Mandate of Generic Medicines : making the Prevention & the Cure - 'bitter' ?
How to bridge the gap between the noble Intention and its actual implementation ?
Adv. ROHiT ERANDE ©
The National Medical Commission (NMC) which has replaced the Medical Council of India (MCI) in the year 2020 has recently issued (2nd August 2023) Code of Conduct rules for the Registered Medical Professionals (RMPs). These guidelines deal with various important aspects like How Doctors Can advertise, What is the limit of Record keeping ? What are the duties of RPMs towards patients and Society as a Whole, How informed Consent should be taken ? What is Professional Misconduct ? and so on...
One of the mandate of these guidelines is prescribing Generic Medicines and it reads as under :
8. Prescribing Generic Medicines: Every RMP should prescribe drugs using generic names written legibly and
prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets. (L1 and/or
L2)(Generic Drugs and Prescription guidelines) .
This provision has stirred up hornet's nest amongst the Medical Professionals. If the medicos would remember, prior to it earlier the amendment made by MCI to the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002, as per its circular dated 21/04/2017 to clause 1.5 – “Use of generic names of drugs- every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.”
The part of above amendment of legible writing and in Capital Letters, was welcomed by the Medicos unanimously, but the other condition that mandatory prescription of Generic Medicines was questioned by the Medical field..
What's Generic Medicine ?
Surprisingly the Definition of Generic Medicines has not been made by any of the Concerned Authorities. An example might help in knowing the difference between Generic and Branded Medicines.. a well known branded drug Crocin, which is used worldwide contains Paracetamol, a generic medicine and now as per the above said Circular, instead of brand name of Crocin, Doctors should subscribe Paracetamol.. Doctors would be in a better position to explain this..
Why Generic Medicines have been proposed ?
Cost.. Cost.. Cost.. It's the main reason for prescribing Generic medicines. Its very cheap as compared to other branded goods.. One more reason is about the the nexus between Pharma Companies and Doctors and Doctors don't prescribe generic medicines and only branded ones...
Why Doctors are opposing ?
From the various debates, it's clear that Doctors are not against the fact that patients should get cheaper medicines, but at the same it must be effective too... Else what's the use of taking medicines ? A Branded drug is costlier than Generic because the Company invests millions of rupees is in research and development and that gives the required relief to patients.
Every Doctor would wish that his/her patient gets relief.. If the Generic medicines, which are cheaper in costs but not as effective as branded drugs, Doctors would certainly prescribe the effective one... Regarding the conduct, I guess now MCI has categorically banned Doctors from accepting any kind of favours from Pharma Companies..
Practical problems.. Quality and Availability./
In practice a Doctor may prescribe 1 branded drug, comprising of various different drugs to treat a particular disease. But that will not be possible in case of generic medicines and a patient would end up in buying 3-4 different drugs independently. This circular will have impact on pharmacists to.. What about the earlier Stock of medicines ? should it be discarded ? Whether there will be enough supply of generic medicines ? Govt. has to take the responsibility.. If the Doctors are not held responsible for the quality and the availability of the Generic Medicines, then perhaps Doctors should not have any problem.
What may be the solution ?
One may argue legally that, yes there is mandate of prescribing generic medicines, but does that ban prescribing branded medicines simultaneously ?
I feel, if the Govt. can reduce the prices of stents, it can certainly control the prices of branded drugs and/or it should endeavour in quality of Generic Medicines.
It may be argued that the guidelines no where expressly bar use of branded medicines along with generic medicines.
Per se, Patients are least bothered about the medicines, what they want is to get cured. Patients want easily available Medicines and expect the same within their reach.
If they don't get cured, again entire blame will be likely to be on Doctors... Already the relationship between Doctors and patients is going through a vicious circle.
Plus this circular is applicable only to Allopathy, I guess.. What about other branches like AYUSH ?
Thus if the Govt. could assure about this, both, Doctors and patients will be happy. Its my humble opinion.Otherwise it should not happen that the prevention and the cure both become bitter !
Thanks and Regards,
Adv. ROHiT ERANDE
Pune. ©
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