Thank you for your response as it does highlight two issues in the generic
You state that the private practitioner should be able to prescribe whatever
they want (or rather whatever the patient wants). Private medicine differs
from state medicine (public health system).
I am glad we agree that the public sector is different to the private sector
and if the government or as happens in the US the insurance company insists
on generic prescribing they have the authority to do so. Now your point that
private practitioners should be able to prescribe whatever they want is also
not really true. If the drug is not registered in the country the private
doctor cannot prescribe it. Also do you believe that a private primary care
provider (a GP) should be able to prescribe cytotoxics or some of the new
protease inhibitors. Clearly some drugs should be prescribed by specialists.
So some limitations always occur. The issue is how much limitation should
What you describe of your ministry tendering for drugs and then dispensing
whichever drug wins the tender is generic substitution. I would advocate
however that it would be less confusing for the patient if the nifedepine
was labelled nifedepine and not Adalat. Next year a different company may
win the tender and the patient could be confused if they think they are
getting a different drug.
Your point about the total profit for the pharmacist being higher selling
brand name drugs at a lower percentage markup on a higher base price is
true. However many pharmacists have a cash flow constraint and a higher
percentage mark up may be attractive. Also the value of the stock which
needs to be held and possibly expire is far greater when selling a range of
brand name products rather than a single generic which would turn over rapidly.
Your point about the great price differential between generic chloroquin and
Nivaquin or diazepam and Valium is a good one. Are we doing our patients any
good selling drugs at 5 to 10 times the price for what pharmacologically are
the same products. At the very least the patient, the consumer, should be
given the choice.
I look forward to further comments on this issue.
Boston University School of Public Health