[efgritesh]

Originally Posted by Night Raven

I choose what to prescribe solely based on the credibility of the manufacturer. There are enough and more fly by night brands for every drug molecule with no quality Control which I don’t want to give my patients.

Thanks for bringing the other side of story which gives a nice balance to the discussion. And i completely agree with what you have said on the quality part of the drugs.

Just one thing I want to understand, as a medical practitioner are you in position to evaluate the quality control methods/process put in place by the drug manufacturer or its based on the brand value solely. Asking this as going by brand value is of course a good indicator on quality, but I am not sure how effective it would be when the money is being paid by someone else who might still want to settle for a cheaper brand.

[n33rav]

While the idea of generic is good, lack of control and quality enforcement makes it useless.

I often get to visit a mini local pharma plant (or call it a shed). Condition of that plant, peopel working there and their practices and standard, they are as good as soya namkeen factory adjacent to it.

Forget Generic, most doctors prescribe this local brands cause medical store is owned by the doctors himself and this local brands not just give better direct perks to doctor, they have much higher commission percentage on sales aswell.

[Slushmaster]

I don't understand the point of people bashing doctors about taking kickbacks from Pharma companies and prescribing medicines. Name one industry where the brands don't offer incentives to distributors or retailers or employees. Doctors first prescribe what they think is best for the patient, not going to prescribe something based on the commission only.

The biggest problem is spurious or imitation drugs sold by some of the top pharmacists and nobody is going to take any action against them as it is run by some neta or their relatives. Search on google and you will find many cases where big chemists caught by authorities for selling spurious life saving drugs that are very costly

Govt. want to make healthcare affordable, what are the steps taken to reduce the hospital bills that are truly dependent on the type of insurance you have. A fellow BHPian rightly mentioned that the implant price has gone down, but the overall bill is the same or more. Why? They want to make healthcare affordable, why can they reduce the GST on health insurance to make it more affordable.

The people in rural India die because of unavailability of doctors or medicines, not because of chemists or doctors prescribing branded medicines. I have seen people in my village dying due to diarrhoea and fever as basic medicines or medical help was unavailable.

People talking about cheap cancer drugs in generic medicine shops, the newer medicines or techniques are still protected by patents and you will have to pay more to access them and believe me a bigger portion of the cost still goes to the distributor. What are steps taken by govt. to reduce margins.

Make in India is a beautiful concept, but passing sub-standard stuff just on the basis of somebody manufacturing it in a shady locality of Delhi after importing dubious quality raw material from China is just unacceptable.

[Bonemechanic]

I am a practising doctor. This is the only profession I know. (most Indian doctors fall into this category,I think). It takes 5.5 years to complete MBBS and may take more than 13 years to become a super specialist,so knowing other professions is a little difficult.I became successful in my profession when my practise roared. For this, I need happy" customers". (The medical profession comes under the Consumer Protection Act, so preferring customer instead of patient is apt, I think.)

When I prescribe a medicine, I make sure of its efficacy. I expect the minimum result from that drug. Also, I have a point of contact if the desired result is not obtained.

When the dispensing person decides which drug is to be taken by the "customer," that point of contact is lost. Ultimately, that doctor may lose that customer."

Here, the so-called pharma-doctor mafia is replaced by the pharma-medical shop mafia.

The first thing the government should do is find a way to check the quality of every batch of medicine manufactured before it is sold.

In India, quality check results come months after the so-called failed batch is sold out. So after addressing this quality check,they should implement the generic name-only prescription.

Restricting the price of a stent or implant doesn't come down to the final bill for the "customer.". I hope this doesn't fall into this category too.

In a government OPD,a doctor sees more than 100 "customers" per day.
Writing AUGMETIN is very easy and less time-consuming. To write amoxicillin + clavulanic acid 625 will take more time. Imagine a medicine with a triple combination or some calcium combinations. It will take more time. A doctor may adjust,but the "customer" behind the lines will become agitated.*

[furyrider]

Let me give some insight from the pharmaceutical industry perspective.

I have almost a decade working experience in the industry and work for a large CRO with experience ranging from working on potential drug candidates under clinical development to post marketing experiences.

