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[e-drug] For cheaper drug options, send SMS (3)

E-DRUG: For cheaper drug options, send SMS (3)
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[Some practical difficulties of implementing this scheme in India are 
addressed. However, providing patients with price information can be a very 
powerful tool leading to patient pressure on prescribers and dispensers for 
cheaper options. Let's hope they will have means of assessing whether the 
measure has any effect once implemented. DB]

Dear colleagues

I am afraid this SMS idea is impractical and even illegal for the following 
reasons;

(1) Under Indian laws applicable to retail pharmacies, substitution of one 
prescribed brand by another brand, even if cheaper or more expensive, is not 
permitted. Hence even if the patient is informed about a cheaper brand, the 
pharmacy will not dispense the same.

(2) The trade discount on drugs is in percentage terms usually 16 to 20% of the 
retail price. The pharmacy will make less profit on a cheaper brand; hence it 
will not dispense.

(3) There are over 60,000 brands of medicines produced by just over 8,500 
pharmaceutical manufacturers in India. Most brands are sold in certain areas 
only. Hence even if a cheaper brand is suggested to a patient, the same is most 
unlikely to be available in the local pharmacy.

(4) Even if brands of large manufacturers (except MNCs) are suggested as 
alternatives, the price difference is not much. Hence the whole exercise may 
not be worth the trouble.

(5) Major benefit is if unbranded drugs are suggested because they are far 
cheaper. The problem is that (a) multi-ingredient products (about 47% of all 
medicines sold in India) can not be sold without brand name for obvious reasons 
and (b) the power of prescription will merely shift from prescribers to 
pharmacies.

(6) The responsibility for the treatment of patients lies with doctors. If a 
brand is substituted and the patients does not benefit, the doctor (who is 
obliged to the drug companies due to incentives and freebies) will wash his 
hand off and hold patients for consuming the 'wrong' medicines.

(7) There are many critical medicines such as anti-epilepsy drug phenytoin 
sodium where brand substitution is not permitted due to lack of 
bio-equivalence. In such cases patients can be harmed.

(9) Generic drugs, produced domestically, are not very expensive in India. The 
major problem lies with patented monopoly drugs which are beyond the reach of 
90% or more Indians. There are no cheaper alternatives to such medicines.

All in all the whole idea [should be shelved - part of message missing; 
moderator] at the least and a well thought out diversion to distract attention 
from the popular demand to put a cap on all drug prices in India. Under the 
influence of the drug industry lobby, the Government of India has been dragging 
its feet in implementing a Supreme Court directive to bring all essential drugs 
under price control.

Dr. Pankaj Talwar, MD.
Consultant Physician. 

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