Research by
Subhash Chandra Agrawal
Jan Aushadhi Kendras are now being opened under Pradhan Mantri Bhartiya Janaushadhi Pariyojna claiming a huge saving to commoners ranging from 50-90 percent on purchase of generic medicines from these about 10000 centres throughout the country with average monthly sale of just rupees 1.50 lakhs per month for each centre. Much more could and should be achieved simply by fixing a maximum trade margin on all medicines and medical-consumables including generic medicines of say 30-percent between ex-factory price and Maximum-Retail-Price (MRP).
Presently there is a huge trade-margin specially on generic medicines are considered to be economical substitute of branded medicines. A box of 10-20 strips is available with distributors at about one-tenth of printed MRP including those marketed by renowned drug-manufacturers of branded medicines. A box containing 20 strips of ten tablets each of Vogliboz-0.3 tablets marketed by Knoll Healthcare Pvt Ltd with printed Maximum-Retail-Price MRP of rupees 100 each (MRP of complete box rupees 2000) was available with the distributor at just rupees 250 meaning a profit of 700-percent for the retailer. A box of 300 tablets of Lipvas-10 (Atorvastatin) manufactured by Cipla Limited with total MRP rupees 1837.20 was available at rupees 300. A box of 20 strips of ten capsules each with MRP rupees 114 per strip (Total MRP rupees 2280) of Pantosec DSR marketed by Cipla Limited was available at a wholesaler at just rupees 550 meaning thereby a trade-margin of 315-percent. Even wholesalers are at liberty to earn huge by offering just 20-percent discount on printed MRP of Generic Medicines. Same is case with thousands of generic medicines manufactured by various companies Even branded medicines had varying trade-margins with a box of 10 strips of 10 capsules each of Bifilac-HP with total printed MRP of rupees 2100 per box was available with the distributor at just rupees 1140 per box. Even World Health Organization (WHO) established that even essential drugs in India with lowest printed MRP are exorbitantly priced over manufacturing-cost followed by abnormally high trade-margin between ex-factory price and MRP. Same holds good for other medical-consumables like a box of 200 Accu-Check Safe T Pro Uno single-use lancing device with printed MRP of rupees 2200 used to be available at just rupees 400 only.
Drug-manufacturers at times pack just eight lozenges per strip of commonly advertised cough-medicines instead of usually ten because consumers usually judge by price per strip rather than per lozenge. Many drug-manufacturers have started packing medicines in strips of fifteen rather than earlier ten to boost up sale because most chemists sell complete medicine-strip rather than cutting the strip to sell in loose. National Pharmaceutical Pricing Authority (NPPA) should direct all medicines to be compulsorily packed in units of 1, 2, 5, 10, 20, 50, 100, 200, 500, 1000 and likewise higher multiples unless permission is sought from concerned authorities to pack certain medicines in units other than these for dose-wise administration. Name of medicine is usually printed just once on a side of medicine-strip. Wrapping-foil must be so designed that name of medicine may appear for each packed tablet/capsule with name of medicine also embossed/printed on each tablet/capsule.
Ex-factory prices of different branded medicines for same basic salt has vast difference. Branded medicines from different renowned companies are priced with heavy difference depending on popularity of brand like Calmpose and Valium-5 both having Diazepam-5 as basic salt have huge price-difference. Government-owned Indian Drugs & Pharmaceuticals Limited (IDPL), since closed, sold Diazepam-5 under brand-name Calmod at still lower price. Medicines are put in different categories for price-regulation with Calmpose and Valium-5 put in a category where there is no price-regulation. System of having multiple categorization for medicines must be removed because patients have to take prescribed medicine irrespective of their categorization.
A study conducted by a prominent newspaper in the year 2018 revealed that five chemist-shops around premier Post Graduate Institute of Medical Education and Research (PGIMER) at Chandigarh were selling a particular medicine having price ranging from rupees 255 to rupees 1550. There is a regular price-increase of many branded medicines, with NPPA being mute spectator. NPPA should devise a mechanism whereby drug-companies may be allowed to have some basic profit-margin on all types of drugs irrespective of their categorization allowing any price-revision only once in a year say in January or April every year. Madras High Court once directed Income Tax Department to submit details of claims made by pharmaceutical-companies towards tax-deduction for gifts made to doctors, names of doctors and penalties paid by these companies for drug-overpricing. Any type of gifts by drug-companies must be banned. Paying commission to medical practitioners by pathological laboratories, investigating centers and hospitals should also be criminal offence to ensure economical medical investigations. Private hospitals should be directed not to take any share from consulting/visiting fees of medical practitioners. Some upper limit should be fixed for consultation-fees of medical practitioners.
