Cheap generic vs costly branded: Issues in picking right drug in India

Prime Minister Narendra Modi wants doctors to prescribe generic medicines over branded ones. KAUNAIN SHERIFF M answers key questions on the pricing of drugs and beyond.

Written by Kaunain Sheriff M | New Delhi | Updated: April 20, 2017 8:45 am
generic medicines, modi generic medicines, pm modi medicines, what are generic medicines, generic medicine prices, narendra modi, modi generic medicine law, generic medicine india, india news, latest news, indian express news In the United States, the Food and Drug Administration notes that the cost of a generic drug is 80% to 85% lower than the brand-name product on average.

What exactly has Prime Minister Narendra Modi said on generic drugs?

Speaking in Surat on April 17, the Prime Minister referred to the Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP), which aims to provide cheaper medical drugs to the people. “In the coming days, the government will bring a legal framework under which doctors will have to prescribe generic medicines which are cheaper than equivalent branded drugs, to patients,” the Prime Minister said. “…If a doctor writes a prescription, he has to write in it that it will be enough for patients to buy a generic medicine, and he need not buy any other medicine,” he added.

Is this a completely new intervention?

Not exactly. After seeking approval from the central government, the Medical Council of India — which registers doctors to ensure proper standards of medical practice in the country — had on September 21 last year, notified an amendment in Clause 1.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. This clause now reads: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”. The words “legibly and preferably in capital letters” were not there originally.

Also, the UPA government had from time to time, issued circulars and instructions to government hospitals and Central Government Health Scheme (CGHS) dispensaries to “prescribe generic medicines” to the “maximum extent possible”. In December 2012, the UPA government had issued a “statutory direction” to state governments under sections of the Drugs and Cosmetics Act, 1940 to “grant/renew” licences to manufacture for “sale or for distribution of drugs in proper/generic names only”. This was intended to build a mechanism for wider use of generic drugs.

Most recently, a countrywide campaign has been under way to ensure availability of generic medicines under the Pradhan Mantri Bharatiya Janaushadhi Pariyojana. A total 861 PMBJ Kendras are functional in 28 states — at which 99 private manufacturing companies, certified by the World Health Organisation, have been empanelled to supply generic drugs, specially manufactured and packed for the PMBJP.

Okay, but what exactly is the difference between a generic drug and brand- name drug?

When a company develops a new drug — often after years of research — it applies for a patent, which prohibits anyone else from making the drug for a fixed period. To recover the cost of research and development, companies usually price their brand- name drugs on the higher side. Once the patent expires, other manufacturers duplicate and market their own versions of the drug. Since the manufacture of these generic drugs do not involve a repeat of the extensive clinical trials to prove their safety and efficacy, it costs less to develop them. Generic drugs are, therefore, cheaper.

However, because the compounds in the generic versions have the same molecular structure as the brand-name version, their quality is essentially the same. The generic drug has the same “active ingredient” as the brand-name drug. This ingredient is the one that cures the patient; and other, “inert ingredients”, which give the drug its colour, shape or taste, vary from the brand-name drug to the generics.

And exactly how much cheaper is a generic than a brand-name drug?

In the United States, the Food and Drug Administration notes that the cost of a generic drug is 80% to 85% lower than the brand-name product on average. In India, prices of drugs in the National List of Essential Medicines (NLEM) included in the First Schedule of the Drugs (Prices Control) Order, 2013, are fixed as per the provisions of the Order. These prices are uniformly applicable to all branded and generic medicines containing the “same molecule/Active Pharmaceutical Ingredient”. All manufacturers of scheduled drugs/formulations have to comply with the price fixed by the National Pharmaceutical Pricing Authority, from the date of its notification.

In the case of non-scheduled medicines, i.e., medicines not included in the First Schedule of the DPCO, 2013, manufacturers are free to fix the launch prices. However, they cannot increase the Maximum Retail Price(MRP) by more than 10% of the MRP of the preceding 12 months. Currently, in the case of Cetirizine, one of the most common anti-allergy drugs, the branded drug costs about Rs 35 for a strip of 10 tablets, whereas the generic drug costs approximately Rs 25.

