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Re: E-DRUG: Mandatory generic prescribing vs trade mark rights

Richard,

Regarding your message on generic prescribing vs trade mark rights:
[...]
> So what do I think should be done. Firstly generic prescribing,
> dispensing, education and training in public sector  is a MUST. Also copying
> the American model of requiring pharmacists to offer generic substitution to
> all patients may help. In the Philippines the EDP program survey pharmacies
> and publish the costs of widely used drugs in the newspapers. This clearly
> shows the generic brand name price differentials. 
[...]

I don't understand this.  In the private sector the private practitioners
should be able to prescribe whatever they want (or rather whatever the
patient wants)? Private medicine differs from state medicine (public
health system)..?

I find this hyperventilating about generic prescribing in the public
sector (read this in the state service to the indigenous) merely annoying.

Our Ministry tenders out according to generic specifications and whoever
offers cheapest gets the tender.  It is Interesting to see that this year
Bayer got the Nifedipine tender :-)-O, which means whatever I precribe,
Nifidepine or Adalat, this year they get Adalat.  And here the patients get
it for a follow-up fee of 30 cUS per monthly visit.

Now if the state patient were to have to buy the drugs and only gets the
doctor's visit free/subsidized, that's a different matter altogether. 

> If you have price control regulations you may want to allow a differential
> mark up to encourage generic dispensing. For example if your price
> regulations allow a 33% mark up on drugs you could change that to allow 25%
> on brand name drugs and 40 or even 50% on generics. The base price for the
> generic is lower and so the patient will stay pay less and the pharmacist
> will make a bigger percentage profit so they will have an incentive to
> substitute.
[...]

Come on, percentage profit? If anything pharmacists can count.

Here it works like this, a drug of 100$ to the pharmacists costs 200$ to
the private patient.  So if you lower the markup it will cost the patient
150 - 175. 

Now the generic may cost 10 to the pharmacist and so he will make 10$
profit if he marks it up to 20. Hm, 10$ profit vs 50-75? I'd take the
50-75 myself. And the ratio is sometimes much worse (chloroquine costs a
couple of cents per tablet when generic and more then a dollar when you
take the Nivaquine brand, Amoxicillin has a similar ratio).

Dr. Eberhard W. Lisse   \         /              Swakopmund State Hospital
<el@lisse.NA>            *        |               Resident Medical Officer
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Swakopmund, Namibia        ;____/ Zone/Domain Contact for the NA-DOM
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