One fine winter evening when I was consulting a 45 year old obese fair lady who actually forgot to bring her past health records, I enquired about the medicines she is taking on daily basis. She recollected a few brands which I noted down. On asking whether she is on Aspirin or Thyroxine, she denied of such drug but quickly recollected that she takes Eltroxin 50mcg and Ecosprin AV75mg daily. Well, she did not know that the active ingredient of Eltroxin is Levo Thyroxine and that of Ecosprin AV is Aspirin & Ator vastatin combined. The former is given to replace thyroid hormone deficiency to those who are hypothyroid and the latter is usually given to those who are suffering or are at the risk of developing coronary artery disease.
If I am not that very wrong, more than 95% of patients do not remember medicines by their generic names. So what difference does it make? Well, it’s the money that matters. For those who are ill-informed, the market prices of most of the drugs of regular as well as special use are tagged with exceptionally high price just for the sake of an industry.
The statistics from McKinsey & Co. states that the growth rates of Indian Pharmaceutical Industry is compounding at 12 to 14% per annum since last 5 years and have projected the value of the industry is going to be around $20 to $24 Billion by 2015. This growth would be driven primarily by rising incomes, and be supported by five other factors: enhanced medical infrastructure; rise in the prevalence and treatment of chronic diseases; greater health insurance coverage; launches of patented products; and new market creation in existing white spaces.
If we zero down to the basic issue of generics versus branded drugs it is the pocket pinch that matters. I don’t think if quality is assured, people will love to shell out more for a branded drug rather than buying a generic product.
What are generics?
All drugs are products of research. They are born in a research laboratory and end up in a pharmacy shop. Whatever be the results of the research product in the laboratory, their usage in general public for any particular indication is highly regulated by the US FDA. Financially the companies have to bear a huge burden to research and develop a drug, undergo clinical trials for them in phasic manner and further make them available for general prescription. Further, after the drug is launched and approved by USFDA the company holds a patent for the drug for say tenure of 10 to 12 years. Hence, during this period the cost of drug is very high as the company needs to recover the cost of R&D. However, after lapse of license,the drug molecule is available for other companies to copy and rebrand and bring them into market again. The cost of the drug falls drastically now as the companies now selling the copied drug did not have to spend on the R&D. The only investment for these companies is the price of the molecule and the technology of packaging and marketing. These drugs which are sold under different brand names after the post licensing period of a particular molecule are called generic drugs. However, the qualities of these generic drugs are also under FDA regulation. According to FDA, to substitute a generic for a brand name drug must follow these criteria:
It must contain the same active ingredient, the same dosage strength and the same dosage form (e.g. tablets, syrup etc) and have the same route of administration and further it must deliver the same of active ingredient to the blood stream.
Hence cheaper does not mean poor quality. The difference from patented drugs is the generics may vary in shape,size, color or taste. They have different inactive ingredients. However, there are authorized generics that need to maintain similarity in these parameters too. Almost 50% of all drugs prescribed in India are generics. Thus generic drugs may cost almost 20 to 80% cheaper than the patented drug.
Is the quality guaranteed in a generic formulation?
Researchers have compared patented drugs with generic formulation from different companies in a random manner and 36 of 38 studies virtually found no differences in the drug quality control. But, FDA has barred the publication of drug equivalence studies. Hence it is difficult for the prescribing doctor to know whether there had been any difference between the drugs in the equivalence study or not. It’s worth mentioning thatIndia tops the world in exporting generic medicines worth of Rs.50,000 Crores and currently Indian Pharmaceutical industry is one of the world’s largest & most developed.
What is the price paid for not using generics?
It’s worth mentioning that India tops the world in exporting generic medicines worth of Rs.50,000 crores and currently Indian Pharmaceutical industry is one of the world’s largest & most developed.
In spite of being the largest exporter of generics in the world the story behind the screen is very dull. Just have a look at few of the statistics.
- WHO says that 3.2% of Indians will fall below poverty line because of inflated medical bills.
- Approximately one third of the rural population do not seek medical treatment due to financial constraints.
- And about 47% of rural and 31% of urban hospitalizations are financed by loan and sale of assets.
- About 70% of Indians are spending their out of pocket income on medicines and healthcare services in comparison to 35% in other Asian countries and are still suffering from infectious & communicable diseases due to lack of quality and affordable treatment
Where do I get the generics?
Generic medicines are best bought from the government sponsored generic drug shopped opened under the banner of “JANAUSHADHI”in most of the Indian states. Janaushadhi stores are functioning under the banner of Bureau of Pharma PSUs of India (BPPI) under the aegis of Department of Pharmaceuticals, Government of India. States like Punjab, Delhi, Haryana,Andhra Pradesh, Odisha, Uttarakhand, Chandigarh, Jammu & Kashmir, Himachal Pradesh and Jharkhand have already implemented Janaushadhi stores providing quality generic medicines at a cheap and affordable price. Few states like West Bengal has initiated Fair Price Medicine shops in a Public Private Partnership models to provide generic medicines at a whopping discount of up to 62.7%. They are opened adjacent to or in collaboration with different government healthcare establishment the largest being at the SSKM Hospital, Kolkata.
Can we have examples of price comparison?
I have made an attempt to compare the prices of the generics available on the website of Janaushadhi to that of branded generics available in the market. In fact I have approached a regular chemist shop and asked for these prices. Also I have reduced the quote by 11%as that particular chemist shop was giving a discount of 11% on any drug bought from the chemist. Now let’s compare the cheapest discounted branded drugs with the Janaushadhi generics. Generics and Branded Generics : The price difference
Do we get all sorts of medicines at these generic drug stores?
Well, wish the answer could have been yes. Unfortunately all medicines are not available at the generic drug stores.While scrolling down the list provided by Janaushadhi website I found drugs for treatment of Rheumatoid Diseases are missing. Drugs for treating neurogenic pain, Parkinsonism, schizophrenia, newer drugs for diabetes management,inhalers and insulins are missing. I am sure they will soon be incorporated or might have been incorporated by now. Even without these drugs the net price of the monthly medications fall drastically if purchased from the generic drugstore.
Any words of Caution?
Well, there has to be some words of caution. The country is lagging in maintenance of quality control and most of the quality control is outsourced. Further, the government not necessarily declares the data of quality check to the general public. Hence, many doctors keep on highlighting the quality of the generic medicines.
My recommendation is, whenever you have the opportunity to buy the drugs from a government sponsored stores, consider the quality is guaranteed by the government. Hence, you can very well go and purchase the medicine and use it personally.
Adverse Reactions: Unless the drug is too spurious, it is unlikely that somebody will suffer from any adverse reaction. Spurious drugs are usually sold in peripheral aspects of a city or major town mostly is districts and village areas. Hence, one should be very careful about purchasing generic drugs from these areas.
What I practice and recommend?
When I am sitting in my clinic at Kolkata, I write the composition of the drug e.g. Paracetamol.[ Drug that reduces fever ], Amlodipine [Drug that controls blood pressure] ,Pantoprazole [ An Antacid ] instead of the brand names. This helps the patients in two ways. Either they can go to the Fair Price shop and buy the cheapest ones and save a lot, or they can go to any chemist and ask the chemist to provide the brand which is cheapest for that particular composition.
I do practice in districts of West Bengal where there are brands which I have never heard off. In these areas I always write the brand of the drug and tend to keep the price low. In this way the spurious drug sellers can be fended away and I can ensure that quality drug is served and chances of health hazard is minimum.