NEW DELHI: The Union Ministry of Health and its regulatory arm Medical Council of India (MCI) have failed to ensure that doctors write only generic medicines in their prescriptions despite clear statutory directions and order from Prime Minister Narendra Modi himself.
While inaugurating a hospital in Surat on 17 April 2017, PM Modi had stated that the government was going to make arrangements to make sure that the doctors only prescribe generic medicines. Following his announcement, the MCI released a circular on April 21 directing that every physician was required to prescribe drugs with generic names, that too in capital letters.
The issue of benefiting poor patients, according to people who know Modi for long, has been very close to his heart. However, though almost two years have lapsed since the PM expressed his intent, which was expected to benefit crores of poor people and generate a good will for the government, neither the Health Ministry nor the MCI has taken the matter seriously but rather have reduced it to a mere formality that began and ended with issuing circulars only.
The Sunday Guardian spoke to a number of doctors and patients and also went through several prescriptions. It is clear that almost all the physicians, even those who work in Delhi where the ministry and the council have their headquarters, prescribe the drugs of specific brands rather than just writing its generic name. This is the case across government hospitals and private clinics as well.
The ministry too, it appears, despite being made aware about the issue by MPs in Parliament multiple times, has failed to take up the issue in right earnest and is more content in shifting the onus to the MCI.
Earlier this month, Union Minister of State for Health Ashwini Choubey, while responding to a question in Parliament over doctors not prescribing generic medicines, gave a perfunctory reply stating that “Prescription of generic drugs has been encouraged” and quoted the April 2017 MCI circular. He added that complaints related to generic medicines are handled by MCI itself.
An analysis of many similar questions that were asked in the past reveals that they too had elicited similar mechanical response from then Health Minister which reflects the lack of seriousness of the ministry regarding the issue. Official sources and private practitioners said that the margin given to retailers, incentives given to doctors and private hospitals by big pharmaceutical companies is very lucrative as a result of which they advise branded medicines which cost in some cases by 10 times.
According to patients, even when they ask doctors to prescribe generic medicines, in most of the cases, the physicians caution them against taking generic medicines and state that if they take those medicines, they may not work. “The medicines advised by the doctors are always very expensive. However, I manage by requesting the medicine shop owner to give me a cheap alternative, which he does,” said Anita, a domestic help whose 8-year-old daughter is undergoing treatment for skin allergy.
The big pharma companies, according to doctors, who spoke to this newspaper, give them expensive gifts including cars, iPads, foreign jaunts. In return, the doctors “oblige” the companies by recommending their drugs.
“The margin in medicines is huge, especially when it comes to the medicine manufactured by big companies and since they have deep pockets they freely spend on the doctors. The medical representatives of a particular pharma company can easily keep a tab on whether the doctor in his area is prescribing the medicines of his company or not,” a medicine shop owner said.
“If the demand of that medicine in that area increases, it means the doctor is ‘working’ for the pharma company. Secondly, the margin given to retailers by these companies to stock their medicine is several times more. As a result, the medicine shop owners too recommend and ‘push’ medicines of a particular brand,” he added. The government-promoted Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP), which was launched in 2008 under which quality generic medicines were supposed to be made available at affordable prices, too has failed to take off as till now only 4,844 such centres have opened across India.
Official sources said the pharma lobby has managed to keep up the pressure on the decision makers in the Health Ministry to make sure that the PMBJP does not flourish as it will impact their profits in a big way if these centres mushroom.
“The medicines available in these centres are very cheap and cost in most cases one-tenth of the branded medicines. However, they have not been allowed to take roots and the pharma companies have successfully prevailed on the ministry officials despite PM Modi himself pushing for opening of more PMBJP centres,” an official said.
Recently, Union Minister for Road Transport and Highways, Shipping, Chemical & Fertilizers, while speaking in Parliament stated that people have saved around Rs 1,668 crore on medicine so far under PMBJP. According to him, unbranded generic medicines worth Rs 417 crore have been sold through PMBJP Kendras from inception of the scheme till the end of December 2018. This sale is roughly equivalent to sale of Rs 2,085 crore of the branded medicines.
“This Rs 1,688 crore is in reality a loss for the pharma companies. That is why they are doing everything to make sure that the practice of generic medicines being prescribed does not become a norm and this is why they are not letting more PMBJP centers open. Unless and until the Health Ministry and the MCI take a more serious view of this, the patients will continued to be fleeced,” a doctor with a government hospital said.