Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 150
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 151
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
Warning (2): Cannot modify header information - headers already sent by (output started at /home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php:853) [CORE/src/Http/ResponseEmitter.php, line 148]
Warning (2): Cannot modify header information - headers already sent by (output started at /home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php:853) [CORE/src/Http/ResponseEmitter.php, line 181]
LATEST NEWS UPDATES | No Medicine for the Common ‘Jan’ -Archana Mishra

No Medicine for the Common ‘Jan’ -Archana Mishra

Share this article Share this article
published Published on Jul 7, 2015   modified Modified on Jul 7, 2015
-Tehelka

The NDA government’s move to open more Jan Aushadhi stores ignores the multitude of issues currently plaguing them

Amidst the jostling crowd at the Guru Teg Bahadur Hospital in Shahdara, Delhi, is 68-year-old Suresh Chandra, holding his medical files on one hand and prescription letter on the other. Chandra, who is a lung disease patient, moves towards the Jan Aushadhi store, situated in the hospital premises.

Chandra hopes that the government-run medical store which is supposed to sell medicines at an affordable price, much lower than the market price, will be able to provide him the medicines he requires. However, he finds that the store has not stocked any of the medicines in his prescription. A disappointed Chandra says he cannot afford to buy the medicines from private stores.

In the 30 minutes that the TEHELKA correspondent waited outside the store, around 10-15 people visited the store and returned dissatisfied.

As per the World Health Organisation (WHO) and Health Action International Survey in 2004-2005, only 30 percent of essential medicines are available in the government-run hospitals.

The sheer apathy, however, is at a time when India is one of the major exporters of medicines. Every fifth tablet, capsule or injection consumed anywhere in the world is manufactured in India.

Establishing Jan Aushadhi stores was an attempt made by the UPA (United Progressive Alliance) government in 2008 to provide quality generic medicines at a lower price than the branded drugs available in the market. The Department of Pharmaceuticals, under the Ministry of Chemicals opened these generic medicine stores along with various state governments, Red Cross Society and few other ngos. Almost 200 such stores were initially opened.

The then government had announced that it would open stores in 660 districts of the country. However, only 98 stores are functional today, as they started incurring losses due to the unavailability of medicines and lack of awareness among masses regarding the quality and the therapeutic properties of generic medicines in comparison to branded drugs.

For instance, the Jan Aushadhi store in Srinagar, located in the building of the regional chapter of Indian Red Cross Society (IRCS) , has only 100 medicines stocked. IRCS’s general secretary Roma Wani says that only few people visit the store as there is not enough awareness.

Despite the ground realities, the ruling government is planning to upgrade Jan Aushadhi campaign by announcing the setting up of thousands of such stores across the country.

Recently, Minister of Chemicals and Fertilisers, Ananth Kumar claimed in a press conference that the number of the stores will be expanded to 3000 by signing mous with seven states initially and covering all the district hospitals via a new comprehensive plan.

The proposal sounds ambitious. Making this a reality would mean less dependency on branded drugs manufactured by large Indian companies, easy availability of affordable medicines and a radical change in the public healthcare sector.

Currently, the operational Jan Aushadhi stores provide only few drugs such as antibiotics, analgesics, anti-pyretics and combination of analgesics and anti-inflammatory drugs, manufactured by five public sector drug companies— Indian Drugs and Pharmaceuticals Limited, Hindustan Antibiotics Limited, Bengal Chemicals and Pharmaceuticals Limited, Karnataka Antibiotics and Pharmaceuticals Limited and Rajasthan Drugs and Pharmaceuticals Limited.

According to sources in the ministry, these PSUs are in dire need of revival. “Since there has been no upgradation in the technology, these units are either nonfunctional or have minimum supply,” says the source, who preferred anonymity. Apparently, the government has been merely running these companies for namesake without bothering to implement their actual motive of providing quality generic medicine at affordable prices to the poor.

The medicine stock that should be available at the Jan Aushadhi stores should have all essential medicines of the national list or the state list. However, the medicines which are being sold at these stores are determined by the inventory of these PSUs.

People have also developed a belief that it is better to buy expensive branded medicines than cheap generic ones, thanks to government policy, manufacturers, retailers and doctors.

“Patients seem to have little or no faith in the quality of generic medicines available at the public facility. They appear to be reluctant to purchase generic medicines at drug stores because they question the quality,” says Anita Kotwani, associate professor, Department of Pharmacology, VP Chest Institute, University of Delhi.

Kotwani along with a team of pharmacologists did a study to judge the quality of the medicines available in the Jan Aushadhi store. The study done on four medicines revealed that the generic drugs were at par with their respective counterpart branded medicines available in the market. Generic medicines manufactured at these PSUs were found to be Good Manufacturing Practice (GMP) compliant.

The study raises several pertinent questions. If the generic drugs are just as good as the branded ones, then why are people flocking to buy the more expensive branded drugs? In government hospitals when free medicines are unavailable, do doctors suggest the patient to purchase medicines from the generic store? Secondly, are doctors prescribing drugs with generic names? The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, states that every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of medicine.