Drug development is a lengthy and expensive process. For a potential new drug candidate to be launched in the market, it takes around 10-15 years of clinical trials, regulatory hurdles and millions of dollars in investment. Even after going through all this, most new drug candidates fail to get approval for marketing. Efficacy (effectiveness) is just one side of the coin. The other important and often ignored part (by the general public) is safety (side effects). If a drug is pretty effective for a medical condition, but has horrible side effects, the drug application will likely be rejected. The logic is simple here - the benefits of the drug should always outweigh the risks. Of course, the innovator company can tweak the molecule to reduce side effects/improve efficacy - a domain called Structure activity relationship. I won't go into further details though.

Now let us assume that Innovator Company (Let us call it 'IC') received marketing approval for Drug D. Since the company invested millions if not billions into bringing Drug D to the market, the company will be granted exclusivity period for 5-7 years to recoup the investment on the drug. This is why innovator drugs are crazy expensive. Patents are a different story and will be granted for around 20 years from the date of application irrespective of approval status.

Let us assume that Drug D has seen decent success for IC and the exclusivity period has ended. This is where generics come into the picture. Company X now wants to launch a generic version of Drug D. They simply can't use the same manufacturing process as IC. They will get sued since it is the IP of IC.

What should company X do? They try to tweak the manufacturing process/inactive ingredients to develop a stable formulation containing the active ingredient of Drug D. They then go for an ANDA approval. As part of the package, company X is expected to submit results of Bioequivalence/Bioavailability (BA/BE) studies. As the name implies, Company X's generic variant of Drug D should demonstrate that it is as effective as the original from IC - meaning: the generic version should show similar effect as the original (Bioequivalence) and similar drug levels in the blood at specified intervals (Bioavailability). The key here is the word "similar". To oversimplify things, let me provide an example (bad, i know) - consider Jeep Wrangler as the original and Thar as the generic. They both are good in their own right, each has it's own advantages. The Wrangler costs a lot more and is very capable. The Thar on the other hand costs a fraction of what the Wrangler costs and is almost equally capable.

Why do generics cost lot less then? For starters, all company X did was to conduct a BA/BE study. IC on the other hand went through pre-clinical development to 4 phases of clinical trials. They spent decades trying to find the right formula that works. They simply invested a lot more and had to recoup that somehow.

Now, to the original question: why this outcry? As a consumer, it helps me save money, right? Well, to explain that question, the answer is partially correct. You see, CDSCO/DCGI's (the Indian equivalent of USFDA) rules for generics were pretty vague to begin with. Until around 2019, the BE part in BA/BE studies was optional for approval. They later amended it to include both BA and BE parts now, but still the regulations are not as stringent as the USFDA or even EMA. On paper, everything seems fine, but when it comes to ground reality, we do not enforce quality standards as stringently as the FDA. It is a nightmare for any manufacturer to deal with FDA inspections. They cancel licenses if a company fails inspection. Sometimes, the fines are enough to break their bank. On the other hand, our inspections are like a slap on the wrist in comparison.

Should we stop using generics altogether then? No, before you decide, take a look at the packaging and try to find the manufacturer. Reputed Indian companies like Cipla, Dr. Reddy's, etc have a huge portfolio of generics and their quality standards are usually on par with the global giants. If you find a manufacturer who you can't even find on google, my suggestion would be to stay away. It may not work at all, or in the worst case, it does more harm than good.

Why do Pharmacies stock generics then? For starters, profits. How fat are the profits you ask? I have a friend who owns a pharmacy chain (around 10 stores mostly in villages and small towns) who sells generics exclusively. He sources a cough syrup from a non-descript manufacturer/wholesaler who is happy to sell him the bottle for INR 10-12 excluding shipping. The MRP printed is INR 80. My friend then goes on to give 10-20% discount to the customer without the customer even asking. Business is booming for him.

In conclusion, not all generics are bad, just stick to reputed companies and you should be fine!

Coming to the main article: while I welcome the idea, I do not like the implementation of it. If the government cracked down on the companies manufacturing substandard generics and then took this decision, I would've welcomed this. As things stand right now, consumers are at the mercy of the pharmacist as to which generic they dispense. Of course, the consumer can always insist on something else, but how many of consumers are aware of it? I agree that there are some doctors (will consider them as bad apples) who prescribe such substandard generics for kickbacks. Instead of curtailing such doctor - pharmacy nexus, why penalise the genuine ones who actually care for their patients? I understand that 'penalise' is an overstatement, but with the current market situation, I would be happy to stick to bigger pharma companies even if it costs me more.

PS: Sorry for the long post. Industry experts will understand that I oversimplified a lot of things. Apologies for that. My intention of this post is to present my views to the lay man.

