Regarding the ongoing debate on mandatory generic prescribing vs trade mark
I have recently been working as a cooperant/senior pharmacist for nearly 3
years in Mozambique. I was linked to the MOH and MEDIMOC - the parastatal in
charge for drug imports to the public - as well as the private sector.
Generic prescribing has been mandatory by legislation and working practice
in Mozambique for nearly 20 years. It is still incorporated in the new drug
legislation (Lei dos Medicamentos) that is about to be approved these days.
No lawsuits have been received till now (maybe the setting is too small,
being brought to court for violating trade mark rights). Anyway - practice
shows several important advantages with the system in Mozambique:
- Drug Prices. Even in such a small market (USD 20 million/year) prices
were evaluated to be favourable in comparison to other countries in a
GATT survey from 1992. A diminished number of items and elevated
tendering volume for each item contributes to this tendency - more drugs for
- Rational Drug Use. As done in several developing countries, the INRUD
indicators have been reviewed in Mozambique public health facilities (Maputo
province). 85% of the 600 patients that was interviewed, knew how to take their
drugs in a setting with extreme poverty and high illiteracy. 98,5% of all
drugs were prescribed and dispensed as generics. I do not know any brand-name
market that has proven a similar patient knowlegde. The Generic setting in
Mozambique is so simple that all health care providers may instruct patient to
have good knowlegde of their drugs - they even remember the INN-names ! All
this will obviously
contribute to elevated patient compliance.
Being a developed country, Norway is also considering generic
prescribing/substitution. The patients have the rights to organise
substitution - cooperating with a pharmacist.
Only 1 out of 10 new drugs entering the market are considered to represent
a real improvement (SCRIP I-95). The other drugs (that may be called "me-too
drugs") are in general terms just elevating health expenditures, and in
addition contribute to a higher grade of confusion amongst perscribers,
nurses and patients. These facts are now driving several Norwegian hospitals
to give preference to generic names in their drug lists.
In summary - I hope that brand names/branded generics will loose the
current right to confuse drug markets in any country. I think Richard puts
forward a very sound and mild strategy in the setting. And I do hope that
Eberhard will change his mind - not only representing the interests of brand
name representatives. It is important to support a generic strategy.
I do not expect this to end the debate.