Medicines are part of our lives. They not only save lives and promote health, but prevent epidemics and diseases too. Medicines are the most important component of the present day healthcare system besides the human resources. As health is fundamental human right so as the accessibility to medicines is too the fundamental right of every person. The non-availability of essential medicines in the public health facilities is an important issue, which makes the general public to buy medicines from the private pharmacy. The National Sample Survey (Morbidity Survey) of 2004 showed that the medicines account for 81 per cent of healthcare expenditure in rural areas and 75 per cent in urban areas with an average figure of 79 per cent. WHO's publication 'World Medicines Situation 2004' reported that two third of India's population lack access to essential medicines against the world average one third population without access to essential medicines. As the share of expenditure on medicine in total expenditure on healthcare is higher among the poor and undoubtedly one of the main reasons for lack of access is price of medicines.
The medicines have basically three types of names: International Non-Proprietary Name (INN), Brand name and Chemical name. The INN is also known as generic name. Accordingly the medicines are available as branded or generics. Though the brand name and generics have different meaning in different countries, the medicines in India are available as branded, branded generics, generics and generics-generics. The brand name is the proprietary name given by the manufacturing company to its product while the generic name is the universal common name. The brand name may vary from country to country for the same medicine resulting confusion. The pharmaceutical companies use different strategy to market their products based on the names by which they market.
The medicines' prices are controlled under the Drug Price Control Order 1995, but currently only 74 drugs are in this controlled category. The promotional expense is the major contributing factor to the cost of medicines, in addition to the manufacturing and other costs. There is a wide variation between the branded medicines and generic products. The trade margin offered to the retailer is often reported to be very high as more than 1000 per cent in branded generics and generics-generics. One study reported that the price of a strip of 10 tablets of ceterizine 10 mg, ranged from 1 to 2 rupees, while the maximum retail price printed on the label ranged from 22 to 36 rupees. The variation between price of the most expensive brand and the cheapest brand of the same drug can be up to 1000 per cent. The variation in price is not just limited to branding in the retail market but there are wide variations in prices of medicines sold in retail and those sold in bulk through tender to institutions. The same company sells the same medicine at two different prices.
Realizing the price of the medicines (affordability) as one of the important determining factor for improving access to medicines, the department of pharmaceuticals, Government of India, initiated the operation of peoples' medicines shop, called Jan Aushadhi, all over the country. These shops are aimed to sell generic medicines only at much cheaper rate than the price of corresponding branded medicines. The first such store has been opened at Amritsar with cooperation of Punjab government. To cite an example of the price of the medicines sold in the Jan Aushadhi, the price of 10 tablets of Ciprofloxacin costs Rs 20.10 in January 2009 against the price of the branded product of same10 tablets was Rs 97.00. This shows that the medicines would be made available at a much discounted price in these stores. Many other states too are showing interest to set up Jan Aushadhi outlets. As such stores are to be managed by NGO or charitable bodies, cooperative societies, the functioning of stores would likely to be transparent. In order to create awareness among the consumers on generic medicines and their prices, the Government of India, compiled the data and are available at http://demotemp95.nic.in/milestone/generic/generic.aspx. Though it has its own limitation like limited number of drugs are listed, many popular brands are not included etc., but is a good beginning.
Lab investigation necessary to check quality of medicine
Often the quality of generic medicines is doubted. The quality can not be assessed by visual checking the product or from its packing. It needs complete laboratory investigation to check the quality of a medicine. Unless there are adverse reports, all products available legally for sale are treated as products complying with pharmacopoeial standard. Even there is no guarantee that all branded products are of standard quality. There were reports that many of leading brands of paracetamol not complying pharmacopoeial requirements. But steps are necessary to ensure that the products available in different brands or generics of the same drug are bioequivalent and therapeutically interchangeable. A legal step is necessary to set such standard.
Just establishing these Jan Aushadhi in health system campus is not enough; a lot of efforts are required to popularize them. Some of the strategies: encouraging generic prescribing, following quality assurance programme in procurement of generic medicines, publicizing the quality checking reports of these products, are perhaps useful. WHO has been advocating generic prescribing in health system. It has added advantage overcoming the brand confusion especially in country, where we have many similar brand names with different drug. A prescription written for Lona (clonazepam, anti-epileptic drug) but was dispensed with Lona (low sodium salt for hypertensives). This is a classic example of brand confusion.
Operations of peoples' medicine store selling generics at much lower prices than the corresponding brands is a welcome step that are likely to improve affordability leading to improved access to medicines. But this should not be a substitute to the free medicines scheme of public health facilities as sizeable population of the country are still below the poverty line.
(The authors are with Division of Pharmacy Practice, Department of Pharmacy, Annamalai University, PO Annamalai Nagar - 608 002)