It is the medicine that cures you and not the brand name printed on it. For example, when you have fever, a doctor may prescribe a Crocin tablet but it is the medicine it contains that cures you - paracetamol. Therefore, when Prime Minister Narendra Modi talks of the government bringing in a legal framework under which doctors will have to prescribe generic medicines, which are cheaper than equivalent branded drugs, it makes sense to patients.
But then, there are few questions that need to be addressed to ensure the move leads to maximum benefit for the patients. That these involve the practises and systems that we have, make it all the more hard to ignore. How do we, for instance, address this question that a doctor had: When you go to buy a generic medicine, are you willing to take the risk of using a medicine from an unknown company with questionable quality?
Do you have the infrastructure in place to ensure foolproof quality checks on all manufacturers? The short answer is: No. Consider this: Ideally, for every 50 manufacturers, we will need one drug inspector, and every 200 medical stores, a single drug inspector. We are woefully short on this. We don't have the exact number nationally.
But take one of the best performing states - Gujarat (Modi's home state). Talk to many in the pharma industry and the drug controller here has a good reputation but even here, there is huge room to expand staff and infrastructure. Gujarat, for its 65 million population, has around 36500 medical stores across 33 districts but has only around 90 drug inspectors. It has little over 3900 total drug manufacturers but only around 50 drug inspectors for these. Not to talk of the laptops, jeeps, labs and other infrastructure that would be needed.
This question is perhaps important or at least cannot be ignored, as under the new format the power shifts from company/ distributor to a drug retailer. Reason: The retailer may now potentially push that generic drug where he gets the maximum profit margins or of that company which offers him the maximum bonus. How do we ensure that this does not happen?
Doctors, could circumvent the process by prescribing a generic but telling patient to opt for the generic of a specific company. For example, to counter an infection, if a doctor is today prescribing Levoflox (which is a branded generic sold by the Mumbai-based pharma major Cipla), he may instead, tomorrow prescribe Levofloxacin of Cipla, which boils down to prescribing the same drug but with a generic name.
And this could be with any drug and any company. For instance, to treat ulcers, instead of prescribing Omez (the branded generic of Dr Reddy's), he may prescribe Omaprazole but tell you to take Dr Reddy's Omeprazole. India is a huge market and today over Rs 1 lakh crore worth of medicines are sold in a year and bulk of these are branded generics.
How do we ensure the move does not lead to shifting from branded medicines to corporate branding? Another question, that may need to be addressed, is how will doctors prescribe generic medicines where there are drug combinations, like for instance, multivitamins.
There is little doubt that generics is the future and globally, there is a trend towards generics. But for the end consumer it is also about ensuing not just low price medicines but also a robust system that gives the comfort on quality. For that alone, will shift the power from the producer to the consumer, the ideal end-goal of any mature or healthy market.