[raj4466]

Originally Posted by Turbanator

Not trying to paint everyone with the same brush, but many Doctors/ Hospitals will prescribe medicines that offer them something. It's a very well-connected and lubed network. Things are gone to such an extent that some specialised Doctors/ Hospitals will write a medicine that no one else but that particular chemist store/ stores in the vicinity will offer. They will proudly give their cards with prescriptions too.

How difficult will it be to pay the pharmacist at your chemist store to stock only one brand by offering him an incentive? In India we do have sub standard medicines as well. I would trust the doctor over the store owner when it comes to medicine quality.

[Night Raven]

Originally Posted by efgritesh

Just one thing I want to understand, as a medical practitioner are you in position to evaluate the quality control methods/process put in place by the drug manufacturer or its based on the brand value solely.

The one word answer is No, I am not.

In an ideal situation I should be able to have the same level of trust on every brand that is available in the market, but I don't believe we are in that ideal world.
Let me ask you a question. If someone I know has to undergo a surgery, will I refer him to a surgeon who has done 1000s of surgeries & has been practising in my hospital for a decade, or to someone who has just come out of medical college and joined us a week back? Strictly speaking the fresher also should have the minimum competence but I am justified trusting the one I have known for years isn't it? It works somewhat similar with medicines also. I trust some brands because I have years of personal experience using them successfully and they have been in the business for decades. The trust those brands enjoy is earned over years of use and it is not correct to punish me for recommending something based on my experience. If you ask me to statistically justify that trust, I am not in a position to do that.

PS: I am not saying cuts and kick backs don't exist, that menace is florid. All I am saying is this is not the correct way of dealing with it.

Originally Posted by furyrider

Let me give some insight from the pharmaceutical industry perspective.


Now, to the original question: why this outcry? our inspections are like a slap on the wrist in comparison.

Should we stop using generics altogether then? No, before you decide, take a look at the packaging and try to find the manufacturer. Reputed Indian companies like Cipla, Dr. Reddy's, etc have a huge portfolio of generics and their quality standards are usually on par with the global giants. If you find a manufacturer who you can't even find on google, my suggestion would be to stay away. It may not work at all, or in the worst case, it does more harm than good.

Why do Pharmacies stock generics then? For starters, profits. How fat are the profits you ask? I have a friend who owns a pharmacy chain (around 10 stores mostly in villages and small towns) who sells generics exclusively. He sources a cough syrup from a non-descript manufacturer/wholesaler who is happy to sell him the bottle for INR 10-12 excluding shipping. The MRP printed is INR 80. My friend then goes on to give 10-20% discount to the customer without the customer even asking. Business is booming for him.

In conclusion, not all generics are bad, just stick to reputed companies and you should be fine!

Thank you so much for this post. You have exactly put forward the situation in a way laymen can understand; and your examples of the cough syrup and "the brand that cannot be found on google" is absolutely spot on.
Just last week I was struggling to find the details of one injectable antibiotic that our hospital pharmacy has on google without success

[Neurodoc]

Hi everyone, there is lot said and discussed already and i am just attaching message which I received in our doctors group.
A thread on the generic vs patented medicines debate for those not from a medical background. Hence I am simplifying some concepts. Experts please excuse.
Here we go!

Medicines are generally discovered/invented by Pharma companies. The company which first discovers/invents the drug gets a patent (monopoly) to sell the drug for a fixed period of time (usually 15-20 yrs). This is referred to as the patented drug.
Once this period lapses, the patent expires & other companies can now make and sell this drug. These are called as generics For obvious reasons, the generics are cheaper than the patented drug, although the company making the patented drug does usually bring down the price of their brand when the patent expires, for obvious reasons (to compete with the generics).
Now it gets complicated Any company wanting to market a generic drug does not have to do trials to show the drug is effective (which the original company with the patented drug had to do to get a licence). However the generic companies do have to provide evidence that their drug is similar to the patented drug in all characteristics eg. Chemical content, it's bioavailability (meaning how the drug gets absorbed & is available in blood stream to act like the original patented drug).
Once they do this (called bioequivalence in technical terms), the generic drug gets a licence to be marketed. This licence is issued by the regulators eg FDA in US or EU in Europe etc. All these regulators insist on bioequivalence studies so that the generic drug will work as well as the patented drug.
Now the generic company has two options
They can sell their generic drug with a brand name or just sell it with the approved chemical name.
The former are called branded generics and the latter are called just generics (I know, this is extremely confusing).

