With directives from the Ministry of Health and Family Welfare to doctors to start prescribing generic medicines along with branded ones, some city doctors have taken to issuing disclaimers in their prescriptions to avoid taking responsibility of any untoward effect from consuming the generic drugs.
In his prescription, paediatric surgeon Dr Rajesh Nathani issues a disclaimer, “I cannot ensure quality, dose (depends on the strength dispensed) and manufacturer of the product that you receive from dispensing chemist. You should try and ensure that the drug comes from a renowned manufacturer, whether Indian or multinational.”
Nathani says that given the lower prices of generic drugs, very few manufacturers are interested in producing them and quality is a huge concern. “If a patient suffers a drug reaction, the onus ultimately falls on the doctor. There should be government regulation on generic medicines and a systematic infrastructure should be in place for it, like it is in the USA,” Nathani said.
Recently, Prime Minister Narendra Modi had said that a mandate to prescribe generic medicines may soon be implemented. The Union health ministry has asked doctors to follow the Medical Council of India’s gazette notification of 2016 for generic drugs prescription. This is in accordance with clause 1.5 of Indian Medical Council Regulations, 2002.
The confusion over which generic to buy, however, may push several patients towards branded drugs. Dispensing chemists, too, are not trained enough to sell these drugs, doctors said. Given these factors, few doctors have started prescribing generic drugs and the majority of them await legal guidelines on the issue.
Doctors also argue that chemists may work for a commission and promote generic medicines of only certain manufacturers. “There should be central government guidelines on quality control and fixed manufacturers for fixed generic drug molecules,” said cardiologist Dr Dhruman Desai. According to him, doctors are not averse to prescribing generic medicines but they must be made available easily to patients. “Patients have asked me whether they should buy a generic drug, but very few hospitals and chemists stock them,” he said.
Mumbai also has only three Jan Aushadhi stores — in Malad, Borivali and Ghatkopar — where patients can get affordable medicines. The state government is taking steps to open more stores across government hospitals in every district.
According to Dr Milind Pandya, a general surgeon who has started prescribing generic medicines, the move has the added issue of doctors needing to remember each molecule in a drug. “Some medicines come in combination of drugs. I have to search for the second and third molecule. Then, the chemist also needs to have stock of it,” he said.
Gynaecologist Dr Nazema Lalla faces similar issues. She is generally required to prescribe myo-inositol for fertility, which has a combination of folic acid, Vitamin D3 and several chemical molecules. “Such medicines become difficult to prescribe in generic form, as we have to list each molecule,” she said.
According to Dr Bhupendra Singh, chairman of National Pharmaceuticals Pricing Authority (NPPA), the government is holding discussions on generic medicines, price control of drugs and taking suggestions on it. “It is under the health ministry’s ambit. But soon, we can expect systematic guidelines on it,” he said.