It’s your right: Demanding cheaper drugs from your doc

When Karthik* approached a dermatologist in west Chennai with a fungal disease, the doctor prescribed him a 30-day dose of Sebifin, a terbinafine 250mg tablet. Curiosity caught up with him and a Google search revealed not just the composition and uses of the generic drug, but cheaper alternatives of the prescribed medicine.
Karthik’s though is not an isolated case of the doctor prescribing a more expensive drug when a cheaper alternative is easily available.Breach of the Code of Ethics Regulation, 2002 of Medical Council of India (MCI), which says, "Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs," by doctors is quite common, experts say.
With doctor’s fees and cost of tests being almost non-negotiable, cheaper medicines are an effective way to reduce medical bills, say activists. They point out it is not always that the money paid is utilised to manufacture it. "A maximum of 15% to 25% of the price is spent on research (for a new drug and not a generic drug) while 5% to 10% is spent on production. The rest is for marketing," said Dr Rakhal Gaitonde, senior scientist at Centre for Technology and Policy, IIT Madras. "Why should the consumer bear all this when cheaper options are available?" he said.
According to the National Pharmaceutical Pricing Authority, while the price of a new drug not available in the domestic market is fixed by the government "on the principles of pharmacoeconomics of the new drug (and) on the recommendation of a standing committee of experts", the maximum price of a generic drug is calculated by taking an average of the "price to retailer of all brands and generic versions of the medicine having market share more than or equal to one percent of the total market turnover of that medicine".
"This explains the difference in the prices of the same drug sold under different names. We cannot force any company to fix its price, but can cap it," said a senior NPPA official. "Companies have to operate within that range, there is nothing illegal about that," he added.
While a pharmaceutical company is entitled to its pricing, there is no reason for doctors prescribing drugs closer to the price ceiling. "The price is all about brand premium and doctors help the firms by prescribing the medicines," the NPPA official said. Asked if doctors gain anything tangible out of this, as is the usual belief, the official declined to comment saying the MCI must answer this.
MCI president Dr Jayashree Mehta said the body is "well aware that from time to time such practices do occur". "It is completely unethical. The ethics regulation clearly forbids it. Recently the provisions of ethics regulation and the punishment of such practices have been clearly laid down. It is hoped that this will help to curb these practices," Dr Mehta told TOI.
On what should a patient do if he/she cannot afford the prescribed medicines, Dr Mehta said, "The patient has every right to request the doctor for cheaper medicines or treatments commensurate with his or her financial capabilities and the doctor is morally and ethically bound to help the patient."
However, doctors often cite trust in a particular brand and effectiveness of the medicine as reasons while prescribing it. Dr Sai Satish, an interventional cardiologist says, he prescribes medicines which he himself would "swallow". "Ten years ago when there were so many clopidogrel (a generic drug) brands available here, I prescribed only plavix. It cost `80 a tablet then. Local clopidogrel was `10 per tablet but I still wrote plavix because it is not the process of the tablet but the way the molecules are bound. Billions go into research to make the medicine what it is. Plavix gave the best results for my patients," he said.
While trust may well be subjective, Gaitonde, however, said effectiveness is a market myth. The drug controller agrees with Gaitonde. "As per the law, all drugs should have the same effect. We test samples from the market at regular intervals," said Dr S Manivannan, deputy drugs controller, Central Drug Standard Control Organisation, South Zone.
That said, many in the market believe that cheaper drugs are manufactured by obscure firms and hence they are ‘spurious’. But Gaitonde said the argument does not hold any water. "There are several manufacturers who sell drugs at a low price, make profits and are trusted by leading hospitals like CMC, Vellore," he said. "Doctors know which low-cost pharma company to trust, only if they did so."
*(name changed)