[rrsteer]

According to a regulation passed by The National Medical Commission -the top medical body in India- all doctors will have to prescribe generic drugs to patients, or else they will be penalised!

All doctors must prescribe generic drugs, failing which they will be penalised and even their license to practice may also be suspended for a period, according to the new regulations issued by the National Medical Commission. The National Medical Commission (NMC) in its 'Regulations relating to Professional Conduct of Registered Medical Practitioners" also asked doctors to avoid prescribing branded generic drugs.

Source:
https://economictimes.indiatimes.com...campaign=cppst


And today IMA released quite a stern rebuttal:

If the Government and NMC want all the Doctors in the country to prescribe only generic drugs, they should simply order all pharmaceutical companies to manufacture all the drugs without brand names (how simple!!, try to do it dear NMC/GOI). Then no one has to write brand name. Let the NMC/GOI ensure quality generic drugs or accept responsibility if patients fail to respond to prescribe generics. IMA demands deferring of this Regulation for wider consultations by the Government of India and IMA also calls for serious and urgent intervention by Union Government and NMC in this regard.

IMA press release is attached.

The fine doctors of this forum can pitch in with their opinions on this matter.

But as a healthcare recipient and a citizen, my personal opinion is that this just degrades the quality of healthcare. Basis how I interpreted this news, I just hate this thinking of the govt. that everyone is a thief (except themselves). This is unwanted regulation and will force good people to bypass the laws and offer and take bribes.

PS- not attached to the healthcare industry in any which way. As I said I am an ordinary citizen recipient.

[greenhorn]

Ideally if we could have some minimum standards in India that were enforced and tested, then I don't have a problem with generic drugs.
Not an SME in this area, but
https://www.outlookindia.com/nationa...ht-news-261625
https://www.theindiaforum.in/health/...gulation-india

[PaddleShifter]

Drug business is complicated and you will find many politicians are running pharma companies. It is profitable as well.

I dont prescribe medicines or see patients so I have no conflict of interests when I say that this will give a free hand to the pharmacies to dispense any quality of medicine that they please in my opinion. Such orders need to be supplemented with other aspects such as quality control in manufacturing sand sales, vigilance on pharmacies, prohibition of treatment by the pharmacies in the form of over the counter antibiotics etc.

[PreludeSH]

Who is going to complain ?
There is a problem for sure. Being a noble profession (?), doctors should be doing that on their own. It cant be forced on them. India is famous for producing generic drugs so the number of non-generic should be less anyway ?

[Turbanator]

Originally Posted by rrsteer

And today IMA released quite a stern rebuttal

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.

Problem is much worst in smaller towns and rural areas. We all must have seen some of the most significant buildings in otherwise small towns. I occasionally go to Kashipur for work or pass when going to the hills, and a small town like this, if you notice, will have Hospitals that will put any Hotels to shame. What's bad is that most patients who go to such hospitals are uneducated and make daily earnings. Most of the time, they must either sell/ pledge their land or gold if something serious happens.

As with many other things, the intent of the Government on this looks good to me. Yes, it cannot be 100% correct, but if the intent is right, this can be an excellent step. Today, most people use smartphones or have access to one. If a chemist can stock almost 90% of the medicines in a 10x10 Ft shop, how hard is it to make all approved equivalents and upload them in some app? I recollect some similar data already on websites. Doctors prescribe salts and volume and let the patient choose. Obviously, this is not so simple, but even if it takes care of 70-80% of fast-moving drugs, it can mean a lot for normal folks.

[dragonfire]

No use. If they rob the doctors of their commission from the pharma industries, what they are going to do is pass the burden to the patients.

The govt babus think that they can tinker with the market, but the market always finds a way. Always.

[Night Raven]

As a practising clinician, this is my take on this issue.

There are hundreds of brands for each drug that we prescribe. If you look at mims.com which is kind of a directory for various brands, each generic drug will have tens of pages of brand names available in the market. 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.

To quote an example, when I prescribe Augmentin, the dispensing pharmacy has to issue the brand Augmentin marketed by GSK which is a reputed manufacturer. If I write amoxicillin potassium clavulanate instead, the dispensing pharmacy decides which brand to issue, because outside of government hospitals we don’t get generics. The pharmacy/chemist will obviously dispense the brand that gives them maximum margin which might not be the brand that is of highest quality.
If the government ensures a good supply of high quality generic drugs, I am more than happy to just write the generics. Honestly I can save a lot of memory space in my brain by deleting all the brand names I am having to remember now. Until quality generics are made available in the open market, I would prefer to prescribe specific brands whose quality I am assured of, because if the patient doesn’t improve on the drug I prescribe I am the one loosing business.

To summarise, generic prescription isn’t useful if there are no generic drugs available in the market. When the market has branded drugs only, a generic prescription will only shift the choice of brand from the prescribing doctor to the dispensing pharmacy. Whether you trust your doctor or the local pharmacy more with your health is for you to decide.

[rajeevsulu]

Originally Posted by Night Raven

To summarise, generic prescription isn’t useful if there are no generic drugs available in the market. When the market has branded drugs only, a generic prescription will only shift the choice of brand from the prescribing doctor to the dispensing pharmacy. Whether you trust your doctor or the local pharmacy more with your health is for you to decide.