So what's the problem..?
The problem is the Indian regulators (unlike regulators in rest of the world) do not require bioequivalence studies to be done b4 companies get a licence to sell the drug.
So essentially we have no way of knowing whether the drug being marketed in India has the same quantity, quality, impurities etc when compared to the patented drug.
We have to just rely on the Indian Pharma company's word (with no data) that the generic drug they are selling is as good as the original patented drug.
Almost all the drugs sold in Indian market are generics bcoz very few global Pharma companies sell their patented meds here. Even when they do sell their patented medicines in India (once they go off patent) they sell them with a different brand name to their patented brand.
Now some Indian companies sell their generics with a brand name eg. Rozat (Rosurvastatin) sold by Dr Reddy's. Many of these companies also sell these same medicines abroad, so one is relying on the fact that if their drug is acceptable to global regulators, it must be of good quality. (It's an assumption but too complex to explain why here).
Anyways, you have some hope that companies like Cipla, Dr Reddy's, Sun etc have too much to lose by selling poor quality drugs in Indian market.
Then there are the generics. These are small companies (& there are thousands of them, it's a cottage industry) who sell the drug without a brand name & just the approved chemical name. They usually only sell in the local market. In most if not all instances their quality control is poor or non-existent. So a frequent problem with these drugs is NSQ (not sufficient quantity) meaning if a tablet says 200 mg it does not contain 200 mg. This is a real big problem bcoz you may take the medicine in the prescribed dose, but it does not work bcoz it does not have same quantity of drug.
Drs tend to write branded generics based on (a) trusting a reputed company (b) past experience with the brand quality etc. Detractors say that Drs prescribe a particular brand bcoz they get benefits from the Pharma company.
In response to this, the National Medical Commission says that Drs must only prescribe the approved generic name and not the branded generics.
You are still with me or have I lost you?You do see what the problem is here. It's the Indian regulators. They do not guarantee that the drugs they have licensed to be sold in Indian market are of good quality. Bcoz they do not require bioequivalence (remember that earlier in this thread?)
Basically you are taking a chance that the drug sold in India is of good quality.
When Drs are forced to write only the approved chemical name of the drug (not brand name), it is up to the chemist to give you medicine which may have been made by anyone -including a company based out of someone's garage or kitchen. You see it has not solved the problem - instead of pharma companies chasing Drs, they will now chase chemists to dispense their drugs. Drs are atleast regulated by the NMC, chemists are not regulated by anyone. The chemist is likely to give you the drug made by a company which gives him the best commission & not necessarily the one that has any quality. That would be a business decision. In most instances, it will be a unbranded drug made by the cottage industry company.
Even when your Dr writes a branded drug, there is a certain amount of guesswork about the quality of the drug bcoz the Indian regulators do not require bioequivalence to be proven.
The elephant in the room is actually the Indian regulators doing their job poorly. Why do they not insist on bioequivalence studies which is the best measure of quality for generic medicines is the Q we should be asking.
Of course we all want medicines to be cheap, but not at the cost of quality. After all your life is at stake.
If the Indian regulators only licensed medicines with bioequivalence data and studies, all Drs will have no problem prescribing medicines only by the generic approved name.
But until then, your best hope is to trust your Dr's judgement despite everything.

Thanks for reading!

END

[OffRoadFun]

Someone can correct me but I believe generic drug means the patent has expired (25 years?) and any pharmaceutical company can manufacture the drug now (using alternate process as Indian generic drug manufacturers were adept at). This DOES NOT necessarily mean generic drugs are bad or even manufactured by some unknown shady drug company with poor standards.

What seems to me is there is a directive to prescribe generic (salt/chemical) and not a brand by physician. Which is not necessarily bad. Isn't it?

Patient can choose brand/manufacturer (theoretically) by himself/herself and not be driven to a particular brand which physician/hospital might be inclined towards for various reasons.

If true, this does not look bad. Experts can correct me.

[furyrider]

Sir, while I understand that you received this as a forward, I would like to clarify a few points for better understanding.

Originally Posted by Neurodoc

So essentially we have no way of knowing whether the drug being marketed in India has the same quantity, quality, impurities etc when compared to the patented drug.
We have to just rely on the Indian Pharma company's word (with no data) that the generic drug they are selling is as good as the original patented drug.

