them better margins) and blatantly try to push the substitute to unsuspecting patients despite the Doctor prescribing a certain brand.

To the few patients who notice the difference, they advise "Stock of the prescribed brand is unavailable. This is the same medicine from another company - show it to the doctor and return it if you do not want it".

Those patients not wanting to go back and forth between the Doctor / Pharmacist often fall prey to this tactic.

[anandhsub]

Originally Posted by speedmiester

The guidelines suggest that Doctors should prescribe drugs using generic names (i.e. using drug composition). There is a big difference between asking Doctors to prescribe Generic drugs and to prescribe drugs with generic names.

Attaching the notification of NMC as well

+1. This exactly was my interpretation as well. You get the composition prescribed from doctor, go to the pharmacist and get whatever brand he has, not that the doctor must only prescribe generic drugs.

I almost always use Apollo to get prescribed medicines, and that already works the same way where in you can chose which brand of the drug composition you want to order even if the prescribed drug has a different name.

The video consultation/appointment apps like Practo already give the prescription with the generic names.

[Piyush_DT]

Originally Posted by Fx14

The local scenario is quite different.

Many times I have noticed that the pharmacist stocks only some brands (probably offering them better margins) and blatantly try to push the substitute to unsuspecting patients despite the Doctor prescribing a certain brand.

To the few patients who notice the difference, they advise "Stock of the prescribed brand is unavailable. This is the same medicine from another company - show it to the doctor and return it if you do not want it".

Those patients not wanting to go back and forth between the Doctor / Pharmacist often fall prey to this tactic.

I agree that many pharmacist does this but it is extremely difficult to keep doing this in this age of social media. Once people know that they can save money and the Pharmacist is being over smart they would go to other pharmacy which has it. Eventually, pharmasist has to fall in line.

[Hayek]

Strikes me as an example of over regulation which will create more problems than it solves.

Generics can work in the USA or EU where drug regulators hold every supplier to uniform high standards (equivalent of 5 star on Euro NCAP). Our drugs regulator on the other hand often tries to cover up wrong doing by manufacturers as long as they adhere to a lowest common denominator standard and sometimes even when they fail to do so. It is the equivalent of allowing 0 star rated tin cans from Maruti to be sold legally. In short, like I would never buy a Maruti product, I would never buy unbranded drugs in India.

Clearly our regulators seem to think that some Doctors are being influenced by freebies from Drug Manufacturers to prescribe their brands. And perhaps that it true in some cases. But if a generic is prescribed, it is up to the chemist to decide the brand - and between a chemist who is often a local trader who happily adulterates products he sells, and does not see the difference between selling soap and selling drugs; and my family doctor, I would rather trust my family doctor to do the right thing by me.

It will not impact people like us majorly - all that will happen is that my doctor will give a written prescription with a generic name and will tell me which brand to buy. But the less educated will now be at the mercy of the Indian mom and pop shop owner instead of an educated professional with certain standards - and God alone can now help them.

Originally Posted by Piyush_DT

Majority of Indian Pharma companies have good quality and have been exporting worldwide. We can't just question the credibility of all small generic companies which are exporting to the world. We need to start trusting Desi companies and vaccine is such example.

I am sorry but you are mistaken here. Even the best Indian Pharma companies have different standards for plants that export products to regulated markets such as the US, UK and EU, plants that supply to other export markets where WHO norms apply, and plants that serve the Indian market. The US FDA approved plants need to meet the highest standards (on documentation of processes and compliance with the same), the EU, UK and Canada are one notch easier, WHO is even easier, while India has next to no standards at all.

However, larger players like DRL or Cipla meet certain minimum standards at all their facilities - which is not the case for the run of the mill Indian drug maker. Being patriotic is fine but ignoring Indian realities could put your health at risk.