As a practicing surgeon, I agree 100% with you. This so called "Doctor-pharmaceutical industry"" nexus which is in people's heads is a big sore point. Passing rules and laws with zero or very less quality control is the issue.
Your example with Augmentin is spot on.
Cheers

[GTO]

Originally Posted by greenhorn

Ideally if we could have some minimum standards in India that were enforced and tested, then I don't have a problem with generic drugs.

Originally Posted by Night Raven

The pharmacy/chemist will obviously dispense the brand that gives them maximum margin which might not be the brand that is of highest quality.

Due to lack of quality control, I generally avoid medicines from small / unknown brands. Am very particular about what goes in my body and I will happily pay a little extra for a brand I am comfortable with.

Reminds me of the Maiden Pharmaceuticals case which resulted in the death of several kids.

[FrozeninTime]

An insightful article in Linkedin by Dr upendra Kaul who was AIIMS professor and chairman of Batra hospital.

https://www.linkedin.com/posts/upend...alSubdomain=in

[Gansan]

People will buy the best engine oil for their cars, but will go for generics when it comes to medicines!

People will generally buy whatever brand the doctor prescribes when the treatment is short term. But when it comes to medications that need to be taken continuously, cost of branded medicines pinches and people look for generic options. Especially if more than one family member needs to take such medications. And the price difference is really huge and hard to ignore. Some of the branded hypertension medications, for a single tablet, cost what an entire strip of it costs in the generic store. I understand brand premium, differences in manufacturing process etc, but so much price difference can't be justified.

Also, pharmacies don't always issue what the doctor has prescribed. They say it is not available but the same medicine in a different brand is available. The customer more often than not will accept it. And not all pharmacies stock generic medicines either. Because the margin will be very low.

If one wants to buy generic medicines, please get them only from the Jan Aushadi stores run by the central government all over the country, and don't buy from outside sources. Most of the medicines they sell are manufactured by units affiliated to the Pharmaceutical and Medical Devices Bureau Of India, a public sector undertaking. They are reputed to test the medicines for bio availability before selling them in the market. Whatever they don't produce, they source from regular branded pharma companies and sell. The second category will be more expensive than the generics they sell, but will still be cheaper by 40% when compared to outside prices. I have seen people buying cancer medication from this store for about 20% of what it costs in the market. The store is a lifeline for them.

I and some of my family members have been taking HT medication purchased from this store for a long time and the outcome has been good during regular check ups. Just google "Jan Aushadi store near me" and there will be one in your area.

I told my doctor during a review that I am buying medicines from this store. He said I can continue to buy from there, with one caveat. Whenever he changes the medicine or alters the dose of the existing medicine, I should buy and take what he prescribes for a month and go for a review. After that I can buy from the Jan Aushadi shop, and go for review after another month. If the outcome is still good, I can continue with the generic medicine. Fine with me!

Actually it is a delicate issue for patients. We can't say the doctors prescribe only the brand which gives them the highest financial benefit. Even if they do,they will definitely ensure the outcome of the medicine because after all their reputation depends on it. But on the other hand we can't ignore the probability of such connections either, so one needs to be circumspect. I have close friends who have worked in the pharma field and have heard some stories.

[speedmiester]

Originally Posted by rrsteer

According to a regulation passed by The National Medical Commission -the top medical body in India- all doctors will have to prescribe generic drugs to patients, or else they will be penalised!

PS- not attached to the healthcare industry in any which way. As I said I am an ordinary citizen recipient.

When I read the news, first thing I did was to ask our Family Doctor. According to him, the NMC guidelines has been misinterpreted.

Please find the attached relevant section in the Gazette document released by NMC on 3rd August.



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

[Nikhildrao]

Originally Posted by PreludeSH

Who is going to complain ?
There is a problem for sure. Being a noble profession (?), doctors should be doing that on their own. It cant be forced on them. India is famous for producing generic drugs so the number of non-generic should be less anyway ?

The situation is not as black and white as you make it out to be , I from personal and formal experience know that the generic medications are not always but most of the time inferior in quality compared to medications from reputable brands. I go out of my way to tell patients from the lower economic classes to get generic medications, that way they atleast buy the drugs and hopefully continue it's use as suggested and if the patient can afford it , better get branded medication which are functional more effective.

[Mystic]

if one cannot convince the consumers on the pros and cons of generic drugs, then confuse them.

An oligopoly is a type of market structure that exists within an economy. In an oligopoly, there is a small number of firms that control the market.

We as consumers are made to believe that oligopoly is good for us. We have few choices in each industry to choose from.

The power of Oligopoly and its lobbying is very well know in the pharmaceutical industry for many decades. I will not be surprised if the companies which produce the generic drugs will be bought over by the few top players and we as consumers will be buying them without knowing the parent company.

I see this Oligoploy trend coming up very recently even in the recent new AI industry after the advent of chatGpt and the big companies who appear as rivals to us are actually trying to collude together with the Government and create a situation that no new enterprises comes into this brand new industry.

[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. So if you want medicine from top company tell the pharmacist to do and that's done.

It is great step by government to make healthcare affordable. We all know Doctors prescribed top brands which are expensive. So let the patient decide rather Doctors deciding which brand.

But to say other small companies doesn't have quality or to say pharmacist will only give which he thinks appropriate is false. 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.Yes, there are few companies which may have inadequate quality of products and these are being reviewed by the government. One such examples is quality check of syrups before exporting.