Pradhan Mantri Bhartiya Janaushadhi Pariyojan: A Generic Buzz
By Sandhya Mishra
The progress in developing breakthrough medications is impressive but this comes with a price tag so high which poor and marginal of India too often are paying with their lives.
Generic drugs are medications having chemical formulation similar to the private brand medicines. They come into the market, when the patent of innovator of drug expires. The biggest perks of using generics over branded drug, is the price with benefits remaining the same. These are priced 50%-90% lesser than their branded versions having same efficacy, strengths, safety and quality. So what stops us from using them? Let’s discuss.
Meanwhile, to promote the use of generic medicines and to reduce the Out of Pocket expenditure by Indians, a powerful intervention initiated by Government of India called Jan Aushadhi Scheme (JAS) comes to our rescue.
Accolades of JAS
Though launched in 2008, by Bureau of Pharma PSUs of India (BPPI), a special wing of Department of Pharmaceuticals to execute the operation of JAS, gained its full momentum in year 2018. The number of JAS stores increased from 99 units as on FY14-15 to 5000 plus units in FY18-19 and is expected to double up to more than 10,000 stores by FY20-21. This is because the current government has expedited the project JAS by incentivizing retailers and distributers, increasing trade margins etc. As on today it is claimed that country has 5000 plus operational JAS and more than 800 drugs & 154 surgical and consumables under the scheme which shelves from pregnancy test kit to cancer treating medicines to stents. With this progress, the market of Generic medicines may dent 20% of Indian Pharmaceutical Market sales by FY20-21 as reported by Edelweiss securities.
Today, along with public, private sectors are roped in to manufacture and supply drugs to JAS stores so as to avoid delays and maintain a healthy supply of drugs. The procured drugs are tested for quality controls at empaneled government certified labs to ensure quality, safety and efficacy. The annual turnover is already above 1.2bn INR and it is believed that come FY20-21, annual sales could top 60bn INR, giving shudders to IPM in anticipation.
This scheme is not only benefiting poor of India to save more money and lives but also creating employment and opportunities to get self-employed.
Criticism
However, according to the data fetched from the inside sources, though the number of stores have increased only 3,200 of them are functional. Also, these numbering includes pre-existing pharmacy stores at government hospitals.
Apparently there are also questions on functioning and productivity of JAS as reported by researchers in Chrismed Journal of Health and Research. The stores are not supplied with all the drugs and even the stocks for the supplied drugs are not enough.
According to the reports by Indian Express, few of the owner of stores were even found selling branded drugs to fulfil the demand of customers in the absence of generic supply. Shop owners suspect the role of private players behind the shortage of supply.
Questions are raised on the quality of generic drugs since 11 medicines were recalled in just first 4 months of year 2018. “Such frequent drug recalls are unusual in India, where a single recall can land a company in serious trouble, including legal action, an export ban, and financial losses. Drugs are typically recalled if the product is defective, contaminated, contains a foreign object, fails to meet specifications, or is misbranded.”, report by The Print.
It was also found that not all generic medicines at JAS stores are cheaper than their branded versions. “For example, cefuroxime axetil brands are cheaper than their JAS counterparts,” researcher wrote in International Journal of Health Policy and Management, 2017
Challenges
Jan Aushadhi Scheme has a long way to go considering there are over 50,000 retail pharmacy stores in the country selling branded drugs. There is definitely a need to increase the number of stores to increase the access to the Generic drugs.
Lack of awareness among people who still believe that high price is synonymous to high quality, is one of the major reason why a switch to generics is still tough to achieve.
Even if there are stores in vicinity with the generic stock in place, people are hesitant to buy the drug citing their fears on efficacy and safety of the drugs or because their doctors do not prescribe the generic medicines in first place.
Doctor’s reluctance to prescribe generic drugs can be related to pharma-doctor nexus. Out of all the retail pharmacies available, many private doctors ask patients to purchase from their ‘choice’ of a retail drug store let alone the advice to buy a generic drug. Doctors sometimes do not want to advice generics because of their lack of confidence on such drugs. These are few reason why prescribing branded medicines is more prevalent.
Now that JAS is given a power to substitute the prescribed branded medicines with their generic counterparts to the demanding patients could be a game changer. Drugs Technical Advisory Board have allowed to amend a rule under Drug Law permitting chemists to substitute brands prescribed by doctors, however, this is only allowed for the Jan Aushadhi stores as of now.
Maintaining the quality and safety of the drugs, timely and adequate supply of all the medicines are few other challenges that need to be worked on.
Recommendation
Increasing the number of stores under PMBJP scheme.
Creating awareness in people to demand generic drugs by educating them with the facts through effective campaigning and aggressive promotion of Jan Aushadhi Scheme or use of generic medicines.
Conducting a training programs for both government and private doctors since they could play a major role in making the scheme a big success or failure.
Organized and efficient supply chain management can stop the JAS stores getting deserted majorly due to lack of generic stock.
Increasing the number of therapeutic drugs and surgical items under the ambit of scheme.
Incentivizing the manufacturers, distributers, dealers and shop owners.
Maintaining the high quality of the drugs, bringing in some stronger regulatory interventions, etc. can help in making the generic medicines a generic choice of India