As the state approved its first drug policy claiming it would reduce cost of medicine and help in quality control, the people associated with the trade say it will put two lakh people out of business. A special report by Syed Asma.
The familiar names of medicines will no more be figuring in the prescriptions at the government hospitals. The recently approved first drug policy for the state makes it mandatory for the doctors serving in government hospitals to prescribe medicines by their generic names rather than the brand names. The state cabinet approved the policy, the government claims for improving the standard of health sector and the quality of drugs available in the state.
The practice of prescribing generic names in Tamil Nadu has immensely reduced the prices of drugs there. Seeing the success of the practice the government agreed to implement the policy in J&K, says an official from Directorate of Health services.
In the first phase the policy will only be implemented for the allopathic discipline in state’s government hospitals and health centres. The government has also asked the semi-autonomous Sher-i-Kashmir Institute of Medical Science to consider adoption of the State Drug policy.
The drug policy also envisages rationing of drugs andhenceforth only those drugs listed in Essential Drug List (EDL) will be procured.
“Although, there may be about 20,000 medicines/combinations available in the market, with about 300 drugs recommended by the World Health Organization (348 list) in the Essential Drugs List of Government of India, it would be possible to tackle almost all disease conditions,” the drug policy states.
The drugs would be selected on the basis of demand, transportation, lead time and emergency needs. The drugs on the EDL would be purchased by a single authority.
“The concept of essential drugs is central to the state drug policy because it promotes equity and helps in setting priorities for the health care system,” it reads.
The limited number of carefully selected medicines based on selective treatment protocol will lead to better supply of drugs, rational prescribing, reduction in costs and finally to a better health outcome. Rational use of drugs will help the patients get the medicines appropriately, the government claims.
The government is setting up a State Drug Committee comprising of clinicians, microbiologists, qualified pharmacists and independent experts besides senior functionaries of the departments, which will recommend changes to the EDL after every two years keeping in view the therapeutic advances, changes in costs, resistance patterns and public health relevance.
It also provides for ‘drugs and therapeutic committee’ in all the hospitals. The concept of essential drugs, rational drug use and generic prescribing shall be integral part of basic and in-service training of health professionals.
¬The policy also envisages strengthening of drug and food control organisation and drug testing laboratories.
In addition to the drugs in the EDL, some drugs are required for specificdiseases or in exceptional cases. The policy provides for a Complementary Drug List (CDL), which can be procured for 10 per cent of the allocated budget.
The policy makers claim the implementation of this policy, at least in its first phase, will not much affect the wholesalers, retailers, chemists and medical representatives (MR) as it is only meant for the government sector. But people associated with the trade believe otherwise.
“Around 80 per cent sales of the pharmaceuticals come from the patients which go to government hospitals and this policy is going to ruin everything,” says Aashiq Hussain, general secretary, Chemists and Distribution Association.
People associated with the trade foresee this policy as a failure which cannot work for more than six months in the state.
“We know what is the condition of the drug stocks in the hospitals presently, they do not even provide some basic medicines in there, how do you expect they will manage the whole system of drugs. It is not going to work,” says Ruhail Ahmed, a medical representative (MR) hoping everything will get back to the present situation after sometime.
The new drug policy has shifted the focus from a doctor to a chemist. Role of medical representatives who had the job of convincing doctors to prescribe different brands of medicine will be minimized, at least in the government sector. However, people associated with the trade say that MRs can continue their practices before 10 am and after 4 pm with doctors doing private practices.
While the government claims the policy as a significant development in the health sector the MRs, chemists, drug manufacturers, drug distributors, and many others in the trade are protesting the implementation of this policy saying it will affect their trade badly.
“It will get us jobless,” says Aijaz Ahmed, an MR who earns Rs 10,000-12,000 a month. “I will have to look for another job if the policy gets implemented.”
About two lakh people associated with the pharmaceutical trade will get affected by this policy, says Aashiq Hussain. “The government has already failed to adjust these 4000-5000 boys who are today working as medical representatives and now when they are somehow making a living the government is creating hardships for them. Seeing the high sales in the drug sector in Kashmir the government wants to earn profits from it.”
Some MRs allege that politicians and bureaucrats are planning to establish their own drug companies locally to have a significant share in this profit making sector in Kashmir.
“I cannot expect these corrupt politicians of thinking good for the people. They are looking for their own profit every time,” Aijaz Ahmed adds.
Similar drug policies have met with some success in some states but in Jammu and Kashmir experts say it is hard to figure out if the policy will work.
Senior oncologist Dr Shad Salim, suggests that policy should be implemented first as a pilot project to see its impact. “I suggest to implement it first may be in SMHS and few other hospitals to know the loop holes and lacunae in the policy which after sometime can be looked after or rectified. If the policy is implemented at once in whole of the government sector it can collapse the whole system.”
Dr Salim, however, appreciates the move of establishing drug and therapeutic committees in hospitals. He says it can surely raise the standard of the health sector as it acts as monitoring and approval committee for getting any new drug in the hospital.
Doctors rather than sharing well known brand names with the patient, a lay person, should discuss the affects of the medicine that he is prescribing, says Dr Salim. But he thinks getting brands out of the medicine may affect the quality of drugs. “There are some companies which have developed a standard over the years in producing some best medicines which had good effect on the diseases but this policy will take it all away.”
Another issue he says will be lack of well qualified and trained chemists. “Reading generic names is the most difficult job in the world because they sound alike and look alike. It needs a well qualified and well trained pharmacologist in pharma shops which is not seen in here,” says Dr Salim.
In Kashmir, anybody who has passed matriculation and has worked as an assistant in a drug store for five years can have a chemist shop and can be granted a drug license.
Experts also express concerns over the way government makes purchases. The government seeks tenders and selects the lowest cost product, which in the case of drugs may lead to purchase of substandard drugs, they say.
Dr Salim who is already into the practice of prescribing generic names says he usually has to explain his prescription to the chemist. As of now our chemists and pharmacologists are not well trained in reading generic names.
Ordinary people too have some worries. Saiba, who has been treated for cancer ten years ago says she cannot trust the government or any other chemist. “I only purchase medicines manufactured from international reputed companies because the Indian companies do not match their standards of quality,” she says. “I cannot risk my life by getting anything of the same generic name without knowing which company has manufactured it.”
Amid the mixed response to the new policy some are preparing to take advantage.
“Many doctors did not even allow my MRs to attend them. They were not paying any attention to the quality of the drug been provided, they were just interested about their incentives and perks provided by these companies for prescribing their drugs,” says a local manufacturer wishing anonymity.
But now he says names will be gone and government will “hopefully be concerned about the quality and good price which local companies can easily provide because of the exemption of all taxes etc.”
