In India, a significant portion of the population lacks insurance coverage. Even for those who are insured, the coverage often extends only to hospital admissions and outpatient department (OPD) visits. Domestically, the treatment of chronic diseases is primarily managed by patients themselves. Consequently, the substantial burden of healthcare expenditure in India is shouldered by the patients.
Understanding Generic Medicines:
The concept of generic medicines in India differs significantly from the rest of the world. In developed nations, generic medicine refers to products manufactured by companies that did not originally invent the drug molecule. Once the patent for a drug expires, other companies can produce and sell it under their own brand names. In this context, the prices of generic drugs are expected to be lower than those offered by the company that initially developed the drug. However, this is not always the case.
In India, less than 1% of the total number of drug molecules are invented by Indian companies, making almost all Indian brands essentially generic. Therefore, the real issue in India should be framed as branded versus non-branded drugs, rather than generic versus research drugs.
This misinterpretation of the term "generic medicines" has led to confusion among many Indian patients and doctors alike. Ultimately, the decision to choose between branded and non-branded drugs rests with the patients. If a patient decides to opt for a drug without a brand name, it is entirely their choice.
Considerations of brand value and quality are natural for anyone making a purchase. Individuals often inquire whether brands hold any significance in terms of product quality, and this question naturally extends to medication choices.
Should absence of a brandname imply inferior quality?
Recent government data reveals that approximately 15% of medicines produced by small and medium-sized manufacturers are of inferior quality. This raises a critical question: What if the medicine our patient took falls within that 15%, and for them, it becomes a 100% problem? While the government is intensifying quality control measures , manufacturers argue that drug prices may need to be increased in response, creating a complex balance between quality and affordability in healthcare.
With the aforementioned challenges, doctors find themselves in a big dilemma. Should they choose to prescribe branded medicine from reputed Indian companies (which are also generic for all practical purposes) or suggest unbranded medicines? In most cases, unbranded medicines are not readily available. Even small players in India aiming to grow will brand their product in 90% of cases.
At the same time, the government has implemented initiatives like Pradhan Mantri Jan Aushadhi Kendra, which aims to alleviate the cost of medicines. It is crucial to focus on solutions that benefit the public rather than engaging in periodic media campaigns that target doctors and prescribe generic medicines, potentially damaging the image of healthcare professionals. The emphasis should be on educating the general public about the realities of healthcare. If the government aims to eliminate brand names (following the Hathi Committee's 1975 recommendation for the gradual elimination of brand names) and envisions a scenario where manufacturers produce standardized medicines, the feasibility and practicality of such a utopian state warrant careful consideration.
Cost of Generic Medicines and Patient Choices:
The cost of generic medicines in India is not necessarily lower compared to research companies. As they come off patent, research companies may reduce the price of their product, which they can undoubtedly do since they invented it, if they believe quality is not compromised. This factor must be taken into consideration before making decisions. As a cardiologist, I am concerned if my patient, after angioplasty, expresses a desire to switch to other brands. In this case, if things go wrong, it could lead to significant complications. Therefore, I advise my patients to consider standard medicines for at least a few months before deciding to make a change later when the risk diminishes. This, however, is a compromise I resort to because the patient chooses to do so.
The complex dynamics of generic medicines in India pose a challenge for both healthcare professionals and patients. The decision-making process involves a delicate balance between cost, quality, and the patient's freedom of choice. Government initiatives like Pradhan Mantri Jan Aushadhi Kendra aim to address affordability issues, but a comprehensive and nuanced approach is essential. Rather than engaging in debates that may inadvertently target healthcare professionals, it is crucial to focus on educating the public about the intricacies of healthcare choices. As the government envisions a shift toward standardized medicines, careful consideration of the practicality of such initiatives is necessary to ensure a balanced and accessible healthcare system for all.