Since wholesale medicine-market of Bhagirath Palace (Delhi) has virtually turned to be a retail market giving 20-25 percent discount even on single strips of medicines, tenders can be invited for opening chemist-shops in government and private hospitals at least in big cities where branded medicines may be available even in single strips at 20-percent discounts.
It is quite usual that many a times some medical-practitioners including in Unani, Ayurvedic and Homeopathic fields mix strong doses of allopathic steroids in unbranded medicines like powders and syrups in a bid to exhibit their self-acclaimed expertise in curing diseases. Only branded medicines should be allowed to be prescribed in all fields of medicines including Allopathic, Ayurvedic, Unani, Homeopathy with Central Government having its large production-units for very type of medicines by reviving Indian Drugs & Pharmaceuticals Limited (IDPL) in a big way and popularising and extending scope of its Ayurvedic unit Indian Medicines Pharmaceuticals Corporation Limited to develop a healthy competition to force big drug-companies to bring down heavily prices of branded medicines.
Central Information Commission (CIC) in its order dated 01.10.2018 in file-number CIC/NPPAT/A/2017/152869-BJ recommended NPPA and others concerned to consider all these suggestions in larger public interest. But shockingly, NPPA challenged the CIC-decision just on recommendations (and not directions) at Delhi High Court vide WP(C) 10366 of 2019 and CM No. 42777 of 2019. Soon after Competition Commission of India (CCI) in its policy-note also pointed out towards unreasonably high trade-margins as reason for exorbitant drug-prices. But no corrective measures are seen at least on non-essential and generic medicines.
BJP MP Bhartruhari Mahtab raised issue of generic drugs in Lok Sabha on 19.07.2019, rightly demanding an inquiry to find out the efficacy of generic drugs quoting a book-study that Indian drug manufacturers were producing quality generic medicines for US and European countries with sub-standard generic medicines marketed in domestic market. NPPA should ensure that generic medicines sold in Indian markets are of export-quality. Export of world-class generic medicines can provide country adequate foreign-exchange and reputation because of Indian generic medicines are economical than foreign-branded medicines of which major part is royalty of drug-manufacturing companies.
Lucknow bench of Allahabad High Court in the year 2018 imposed fine on three doctors for illegible hand-writing on injury-reports. Odisha High Court on 13.08.2020 advised doctors to write legible prescriptions preferably in capital letters. Medical-practitioners should compulsorily issue computerised prescriptions. Exemption may be for aged ones not familiar to use computers. Union Health Ministry should develop user-friendly soft-wares separately for hospitals, pathological laboratories and medical practitioners providing unique ID for each patient so that complete medical history may be available even online to the patient. Dual pricing must not be allowed in health-services including for pathological and biochemical tests for normal patients and those covered under Central Government Health scheme (CGHS).
Vegetarian cellulose capsules should be encouraged to replace non-vegetarian gelatin capsules presently having 98-percent market share to respect sentiments of majority vegetarian population. Supreme Court ruling of the year 2013 had made it possible to distinguish vegetarian and non-vegetarian medicines by having green and red dots.
Providing land at subsidised cost/lease is substantial government-funding. All such hospitals should be directed to sue-motto declare themselves as public-authorities under section 2(h) of RTI Act, or else pay market-price of land provided to these hospitals at current market rates.
Union Health Ministry in the year 2018 banned 328 Fixed-Dose-Combination drugs out of total 349 recommended to be banned by Chandrashekhar Kokate Committee with six more allowed with restricted sale. Banned medicines included commonly advertised popular medicines like Saridon and Vicks-Action-500 which continued to be household names in India for last so many decades. Medicines considered harmful are banned in India years after these are banned in foreign countries. Union Health Ministry should take immediate decision once some medicine is banned in other countries. Action is necessary against celebrities advertising the popular medicines without having knowledge about the advertised medicines. There should be a total ban on advertisements of medicines in view of ban imposed on commonly advertised medicines.
Reports were there in media with opinion of medical experts about artificial health-food and cosmetic surgery being possible reasons behind the cardiac-arrest responsible for sudden untimely death of Bollywood-superstar Shridevi (54) on night of 24.02.2018 at Dubai. Fast life-style has made youngsters to switch to costly gyms from natural walk. Trend of cosmetic surgery for looking beautiful and fit is also increasing with same pace. Union Health Ministry should set up an expert-committee to study after-effects of artificial health-food and cosmetic surgery, and only certified health-food should be permitted to be sold.
Writer is RTI consultant holding Guinness World record for most letters published in newspaper