[Piyush_DT]

Originally Posted by Hayek

I am sorry but you are mistaken here. Even the best Indian Pharma companies have different standards for plants that export products to regulated markets such as the US, UK and EU, plants that supply to other export markets where WHO norms apply, and plants that serve the Indian market. The US FDA approved plants need to meet the highest standards (on documentation of processes and compliance with the same), the EU, UK and Canada are one notch easier, WHO is even easier, while India has next to no standards at all.

However, larger players like DRL or Cipla meet certain minimum standards at all their facilities - which is not the case for the run of the mill Indian drug maker. Being patriotic is fine but ignoring Indian realities could put your health at risk.

I think you are taking very critical and grim view of Indian Pharma companies. Being in this profession for my whole career I can tell you nobody takes quality for granted not even small company. Yes, there are bad apples but to say majority of them produce substandard quality is completely incorrcet. If that was the case India would have not been called as 'Pharmacy of the World'. All the countries have their own standard and Indian companies are meeting them continuously. Now there is governments involvement to make sure quality products are manufactured and exported. Also, there is lot of politics to defame Indian companies which we fall for and one such example of politics is Covaxin approval by WHO.

It is first good step towards making healthcare affordable which is required considering Indian scenario, per capita income of Indian population and healthcare burden on people.

[wildsdi5530]

Practicing orthopedic surgeon here.
Medicine is an art, not a science. What works for one doctor-patient combo may not work for another.

When the Govt. introduced NPPA for knee implants, we rejoiced because now the companies were forced to give us the best knee implants for a fixed low price. I could happily use the best implants without any consideration because the companies could not charge at their cost price. Indian implants with poor QC were available at 15K, International cutting edge implants were available for 1.5L. Now both had to be sold at 42K.

Unfortunately over the past few years, the total hospital bill has not come down, but the best implants are not available anymore. Even the regular implants are poorly stocked. No dealer wants to give me an inventory of 2 Cr when he can only make a profit of 2K. Getting a particular size of implant will take weeks of cajoling to transport from Mumbai to Bangalore. Used to be airlifted in 4hrs previously.

Some patients request me to operate them at foreign hospitals only so that the can get an implant of their choice. Reverse medical tourism to Bangladesh is a good example.

I don't use much medicines so I'm not an expert, but I have heard of enough stories where the doctor is penalised for adverse drug reactions. Poor irrigation fluid causing blindness in a free camp has victimised a doctor friend that he has lost his career built up over 20 years.

I've seen manufacturing plants where drugs are packed. Basically a room with the drug powder heaped in the middle of the floor and a group of MSME workers filling it with a small spoon. They do sell at a price 1/10 of what a reputed brand will sell.

Before interfering with a doctor patient relationship, the govt. should first clean up it's own house. Bad roads and poor infra kills thousands per year, now bad drugs would kill lakhs.

I know of colleagues who import certain cheap but effective drugs from Bangaladesh, USA, etc. purely because these drugs have been driven out of our market due to low profitability. Looking at phenylbutazone, doxycycline, etc. I buy doxycycline from veterinary shop for personal use because it's not available in pharmacy.

Most doctors would prescribe the brands that they would use on themselves. Something they have learnt over years of practice. We learn to make minor adjustments for maximum effectiveness. For example anaesthesiologists who need 3.5 ml of anaesthetic from local brand which has a similar effect as 1.5 ml from an international brand.

If you don't trust your doctor, don't go to him/her, but do not prevent him/her from treating the other patients who trust him. It's a free economy and with the highest concentration of doctors in the world, we have no dearth of choice. But don't try to legislate an art.

[Grr7]

This generic medicine ho-hum is doing more damage than good.

Another attempt of failed Make in India (in reality its just assemble in India) business. Without strict regulations and their implementations, generics is a dangerous business.

For a CGHS (Central Govt Health Scheme) patient, this generic mandate would mean getting the most substandard medicine from CGHS dispensaries. And necessarily not the cheapest (since the ALA: Authorised Local Chemist) will rule the diktat of which brand drug to dispense.