Well, this is a problem with generics to begin with. As I mentioned in my previous post, the key word here is "similar". Usually, generics around 80-90% as effective as the original. This is a very vague figure, I know, but gives a rough idea of what to expect.

Even when they do sell their patented medicines in India (once they go off patent) they sell them with a different brand name to their patented brand.

This is a common practice across the industry. The same drug can be sold with different names in different countries. We even see this with cars.

Now some Indian companies sell their generics with a brand name eg. Rozat (Rosurvastatin) sold by Dr Reddy's. Many of these companies also sell these same medicines abroad, so one is relying on the fact that if their drug is acceptable to global regulators, it must be of good quality. (It's an assumption but too complex to explain why here).
Anyways, you have some hope that companies like Cipla, Dr Reddy's, Sun etc have too much to lose by selling poor quality drugs in Indian market

It is the other way round Sir. While the above-mentioned companies are big players in our country, their profits lie elsewhere (i.e., export markets). From my understanding, unlike cars where we get watered down versions of international variants, the same batch will sometimes be sold in India as well. Unless the product contains ingredients, which are considered taboo in the intended destination market such as gelatin made from pork, etc, the ingredients usually remain the same.

Also, a little background on what happens in the backend:
Raw materials are supplied by a partner/vendor -> battery of tests performed at the Pharma company to assess if the material is free from contaminants, etc -> proceeds for manufacturing of the medication -> random samples are collected from the batch for analysis. The entire batch is quarantined until results from the QA team are out (varies from company to company though) -> released into the market.

The reagents and equipment used for analysis costs companies several lakhs to even crores (for more sensitive equipment). The equipment has to be maintained and calibrated at regular intervals. A track has to be maintained about the maintenance of the said equipment for audit purposes as well. Samples from all the ingredients used as well as the final product are retained for further analyses in case an issue arises post shipping of the batch. Such data from every batch has to be meticulously maintained for inspection purposes. This is also the reason why generics from established companies cost more than the ones from no-name ones. Also, the profit margins for pharmacies are not as high.

On the flip side, there are a few companies which have separate manufacturing facilities for overseas and home markets. If this is the case, your post still stands valid (although I can neither confirm nor deny it).

So a frequent problem with these drugs is NSQ (not sufficient quantity) meaning if a tablet says 200 mg it does not contain 200 mg

Even for innovator drugs, the active moiety can range between 95-105% of the advertised value. However, I do agree that this range can vary drastically for sub-standard generics.

It's the Indian regulators. They do not guarantee that the drugs they have licensed to be sold in Indian market are of good quality. Bcoz they do not require bioequivalence (remember that earlier in this thread?)
Basically you are taking a chance that the drug sold in India is of good quality.

Agreed Sir. Although CDSCO is taking steps in the right direction, our regulations still have a long way to go. However, I partially agree with the last statement. From what I could gather from friends working in manufacturing units, I can say that the chances of getting a good quality product from companies which have a large export base are relatively high.

[Gansan]

Originally Posted by furyrider

Usually, generics around 80-90% as effective as the original. This is a very vague figure, I know, but gives a rough idea of what to expect.

It is the other way round Sir. While the above-mentioned companies are big players in our country, their profits lie elsewhere (i.e., export markets).

This is also the reason why generics from established companies cost more than the ones from no-name ones. Also, the profit margins for pharmacies are not as high.

Even for innovator drugs, the active moiety can range between 95-105% of the advertised value. However, I do agree that this range can vary drastically for sub-standard generics.

I can say that the chances of getting a good quality product from companies which have a large export base are relatively high.

So where does that leave us? Do you mean even if I seek out medicines exclusively from companies such as GSK, it will be a hit or miss? That being the case, generic medicines are an even big hit or miss? No guaranteed medicines in India?

If anyone wants to buy generic medicines I suggest they buy only from the govt run Jan Aushadi outlets. They are present in all states and they have some checks and controls in place, because it is a kind of flagship scheme. And buy only lifestyle medicines from there which have to be taken long time. Any medicines prescribed for short term duration (fever, jaundice etc), better buy what the doctor has prescribed.

Medicines can be purchased from the Jan Aushadi stores even without the doctor writing the name of the drug. Buy and take what he has prescribed initially. Then take a clear photo of the medicine or the medicine itself to the store, and they will give the equivalent. After starting on the generic medicine, check Bp/sugar/whatever other parameter once every week or ten days for about a month. If everything is fine, continue. Else, go back to what the doctor prescribed.

