When you visit a doctor, you rightfully expect them to prioritize your best interests. This includes not only achieving the best possible health outcomes but also ensuring you receive medication that is both effective and affordable. But what if we could guarantee patients always got high-quality medicine at the lowest possible price? This leads us to a critical question: Should generic prescribing be mandatory?
Dr. Anirban Biswas
Consultant Neurotologist, Kolkata
The Doctor’s Duty in India
In India, a doctor’s responsibility extends beyond treatment. Given the financial constraints and limited insurance coverage for many patients, doctors must consider medication costs. Even when insurance is involved, doctors should prescribe effective drugs at the lowest possible price. This safeguards both the patient’s and the insurer’s interests.
However, a price discrepancy exists. The same medicine can be sold by different companies at vastly different prices.
In fact, the same pharmaceutical product of the same strength is also available at much cheaper rates.
Example: Betahistine Hydrochloride
This drug, used to treat vertigo, illustrates the problem. Over 150 companies market it in India. The printed retail price (MRP) can vary significantly. One brand might sell for ₹25-31 per tablet, while another equally renowned company sells the same product for one-third the price.
This means a patient could lose nearly ₹20 per tablet if a costly brand is prescribed, translating to ₹60 per day, ₹1800 per month, and ₹10,800 if continued for six months.
It’s the prescribing clinician’s prerogative to ensure the patient doesn’t pay extra for a product available at a much lower price. Generic formulations of this same medicine (24mg Betahistine) are available for as low as ₹3.40 per tablet, just 11% of the costliest brand.
Erosion of Trust
Patients, now with access to more information, have grown suspicious of the healthcare system. The sad outcome is a loss of trust in doctors, who are often merely facilitators in a system where some commercial organizations unscrupulously profit.
The Pros for Mandatory Generic Prescribing
Cost Savings: Generic drugs cost significantly less than their brand-name counterparts. This huge price difference directly reduces patient out-of-pocket expenses. For a nation like India, where many pay for medicines themselves, this is crucial.
Enhanced Accessibility to Medicines: Reduced prices directly translate to increased accessibility. Life-saving and essential drugs become affordable for a wider population. This is particularly vital in India’s rural areas and for economically weaker sections, where high drug costs often prevent access to necessary treatment. Mandatory generic prescribing can bridge this gap, ensuring health equity.
Curbing Unethical Practices: Mandatory generic prescribing can significantly reduce unethical influences within the pharmaceutical industry. It can curb the flow of promotional gifts, incentives, and other inducements from pharmaceutical companies to doctors
The Need for Mandatory Generic Prescribing
It’s time to mandate generic prescribing for all medicines no longer under patent. Regulatory bodies like the Ethics and Medical Registration Board, medical councils, the Drug Control Department, and the Central Drugs Standard Control Organisation (CDSCO) must act proactively. Enhanced surveillance and strict enforcement of compliance are crucial.