The new rules notified by the National Medical Commission earlier this month require all registered medical practitioners to prescribe drugs by their generic names. The Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002 had already stipulated this over a decade ago. Generic drugs are estimated to be up to 80% cheaper than branded ones. The NMC has thus reasoned that prescribing generic medicines might help lower healthcare costs in a country where nearly 70% of out-of-pocket expenditure on healthcare is on medicines. While it is true that many drugs come at a high price because of the brand name associated with them, generic drugs might not be the best way forward. First, if a medical practitioner prescribes a generic drug, in most cases, the brand will be chosen by chemist shops that are not duty-bound to keep the best interests of the patients at heart. Over-the-counter dispensing of medications by chemists is one of the leading causes of anti-microbial resistance in India. Second, the lack of standardised testing and approval procedures compromises the reliability of generic drugs. For instance, a database of substandard drugs maintained by Kerala’s drug regulatory authority documented samples from at least 10 batches of paracetamol from a generic manufacturer this year that failed standard quality tests. There is also the question of practicality. Can India’s overburdened medical professionals — the country has about 44.5 skilled health workers per 10,000 people — be expected to write down the eight to nine generic ingredients that make up one medicine for each patient? An error in noting down the generic names may prove fatal.
Enhancing the quality of generic drugs and making them a viable alternative to branded drugs could be the way forward. Price caps by the National Pharmaceutical Pricing Authority could also ensure that big brands do not hike the prices of medicines unreasonably. Moreover, most regular medications are not covered by medical insurance in India. This needs to change. Successive governments at the Centre have mooted the idea of a free drugs initiative. Operationally, though, this has remained a slogan. It is time this idea is implemented in reality.