Technically, we all consume generic drugs. After the expiry of the stipulated patent period, the drug is called ‘generic’. Sometimes, the manufacturing companies market these generic drugs branded with its own name. These are called ‘branded generic’ drugs. The private medical stores provide these ‘branded generic’ drugs, which are essentially the same as ‘generic’ drugs albeit sold at a higher price.

The public sector procures the medicine from the manufacturers as unbranded generics, with the generic name. Government pays a certain amount of Value Added Tax to the manufacturer responsible to supply the medicine to public hospitals. There is no extra cost added to the price of the medicine.

Meanwhile, the price of branded drugs is high due to the cost of promotional activities added to it. The trade schemes that run between the manufacturer, wholesaler and retailer also add on to the cost. Retailers are highly benefitted through these schemes as they get some medicines free on purchase of certain quantity. Despite this, retailers do not bother to give any discount to the consumer.

An interesting aspect of the Indian pharmaceuticals is that manufacturers market both branded and branded generic products with different price. So, the cost borne by the patient largely depends upon what doctors prescribe and what retailers provide.

According to World Health Organisation (WHO), 3.2 percent Indians will fall below the poverty line due to high out-of- pocket expenditure on medicines. Out-of-pocket payments accounts for 80 percent health expenditure in India. Also, 70 percent of health spending on outpatient treatment goes towards purchasing medicines.

Pricing and availability of the medicines is governed by Drug Price Control Order 1995(DPCO). Under DPCO, National Pharmaceutical Pricing Authority (NPPA) was formed in 1997, which comes under Department of Pharmaceuticals.

Surprisingly, government controls the medicine prices of only 74 active pharmaceutical ingredients that come under the DPCO. For the remaining prices are set by the manufacturer. The medicines which include the combination of these 74 ingredients are called ‘scheduled medicines’. The prices of these ‘scheduled medicines’, which includes a few essential medicines, are thus kept low.

For the remaining ‘non-scheduled’ medicines, prices are fixed by the manufacturer. The decision on the final price printed as Maximum Retail Price (MRP) and the price and benefits through trade schemes to the retailers and wholesale dealers are all decided by the manufacturer. They finally register the price with the NPPA. The pricing authority only monitors that the price of non-scheduled medicines do not increase by more than 10 percent in a year.

The purpose of giving manufacturers the right to decide MRP is to create a free market, which is supposed to help in bringing the prices down because of competition. However, the pricing policy fails to do so. The NPPA is focussed on market based rather than cost based pricing system. The prices are controlled by the government on the basis of the average price of the three top selling branded medicines. Therefore, it motivates other manufacturers to increase the rate.

Retailers keep the costly or branded version of the medicine as they benefit from the trade schemes, forcing patients to buy costly medicines.

Kotani writes in one of her papers, “Pharmacists stock those medicines that are frequently prescribed. This tends to indicate that doctors prescribe branded medicines. Legally pharmacists are not allowed to substitute between branded and generic medicines. The brand name (trade name) written by a doctor cannot be substituted with another.” As per mci norms, doctors are expected to prescribe low priced generic versions or branded generics medicines so that people can afford it.

Researchers have even found that manufacturers are selling branded generics at higher MRP than the patented counterpart. It includes injections which are used for critically ill-patients. The private retail pharmacies near government hospitals keep stock of these expensive medicines and sell it at a higher rate to the kin of the patient.

As the government is trying to revive Jan Aushadhi to improve the access of essential medicines to the poor population, the role of manufacturers, retailers and doctors has to be taken into account.

Firstly, the government has to make its pricing policy efficient and people friendly. Kumar recently launched Pharma Price Data Bank, an integrated Pharmaceutical Database Management System that will be used by pharma manufacturing/ marketing/ importing/ distributing companies to make online submission of mandatory information as prescribed under the Drugs Price Control Order, 2013. It will be managed and operated by NPPA. However, it cannot be of much help for patients until government changes the pricing mechanism of pharmaceuticals. The government should have a larger stake in deciding the MRP rather than the manufacturers.

Secondly, the supply chain management of the government pharmacy and Jan Aushadhi has to be strengthened. PSUs and government run pharmaceutical research institutes need to be rejuvenated. There should be awareness programme for different stakeholders, especially the patients, to ensure that affordable medicines reach the needy.



DRUG STATS

♦ Indian Pharmaceutical Industry is ranked third globally in volume and 14th in terms of value, supplying around 10 percent of the total global production

♦ India manufactures 30 percent of the world requirement of Anti-HIV drugs

♦ Indian pharmaceutical industry’s share in the world market is 2.4 percent

♦ Indian drugs are exported to around 200 countries like the USA , Russia, Germany and others with the USA accounting for almost 25 percent of total export

With inputs from Riyaz Wani

Tehelka, 11 July, 2015, Issue 28, Volume 12, http://www.tehelka.com/no-medicine-for-the-common-jan/?singlepage=1


Related Articles

 

Write Comments

Your email address will not be published. Required fields are marked *

*

Video Archives

Archives

Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...

Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...

"Session 1: Scope of IDEA and AgriStack" in Exploring...

"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...

"Session 3: Future of Digitalisation in Agriculture" in Exploring...

Objectives | About Us | Workshops | Disclaimer
share on Facebook
Twitter
RSS
Feedback
Read Later

Contact Form

Please enter security code
      Close