The Parliamentary Standing Committee on Health and Family Welfare led by Rajya Sabha MP Amar Singh has asked the Union health ministry to emulate the Chittorgarh, Tamil Nadu and Bihar models of drug supply for the entire country as they have the potential to make drug-access easier on the pocket of the people and thus save precious human lives.
After studying these models, the committee has recommended that the Department of Health and Family Welfare, in coordination with the Department of Pharmaceuticals (DoP), should convene a meeting of chief secretaries of state governments for the purpose of formulating an effective ‘essential drug supply’ policy, having the components of: generic prescribing; adoption of essential drugs list; standard treatment guidelines; drug procurement by open tender system; distribution of low cost drugs through government drugs stores; and demand generation of generics through public awareness.
In its 45th report presented to the Rajya Sabha on August 4, 2010, the committee said that it has examined an initiative taken by Dr. Samit Sharma, during his stint in the Chittorgarh district of Rajasthan for making affordable medicines available to patients through Low Cost Drug Shops selling generic medicines. Dr Sharma is presently district magistrate, Nagaur, Rajasthan.
The first steps taken by Dr Sharma were in convincing doctors to prescribe medicines by generic/salt name as per the direction given by the state government and removing the false notions about inferior quality of generic medicines. The next action was involvement of government co-operative medical stores in procurement of generic medicines through open tender. Drugs of reputed companies only were recommended by the approval committee. Against an initial approval of 22 drug companies, 57 companies stand approved at present. About 800 medicines and 200 surgical items were procured which were sold at 20 per cent profit margin to the patients.
Large gap in the procurement rate and the MRP of medicines was noticed. While the Generic Drug Chittorgarh Tender Rate for amlodipine (5 mg) was Rs 2.50 (10 tablets), the MRP was Rs 22.00. For cetirizine (10mg) it was Rs 1.20 (10 tablets) against the MRP of Rs 35.00. While the same for ceftazidime (1000mg) was Rs 52.00 (1 injection), the MRP was Rs 370.00.
Awareness about huge difference in prices was created among all stake holders, more particularly among pharmacists and patients. Advertisements to this effect were issued by the District Health Committee (Nagaur and Chittorgarh) under the National Rural Health Mission.
As a result there was sharp fall in the treatment costs. For example, for the treatment of pneumonia involving 7 days therapy, the cost was Rs. 1136 when branded medicines were used compared to just Rs 139.51 when generic medicines were purchased from Co-operative store. A saving of Rs 6.05 crore in the treatment of 4.03 lakh patients in 6 months was estimated. Private Chemist Associations agreed to sell generic medicines at 50 per cent discount on MRP.
The Committee noted that the Bihar government has also taken a similar initiative. Every medical college, district hospital, PHC in the state has a shop where generic medicines at less than 50 per cent of the MRP are sold and yet Bihar Government is earning 45 per cent revenue on the project.
The committee, which also studied the Tamil Nadu model of essential drug supply, noted that it has been able to achieve huge savings on drug expenditure; rational use of drugs; accurate up to date stock information on the computer; and linkage of all warehouses telephonically with the TNMSC headquarters in Chennai.