[furyrider]

Originally Posted by Gansan

So where does that leave us? Do you mean even if I seek out medicines exclusively from companies such as GSK, it will be a hit or miss? That being the case, generic medicines are an even big hit or miss? No guaranteed medicines in India?

No sir. Absolutely not! Generics from reputed companies are perfectly safe for use.

Regarding the amount of active moiety present in a formulation, it is very difficult to achieve the exact amount. Hence, there will always be a normal range. Medicines manufactured by following all the GMP guidelines will typically have around 95-105% of the advertised weight of drug. For example, if a company is to manufacture 500 mg paracetamol tablets, they cannot simply press 500 mg of the drug into a tablet. It would be too small to handle. Also, the active moiety has more chances of degrading or absorbing moisture reducing it's shelf life. Hence, there will be inactive ingredients called fillers (binding agents, preservatives, etc) added to it. This will ensure that the tablet can be handled safely and easily ingested by the patient. Also, it will be easy to formulate enteric coated/ gastro resistant or controlled release formulations. Usually, all the ingredients are weighed to the batch specifications and are mixed thoroughly. This mixture is then pressed into tablets. The same applies to liquid formulations like syrups as well. This is why it is difficult to achieve the exact amount in each tablet.

Let me clarify my statement concerning generic drugs being 80-90% effective. What I meant was if the original innovator drug was considered a gold standard (100%), the generics will typically be somewhere around 80-90% as effective. Well, some generics can even be 95-100% effective as well. There will be a lot of factors affecting this, but this statement should not be considered as generics being ineffective.

My specific concern was about non-descript companies which make use of the lax regulations in the country and manufacture generics. These companies usually source the active moiety from other companies (yes, there are certain chemical companies which manufacture active drug moieties, but not drugs themselves) and hardly test them for quality or contaminants. If we had stricter regulations, half of these companies would simply cease to exist.

Having said that, if you are using a generic and you find it to be working fine for you, please continue to use it as usual (with your physician's guidance of course).

I apologise if my posts felt like fear mongering. I just wanted to give some behind the scenes info on what happens in the backend since there seems to be a lot of misconceptions about medicines sold in this country.

[McLaren Rulez]

My dad worked for a pharma company for most of his career. I've seen first hand how doctors are wooed by these companies with gifts, expensive dinners, holiday packages etc. To get these perks, they simply had to prescribe that company's drug instead of the equivalent one from the rival company whenever possible. It's quite a sordid state of affairs.

While some doctors remained true to their patients, plenty of them are more susceptible to this bribery. What that meant was that a large pharma company with deep pockets could easily crush a small one making the same product for a cheaper price. Even when the products were identical in quality and efficacy! With medicines, consumers aren't price sensitive - they buy whatever they have been prescribed. And as a result, the established pharma companies made even bigger profits and the cycle continues.

That's the issue that the NMC is trying to address here. If they succeed, consumers will benefit massively while pharma companies lose out. There are many hurdles to implementing it well (indeed, certification and regulation are key) but it is a good step in my opinion.

[docprashant]

I will share my 2 cents as I’m in a unique situation of being a medical doctor working in the pharmaceutical industry for close to a decade now.

The intent of NMC regulations might be benevolent but its implications are not. Generic formulations are a boon to the patients as they significantly reduce the cost burden to the patient. However, as a physician I’m well aware of reduced effectiveness, poor quality, incorrect strength of preparation which are a possibility owing to many run off the mill manufacturers skimping on GMP (good manufacturing practices) and stringent QC (quality control).

So effectively, what this mandate has achieved is just the shift of decision making power from Doctor to chemist. So suddenly, trade margins, profit-splitting, and commissions will influence the choice of medicine being eventually dispensed by the chemist.

The patient unfortunately is still at a loss in this situation as owing to prescription medicines promotion regulation they aren’t aware of the subtle differences of different formulations.

What we need more than just cheap medicines is quality medicines, as health isn’t a parameter to be compromised on.

Hopefully the implementation of NMC Regulations and upcoming UCPMP Act will be in truly letter and spirit and not end up being just a voluntary moral code to ensure India remains not only the pharmacy of the world but be the trusted pharmacy of the world.

[vellatechie]

The better regulation will be to prescribe generic medication if it contains single salt and BOTH generic and non generic medication if it contains multiple salts.

Biggest issue that my mother faces with generics is that it increases the number of tablets she has to take everyday.