The advent of pharmacy practice is a recent phenomenon in pharmacy profession worldwide. The conventional role of pharmacists like making and dispensing medicines called as product centered care became redundant as it negated the patient interest and discarded the principles of prescribing of risk vs benefit. The patient safety assumed paramount importance and its practice has been made mandatory by regulatory agencies in developed economies. Regulators expect the industry to practice pharmacovigilance for all their products that are marketed and to submit data for evaluation in case of products suspected to have threats regarding patient safety. If further investigation reveals and confirms potential harm then an order to ban the product sale shall be announced. On the lines of patient centered care the conventional job profile of pharmacists is getting transformed to care giver or clinical pharmacist. Pharmacists are expected to take the ownership of ensuring the best practices with an aim of outcomes of therapy .Pharmacists are engaged in providing medication therapy in management services to the patients.
The current practice engages the pharmacist to use the knowledge to achieve the predetermined outcomes of therapy by coordinating with doctors and nurses. The principles of healthcare delivery involve the teamwork of doctors to diagnose and prescribe, nurses to provide the nursing care and the pharmacists to address all the issues of drugs like its storage, usage, ADR monitoring, the drug-drug interactions and drug food interactions.
The pharmacy industry has to develop market and reach its customers by promotion of the products. The products can only be used when they are prescribed by doctors. This system of marketing practice is accepted and carried out worldwide. However, if there are more manufacturers and make similar medicines there develops a competition to sell the products. This competition usually leads to unethical marketing practices if there is no or inefficient system to check and discipline the marketing practices. The pharmacy marketing is highly regulated and any violation leading to causing endanger of patient safety and also unethical competitive approach are systematically identified and punished with huge financial penalties. There are specially focused rules and guidelines defining the violation of dos and don’ts in marketing practice. There are several examples of violation of pharmaceutical marketing and conviction by the regulators leading to heavy penalties for the violation.
Current scenario of pharmacy marketing
Indian pharmaceutical market is described as hub of cheap medicines for developing and underdeveloped countries. The medicines are really cheap compared to international prices. The cost of production for cheap medicines is attributed to cheap human resource, technical expertise and raw materials. India has large number of pharmacist from basic to highly qualified professionals. There are large number of educational institutes which educate the pharmacist as diploma, degree, postgraduate and Ph Ds. The D Pharm qualified pharmacists are engaged in retail pharmacy whereas the B Pharm and M Pharm are working in pharmaceutical manufacturing further M Pharm and Ph Ds are engaged in research and development. The Pharmacy Council of India has started a Pharm D programme and Pharm D post baccalaureate programme in 2008.The Pharm Ds are expected to initiate pharmacy practice in the country. The pharmacy practice when introduced it will bring a paradigm change from product to patient centered care. There can be more transparency and accountability on how prescriptions are written. This automatically checks the irrational prescribing and over medication in the prescriptions and although it appears to bring down the size of the market, one should realize the objective of the government is to promote the health of the people rather than the profits of pharmaceutical industry.
The new Union government with powerful mandate is capable and willing to bring reforms in health sector along with overall upheaval against corruption and social injustice which was holding the development of the country. The current health sector comprises of government three tier hospitals, primary, municipal and district hospitals. There are super specialization hospitals like cardiac, mental health, cancer, apart from it in semi government ESI hospitals and Military hospitals. There are large number of teaching cum multidisciplinary tertiary care hospitals in government and private sectors. There are super speciality corporate hospitals. The health care is also delivered by private practitioners, in clinics and nursing homes. In all these sectors the doctors and nurses practice healthcare in the absence of pharmacy practice .As there is no accountability and transparency the quality of healthcare service has been addressing just symptomatic and limited to critical care. The introduction of pharmacy practice will bring in much wanted pharmacy knowledge while practicing medicine and shall transform into a rational evidence based medicine.
There are nearly twenty thousand pharmaceutical industries which fall under small scale mid corporate, corporate, national, endogenous MNC and international MNCs, further there are contract research organizations. The research and development in industry is mainly focused on formulation development and upgrading the industry for foreign regulatory agencies of approvals. There are nearly one lakh brand formulations approved by Central and state government drugs control department. The brand products are marketed in the country by promotion schemes whose main focus is prescribing. The medical representatives are frequently visiting the doctors and detailing the products as there are too many players and products in a limited market there are rampant unethical marketing practices in the country. The unethical marketing has crossed all the limits and recently the Medical Council of India apex body of professional medical practice in the country has called in Hindu paper that the public are hereby informed to alert the state or central MCI about the medical misconduct of doctors in the form of unethical advertisements, unnecessary investigations and nexus with pharmaceutical industry to lodge a complaint in order to ensure the punishment for the unethical practice of doctors. This has indicated a change in the trends of professional regulatory bodies who are realizing the necessity of controlling its members. Similarly, Kerala Pharmacy Council and Maharashtra Drugs Control Department are actively campaigning for upliftment of pharmacy profession in state of Kerala and Maharashtra. This will affect the pharmaceutical marketing in a positive manner wherein the focus of the industry shall shift from product to patient.
The government of India is committed to provide the healthcare services to all its citizens in a cost effective manner. To achieve this objective the government is galvanizing its resources and infrastructure. There is an announcement in the Budget that there will be a National Insurance Health Scheme to all its citizens. Government also has started a scheme called Jain Aushadhi to promote the use of generic medicines. Jain Aushadhi scheme is supported by instructing the doctors to prescribe generic medicines as far as possible instead of brand medicines. The variety of brand medicines and generic medicines should comply with pharmacopoeial standards of label. Hence, there can be no difference in generic and brand medicines as the quality of medicines are concerned. But there is a lot of price difference which leads to escalation of cost of medicines and treatments. Government wants to curb this practice of use of brand medicines which is going to influence pharmaceutical marketing practice in the country.
The health insurance in country is in its nascent stages of development and likely to grow in future. The third party administrators and insurance regulator board are giving fillip to the growth of health insurance sector. The health insurance company is going to redefine the expenditures, for example the insurance company controls the health expenses of its clients by promoting the generic drugs pharmacy practice and assigning a contract of healthcare procedure by fixing a seal on medical service fee. The corporate hospitals and super speciality health centres are asked to compete for a tender and quote a price on competitive basis the hospitals could be interested to win the contract and get assured of business. The owners cutting the cost of the healthcare service shall be on the hospital as the profits of the hospital are dependent on margins of expenditure and quotation price. This has a profound effect on pharmaceutical marketing as doctors of corporate hospitals prescribe medicines in interest of the hospital rather the pharmaceutical industry. To bring out the cost of medicines the practice of pharmacoeconomics and outcome research are very much useful as the economic impact and balance in allocating the healthcare budget of the hospital or government becomes transparent and accountable.
The Indian pharmaceutical market is at the verge of transformation and the drivers of transformation have already started functioning. The market is changing its face towards patients and patient centered care from conventional product centered care.
(Authors are with Manipal College of Pharmaceutical Sciences, Manipal, Karnataka 576104)