PM Modi wants to end the unholy doctor-drug industry nexus, but there are many challenges

The intention behind Prime Minister Narendra Modi's recent announcement to amend rules to stop doctors from prescribing brand names of medicines is noble.
 
In theory, if all medical prescriptions are generated in the generic (chemical) names, the patients can opt for the cheapest version of a drug that is being sold by the retail chemist. Pharmaceutical companies will no longer find it meaningful to push the sale of 'brands' through doctors. It will thereby end the unholy doctor-drug industry nexus that results in over prescription in lieu of monetary or other benefits offered by companies to doctors.

The preference towards generic medicines can also encourage the prescription of multiple single ingredient drugs, instead of the current trend of combination medicines. Rational use of medicines will reduce the threat of antibiotic resistance. Finally, universal and mandatory availability of low cost, brand-less medicines will help governments - both central as well as state - plan their free drug supply programmes through government hospitals and government funded retail medicine outlets like Jan Aushadhi with smaller budgetary support.  

Now that Modi has made his intentions clear, what will be the next step?

First, the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, which says that 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, should state that it has now become compulsory. Second, the Drugs and Cosmetics Rules should be tweaked to permit chemists to substitute drugs to ensure that generic formulations are dispensed against all prescriptions.

Once the legal frameworks are in place, one will have to look at the operational hurdles. To begin with how and who can effectively monitor the hundreds of thousands of prescriptions that are generated every day to see if the doctors have adhered to the 'generic' stipulation? What if the medical practitioner advises a particular brand after prescribing a generic medicine? What if the retail outlet offers the 'most profitable' generic equivalent instead of the lowest cost option? How can one prevent pharmaceutical companies from introducing 'unique' combination drugs? What will be the future of brands which carry a great recall value and trust among the patients and medical community?

Before de-branding the private pharmacies, the government should ideally begin this exercise by promoting generic medicines though government hospitals and pharmacies, including the ones that are being set up under the 'Pradhan Mantri Bhartiya Janaushadhi Kendra' (PMBJK) scheme. As against a plan to have 3,000 Janaushadhi generic drug stores across the country by 31 March 2017, the government had opened 861 stores till 6 March, 2017. Once the rule to make generic prescriptions compulsory will be in place, this initiative is bound to speed up. And once such generic drug stores are in place, attempts should be to see that it sells all the essential land commonly prescribed medicines.  

Janaushadi stores offer a little over 600 medicines today. This is only one sixth of the 4000 odd combinations and single ingredient medicines that are being sold in India. The product offerings of Janaushadi stores thus need to be increased. The learnings from the failures of Janaushadi (it was launched by the previous government but had a very slow start) and the decision of several state governments (Punjab for instance) to make government doctors prescribe only generic name should also be studied.

Unless the obligation results in a string of behavioral and structural changes in the way drug marketing happens today, the generic push can remain a great idea with patchy implementation.