India's generic drug paradox

Amrit Dhillon welcomes the government's push to lower health care expenses for the poor

PUBLISHED : Monday, 08 October, 2012, 12:00am
UPDATED : Monday, 08 October, 2012, 2:32am

If you happen to be sick in India, the shock of a bad diagnosis is usually followed by another piece of bad news: the cost of the drugs needed for the treatment. Government hospitals provide free consultations but patients have to pay for medicines, and the price of the branded versions usually prescribed is enough to sicken the patient even further.

For example, a pack of the painkiller Combiflam costs 11 rupees (HK$1.60) - but a generic version costs only two rupees; a generic pack of amoxicillin costs four rupees, as opposed to the branded equivalent, which costs 42 rupees.

For poor Indians, these differences are big. Yet most patients are unaware of generic drugs and blindly follow the doctor's prescription. Thanks to the high costs, many Indians don't even seek treatment.

The costs rise in proportion to the seriousness of the disease. Cancer patients face ruin. The branded drug Nexavar, used for treating liver and kidney cancer, costs nearly 300,000 rupees per month. But instead of prescribing Nexavar, doctors could choose the generic version, made by Indian drugs giant Cipla, which costs about 7,000 rupees a month.

It is a paradox that India's drug companies produce 20 per cent of the world's generic drugs, yet its doctors are reluctant to prescribe these very drugs. India exports US$12 billion worth of drugs every year. Over half goes to the highly regulated markets of the US, Europe and Japan. That alone speaks of their quality. They are cheap not because they are defective but because the raw materials, labour, profit margins and manufacturing costs are lower, and, most importantly, they are cheaper because they are not protected by patents.

If generic drugs are good enough for the scores of countries to which Indian companies export, they are surely good enough for Indian patients.

Now the government has belatedly decided to act and is planning to make it mandatory for doctors in government hospitals to prescribe generic drugs or face punishment.

The move comes as public awareness of generic drugs is growing. Bollywood star Aamir Khan recently argued for doctors to prescribe generic drugs, during a TV programme that highlights social ills. He criticised vested interests that could have stopped more doctors prescribing such drugs.

Clearly, generic drugs are the key to affordable health care in a country where the poor can sink into destitution when there is an illness in the family.

Now the government just has to make sure the drugs are actually available. "The law sounds great but they have to place orders with us so that there is enough stock and so far they haven't been in touch with us at all," said the head of one big generic drugs company.

Amrit Dhillon is a freelance writer in India