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[e-drug] For cheaper drug options, send SMS (4)

E-DRUG: For cheaper drug options, send SMS (4)

Dear E-Druggers

I agree that retail pharmacists cannot substitute the brand name written by a 
doctor in India.  This program is not for pharmacists to do substitution but 
for providing information to consumers.

I have done many surveys on medicine prices and availability in different 
states of India using a standard methodology developed by WHO and HAI. A recent 
survey was carried out in National Capital, Delhi in 2011. The data for private 
sector is collected from retail pharmacies situated in all eight districts of 
Delhi. I have also done the medicine price components study whereby finding the 
actual mark up (profit) for wholesalers and retailers for few medicines for 
their three popular brands and for three not so-popular brand (branded generic).

I would like to make the following points in connection to the on-going 
discussion of providing prices of a medicine for its different trade names:

Every pack of medicines in India is printed with MRP (maximum retail price). 
Except for medicines whose price is controlled by NPPA (national pharmaceutical 
pricing authority), under Ministry of Chemicals and Fertilizers the MRP is 
fixed by the manufacturer.

The Government or NPPA fixes price for only 74 medicines and it includes only 
38 essential medicines, the rest are not commonly used. For all other medicines 
(except the 74) the manufacturer decides the mark up for wholesaler and 
retailers. There is no transparency for in fixing the MRP.

For each medicine (INN pharmacological moiety) there are dozens of trade names 
available in India; Popular trade names are called branded medicines as they 
are pushed by the manufacturer via doctors and not so popular trade names are 
called branded generic and are pushed in the market by the retailer.

I do not agree that on medicines with inexpensive or comparatively cheaper MRP 
(maximum retail price) printed have less percentage of margins for retailers. 
Retailers have higher margins than the established 16-20% on most of the 

In my opinion it is good to provide information to patients or consumers about 
the price of different 'brands' available with the name of manufacturer. 
Consumers should know the price difference and the range available. Maybe next 
time when she/he visits a doctor she/he can ask for prescribing a medicine with 
an inexpensive [lower] price. This program should be taken as creating 
awareness about the medicine prices and this is one of the important factors 
that can bring down medicine prices. 

In India, almost all reputed companies make two versions of the same medicines, 
with difference in price structures, one is their 'branded' product or popular 
product and other branded generic (for details see Singal G, Nanda A, Kotwani 
A. A comparative evaluation of price and quality of some branded versus 
branded-generic medicines of the same manufacturer in India. Indian Journal of 
Pharmacology 2011; 43: 131-136.)

The recent survey conducted in Delhi has clearly shown that there is huge price 
variation in a few medicines which were available in retail pharmacies and some 
of these medicines are ofloxacin, doxycycline, diclofenac, ciprofloxacin, 
amoxicillin+clavulanic acid, amlodipine, amitriptyline, cefuroxime, cefixime.

BUT we should know who is responsible for providing this information on SMS. 
The company or the organization should not have any dealings with any 
pharmaceutical company(ies). The name of the organization, its members with 
their declaration of conflict of interest should be identified and should be 
available on the website and appear in the newspapers. We need transparency in 
the system and we require good governance and commitment.

Anita Kotwani
Dr. Anita Kotwani
Associate Professor
Department of Pharmacology
Vallabhbhai Patel Chest Institute
University of Delhi
Delhi 110007

[Message edited by moderator for clarity. DB]

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