I already know of a very old widowed lady who has to buy medicines from market despite being CGHS beneficiary due to failed efficacy of medicines.

Once she got Vit B complex medicine from CGHS dispensary and the tablets were stinking badly. If there was a system to check the sample in India, that medicine would have failed even for veteniary use.

[huntrz]

The beneficiary of marketing budget will now be pharmacists than the doctors. This is the precise pain point. Those directly involved in either of these professions may not agree but still argue based on their interests. The educated junta already knows how to find and evaluate the branded options online. The non-tech savvy ones can simply rely on generic ones. As far as reliability is concerned we have had issues with branded medicines too. There has to be a limit on the premium levied by corporates on branded medicines. If left uncontrolled the goodwill premium will spiral into monstrous proportions as has happened in many other sectors and then it will be difficult to shrug it off citing shareholder's interests and other innovative and flowery arguments. We already have seen how they tend to make prices of certain medicines beyond the reach of common folks so we can't believe the pharma lobby on their words.
The need is to regulate and ensure the quality of generic drugs and check the practice of manufacturing different quality based on different sales channels.

[DigitalOne]

The government should try to solve this via technology rather than short term haphazard regulation.

Specifically, the government mandate, over a period of time, that

1. a prescription must have both the branded name and the generic name of the medication.

2. the prescription should be printed.

To ease the doctor's job, an application can be provided to retrieve the generic based on the brand name, and vice versa.

It then becomes the responsibility of the patient to take whatever he/she can afford.

With India's rapidly increasing connectivity this shouldn't be a big problem even in rural areas. No need for sophisticated printers - a thermal printer, like the ones you see in retail shops, can do the job.

Printing the prescription in regional languages would also become possible.

[Vishal.R]

I am not a doctor.

As a patient or relative of a patient, I would always prefer to let Doctor decide everything about treatment, which may include perticular brand of medicine as well. It happened in past that chemist would suggest alternate brand of medicine, if exact brand prescribed is not available. I would prefer to confirm with Doctor in that case. Most of the times have observed that Doctors would be ok with any brand as long as there is no change in composition, but I would prefer Doctors to take the call.

[GrammarNazi]

Very insightful thread!

Maybe doctors can prescribe the drug & also separately on a different column, suggest the brand they trust. I think having both (Chemical name + Brand Name) will help patients who may want to check their medical prescription history determine the composition + brand that helped/didn't help them get better.

My mom used to use Neurobest OD until 6 months ago, but had to shift to another equivalent tablet due to its non-availability.

The vast majority of Indian population will find cheaper drugs to be a big relief, so any populist Govt will consider this as a good move from that stand-point. They must simply tweak the rules so as to have doctors also recommend brands that they believe are worthy for their quality.

[pyrodrive]

As a consumer, if I am to buy a packet of biscuits, I would prefer to buy something made by brittania or parle rather than buy a dodgy looking pack which says just "biscuits".

The same thing applies to medicine, if I am prescribing an antibiotic, I would like to prescribe something made by a reputed pharmaceutical company with good manufacturing processes and stringent quality control, rather than a locally made / rebranded product made by some obscure company.
If doctors cannot make the decision on which brand to use, then how can the pharmacy guy choose the brand? He will choose the brand which gives maximum margin to him, not necessarily what he thinks is the best brand.
So the question is, who chooses the brand once a generic prescription is written. The doctor, the pharmacist or the patient? Purely generic medicines are only available at govt hospitals, not in your average pharmacy. Also the quality of those medicines are often doubtful.

[Gansan]

Originally Posted by pyrodrive

As a consumer, if I am to buy a packet of biscuits, I would prefer to buy something made by brittania or parle rather than buy a dodgy looking pack which says just "biscuits".

As a consumer there is a choice between choosing a Brittannia biscuit or just a bakery biscuit; or simply choosing to have no biscuit at all. There is no such choice in health care! There is no choice between illness and good health!