How can the government ensure that generics, apart from being cheap, are also safe for the patient?

Experts say the priority of the government should be to bring a legal framework to ensure “quality” in generic drug testing. No more than 1% of generic drugs sold in India undergo quality tests. Generic drugs should work “therapeutically” and the government should ensure “uniform quality”, experts say — only then can doctors prescribe them with confidence. The number of drug inspectors — approximately 1,500 now — must be increased, they say.

Also, the government has to clarify how it will ensure that once a doctor prescribes the generic drug, detailing its medical composition, the pharmacist or chemist will give the most appropriate drug to the patient. Even on the question of price, studies have shown that it is the retailer’s margin that often plays the key role in deciding how much the patient pays for a drug. To take the example of Cetirizine again, while the difference between the brand-name drug and the generic could be Rs 10 (Rs 35 and Rs 25 respectively), depending on what the retailer keeps in each case, the actual difference in the price paid by a customer of a brand-name drug and that of a generic could be, perhaps, only Rs 4 (Rs 27 and Rs 23).

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  1. S
    s
    Apr 22, 2017 at 9:08 am
    Pharma companies encourage retailers to sell/push their products to customers by giving them huge profit margins . The minimum profit margin recommended by government is 18 to 20 but companies are free to give anything above this hence retailers can stock only those medicines which give them the highest margins . Regarding quality the retail trade can always argue that quality control is the prime responsibility of the Drugs control dept and they are mere sellers of the drug with a valid drug licence. The rule to prescribe medicines in generics only is a great boon to retailers and questionable benefits to consumers hence only the former and gullible consumers will welcome it.
    Reply
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      Shreekant Paranjape
      Apr 21, 2017 at 2:07 pm
      This Marathi joke explains the difference between a generic medicine & a b ed medicine: गावचा पाटील डॉक्टरला प्रश्न विचारतो: जेनेरिक मेडीशीन आन् तुमी लिवून द्येत्यात ते मेडीशीन यात काय फरक आसतो ? डॉक्टरचे उत्तर: कसं हाय काका - घरानं, खानदान पाहून मुलगी करनं, आनि काहिहि न पाहता "फकस्त बाई हाय" म्हनून तिच्यासोबत लगीन करनं,ह्यात जो फरक हाय, त्योच फरक हाय की !
      Reply
      1. K
        Khundrakpam Somorjeet
        Apr 21, 2017 at 7:54 am
        Very Impressive Sir, You have rightly mention that Quality and efficacy of the drugs is matter whether its generic or Research b Drug. Before taking to compulsory to prescribe generic name, I want to mention One think that, in US or Europe Market Govt. allowed limited company's to sell Generic drugs that also under strict vigilance on quality by USFDA authorities, here in India you will find 200/300 b s for one drugs ( which are all generics) thats also in different profit margins, so if doctors prescribe generic name which drugs public will get, manufactured by xyz company somewhere in ankleshwar or vapi or daman or somewherein HP or somewhere in some Gali........with low price????????
        Reply
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          Dr. Mahajani
          Apr 20, 2017 at 5:02 pm
          This issue of "B ed" and "Generic" drugs has no relevance in our country because hardly any of the drugs currently on in the country have been entirely discovered and researched in India. In reality therefore most drugs manufactured and marketed by Indian Pharma companies do not deserve to be sold as "B ed". Hence the new term "B ed generics" for these drugs! The indian Pharma industry has been reaping the fruits of the Govt. policies over the 45 years which effectively killed all "New Drug Discovery research" in the country. Since licenses have been granted liberally over the past 4 decades, there are around 5000 licensed manufacturing units of drugs spread all over the country. According to a rough estimate, there may be around 100,000 formulations of drugs floating in the Indian market. There are number of instances where the same "Generic" drug is being marketed under a hundred different "B " names by 100 different manufacturing companies. its a gigantic task.
          Reply
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            Chaandi
            Apr 20, 2017 at 4:08 pm