The unbranded generic medicines will be available only in government hospitals, not outside. And they have to be compulsorily supplied by even big pharma. The company I worked for had a pharma division, and I know we supplied such generic medicines to the hospitals. All the other so called generic medicines will have a brand and bear the manufacturer name.

It all boils down to cost. I can buy and use a HT tablet which costs Rs 15 per tablet. Suppose the tablet is prescribed to someone from lower income group, and suppose more than one person in the family have to take it month upon month, the cost will bite them, not just pinch them. Think of the cost of life saving medication playing havoc with the finances of such families.

That is where the government run Pradhan Mantri Jan Aushadi shops I mentioned earlier come in. Life saving drugs, particularly cancer medications, are sold at one fifth cost there. I have seen common people making a beeline in that shop. I regularly buy HT medication for three members of my family there. The total cost is just 10% of what I will pay for branded medicine elsewhere. I had my doubts about their quality and efficacy, so we all had weekly check-ups for a month after changing to those medications. Everything was fine. They are reputed to check the medicines for quality as well as bio availability - I am told it means the availability of the medicine at plasma level some x hours after taking it. But I can't vouch about generic medicines bought in the market. If anyone wants to buy generic they should stick to these stores.

We all hear about pharma companies sponsoring overseas visit of doctors, giving them expensive gifts etc. Essentially, in kind instead of cash. I don't want to use the word kickback. We don't know whether to believe or not, but they seem very plausible. I don't see doctors staunchly denying it. Some friends who worked in big pharma companies say not all stories are false.

A GP whom I consult periodically is very particular we should buy the exact medicines he writes, that too in his hospital pharmacy only. He will be displeased if we buy some other brand. When I went to the jan Aushadi store a bit far away for the first time to buy lifestyle medication, they wanted photo copies of prescriptions of all my family members and I handed them over. The man at the counter glanced at the prescriptions and remarked " Oh, this is doctor X of XYZ hospitals! We know him, his parents regularly buy medicines from us!".

There is another reputed gastro hospital in our area. The medicines that gentleman writes will be available only in that hospital pharmacy and nowhere else! I once tried in a five km radius without success! Similarly one dermatologist will write medicines and casually mention to get them from a particular pharmacy. Sure enough, they won't be available anywhere else, not even in Apollo pharmacy!

Why do people go for generic medicine? The first reason is cost. The second reason is, there is no transparency.

[dhanushs]

Well.. This makes it easier for Pharma companies. I wonder how many Pharma companies are owned by people related to the National Medical Commission!

It's easier to hack a medical shop than a knowledgeable/accountable doctor to sell your choice of drug.

[charanreddy]

Some very interesting thoughts and points of view here. I am not in the medical profession but our monthly family medicines bill runs into a couple of tens of thousands and hence I can assume I have slightly more knowledge than the average joe. All in all I believe we are in a much better state than some of the more developed countries out there where even basic medicines for diabetes or hypertension are in affordable and the whole medical industry feels like a nexus between the government, doctors and the big pharma companies.

I am completely supportive of the ask from doctors that government should first provide confidence that they are 100% allowing only high quality medical products in the market before suggesting generic drugs. In India I believe we are overly suspicious of doctors making money at patients expense. While that is true in some cases for the most part I have observed doctors try to do what is best for the patients and not for themselves. Also they have the responsibility of saving or prolonging lives and most average patients forget that they are humans too and not gods. Having said that we as patients need to insist on medicines for reputed companies like GSK / Cipla.

I believe the government needs to use technology to weed out the erring / outlier doctors. For example, mandate all prescriptions to be uploaded and analyse the difference between unit cost of the prescribed tablet and the average median unit cost across reputed companies. If the difference is most than 100% , then put the doctors on notice or take action. Also government needs to work on educating the patients of their right to medical care at competitive costs. Make it mandatory for hospitals and doctors to put up boards that advise the patients of their rights.