            The author of this article is not competent enough to write article on the topic "Generic Drugs". His article is based on limited facts and gives an example of only one drug "Cetrizine" and he quotes it two times. And ultimately says the customer may not benefit much. I have been purchasing Generic drugs for the last one year or so and the difference between Po r B ed Drugs and Generic Drugs is as much as 70 also for many drugs. Here I am referring to Pantop and its Generic Drug variant. Like so there is 50 -80 difference for many common drugs. The author has either tried to confuse willfully the readers about the prices of Generic drugs because by reading the article the readers would ume there is marginal difference between prices of generic drugs and b ed drugs. Or he is totally incompetent because the article is not based on full facts and mostly based on half-truths. Did the author write this article to benefit somebody?
            Reply
            1. S
              s
              Apr 22, 2017 at 9:17 am
              In the argument on b ed vs generics it is fogotten that Indian Pharma companies buy 90percent of their basic raw material from Chima and then convert it into formulations through processing. China can unilaterally increase the prices or even refuse to supply and bring the industry to its knees. All these bigwigs who are now dollar billionaires have made their money through the lax govt licensing policies and they now claim to benefit poor indians but their lax quality systems have earned indian pharma products a bad name even in Africa forget USA and Europe.
              Reply
            2. S
              Shrinivasa Kamath
              Apr 20, 2017 at 1:17 pm
              Government should ensure quality drugs. With limited number of drug inspectors- this is always the case- where there is a need there are less persons working- nobody is sure, even expensive b ed medicines ensure quality. Our drugs have been rejected in the US from the point of quality a few years back. A famous company was sold by its owners and they got into quality problem after selling to a anese firm. It is not known whether any lessons have been learnt after that by the drug industry.
              Reply
              1. J
                Jyoti Sarup
                Apr 20, 2017 at 11:44 am
                I am 68, had a Brain Attack a year back. Since then I am taking some medicines regularly, till I am alive. Where in 4 Bungalows, Andheri W, can I get these generic Medicines ?? Please send me the address on my id because I am not here very regularly. Thanks. Jyoti Sarup ..
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                  emittrap
                  Apr 20, 2017 at 7:41 am
                  Yoga, Pranayam, Meditation should be included in School/College curriculum. This will prevent 90 of the major diseases. Ayurveda can complement this in case of any illnesses. MEDICAL PROFESSION has become a CORPORATE FRAUD system in this POISONOUS ALLOPATHIC SYSTEM.
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                    Nitin shinde
                    Apr 20, 2017 at 8:04 am
                    Pity on your thinking. There has to be some limit to backwardness..!!!
                    Reply
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                      emittrap
                      Apr 20, 2017 at 9:11 am
                      [What is the LIMIT for backwardness? Can you please explain?] [How do you define BACKWARDNESS. Can you please explain?]
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                        damodar biswal
                        Apr 20, 2017 at 3:47 pm
                        Yoga n Pranayam prevents around 90 of diseases which can be practised at home with nil cost.Why not to try?There is nothing wrong in it.Besides,except surgery in all other cases one should try Ayurvedic medicines as they r cheaper n effective.
                      2. M
                        Manu
                        Apr 20, 2017 at 11:10 am
                        Please stop using allopathy medicines and ensure that your near and dear also stop using them. File a PIL to ban allopathy. Please practice first before preaching. Then listen what your people say about you.
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                        nagar.
                        Apr 20, 2017 at 7:32 am
                        {'Allopathy' is a poisonous system which should be abolished} {India should revive her glorious AYURVEDA which is cheap, non-toxic, effective} {HEALTH FOR ALL IS ACHIEVABLE ONLY IF ALLOPATHY IS REPLACED BY AYURVEDA}
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                        1. N
                          Nagar
                          Apr 20, 2017 at 7:36 am
                          I agree with you that ALLOPATHY is not a science but a 'fraudulent mafia' of the 'pharma companies'. India needs to abolish ALLOPATHY & reintroduce AYURVEDA. AYURVEDA gives easy access to the poorest & lays stress on PREVENTION of diseases as well as CURE.
                          Reply
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