Campaign for Affordable Drugs
It is a universal truth that we cannot have access to health care without access to affordable drugs. Statistically, despite a huge network of hospitals, dispensaries and sub-centres set up by the Government in each and every State, 80% patients still prefer to go to private sector and 71% of the cost of treatment is on purchase of medicines alone.
“I am shocked to note that as many as 4 crore people of our country plunge into poverty each year due to expenses on medical treatment.” Said Mr Pranab Mukherjee, the President of India, while addressing 40th convocation function of All India Institute of Medical Sciences (AIIMS) in New Delhi, in October 2012.
The importance of drugs in overall health care was recognised way back in the year 2000, when leaders of the world sat together and set milestones, in the name of Millennium Development Goals (MDGs) to be achieved by 2015. Target 8.E of the MDG relates to affordable drugs: ‘In cooperation with pharmaceutical companies, provide access to affordable drugs in developing countries’. While progress of other MDG goals and targets was regularly monitored, for this target we had to wait for 12 long years. It was only in 2012 that the MDG Gap Task Force Report on MDG 8 concluded that essential medicines continue being unaffordable and insufficiently accessible to the poor, that prices of available essential medicines tend to be the multiple of international reference prices, that obtaining essential medicines, especially for treatment of chronic diseases, remains prohibitive for low-income families in developing countries etc.
Despite this acknowledgement of ground realities by the high and the mighty, essential medicines continue being unaffordable to masses! Pleading with pharmaceutical companies to provide access to affordable drugs is not going to yield results since they cannot voluntarily leave behind their obsession with profit. It is time to explore policy options, which are always available with the Governments, to translate rhetoric into action.
Acting on the directions of the Supreme Court of India in 2003 to formulate appropriate criteria to identify essential and life saving drugs and ensure that they come under price control, Govt of India came out with Draft NATIONAL PHARMACEUTICALS PRICING POLICY, 2011 (NPPP-2011), which was finally translated into Drug Price Control Order, 2013 (DPCO 2013).
It took over a decade to formulate this policy! The inadequacies within this policy are aptly illustrated by the following:
- As per PHFI-ISID 2013, only 17% of the total domestic market of Rs 71246 crore (2012) is covered under price control.
- Even in medicines covered under DPCO, 2013, profit margins are very high!
- To give one example, ceiling price of a strip containing 10 tablets of Cetrizine (10mg) has been fixed at Rs 18.10 as per DPCO, 2013. The price at which TNMC procured it during 2012-13 is as low as Rs 0.9 only! The DPCO, 2013 price is thus 2011% higher than TNMC price! Same medicine is being sold at Jan Aushadhi outlets for Rs 2.75. It is difficult to understand, why the price of medicines fixed by Govt for Jan Aushadhi outlets could not be adopted under DPCO-13!
- Fixed Dose Combinations (FDCs) have not been brought within ambit of price control. About 80% of the paracetamol market and 70% of anti-diabetic market, therefore, remains outside DPCO 2013!
- Drug companies may find another escape route by resorting to non-standard strengths of the same drug. For example, Paracetamol tablet of 500 mg is under price control. If they switch to Paracetamol 650 mg (instead of 500 mg), they will be out of purview of price control!
Consumers India has been actively campaigning for access to affordable drugs at national and international fora. Brief details regarding some of its activities are given below.
Campaign for Affordable Medicine gets Recognition from United Nations
The oral and written Statement submitted by Dr Jayashree Gupta, President, Consumers India, in collaboration with the Society for Upliftment of Masses (SUM), a non governmental organization in consultative status with the Economic and Social Council of the United Nations was accepted by the Secretary-General of the United Nations for circulation amongst all Members in accordance with paragraphs 30 and 31 of Economic and Social Council resolution 1996/31. The Statement draws attention of the leaders of the world to the immediate need to provide access to affordable drugs since efforts to combat diseases and reduce mortality are closely linked to access to affordable drugs. The Statement was translated in all the UN languages ie English, French, Russian, Spanish, Arabic and Chinese for distribution amongst UN Members.
The issue was forcefully presented by Dr Jayashree Gupta before the august gathering at the United Nations meeting at Geneva (ECOSOC-2013) on 2nd July and not only received applause but also the distinction of winning the prize for the ‘best opinion’!
Appeal to Prime Minister to consider following policy options:
- Expand the ambit of DPCO-2013 by putting all chemical analogues of the medicines included in the list under price ceiling. This would block escape routes of fixed dose combinations and non-standard strengths and will pave the way for realizing the dream of making affordable medicines accessible to all.
- Adopt Jan Aushadhi based pricing (JABP) for determining the price of medicines covered under DPCO-2013. This would involve some revision in the price-fixation formula adopted under DPCO-2013, but considering the tremendous impact that it will make in mitigating human suffering, it is worth giving a try!
- Make use of Compulsory license for making cheaper drugs available even if they are under patent. This tool, though available since 1995 under WTO’s agreement on intellectual property rights called TRIPS (Trade Related Aspects of Intellectual Property Rights), was used for the first time in India recently (March 2012), and has helped reduce the price of cancer drug ‘Nexavar’ by 97%. Why not use this provision for other expensive medicines as well!
- Make Patent Law consumer friendly so that patent holders are not able to perpetuate their patents on flimsy grounds. Recent judgment of Supreme Court (2013) in the case of anti-cancer drug Glivec has demonstrated how the cost of treatment can be reduced from Rs 1,20,000 per month to Rs 8500 per month at one stroke if only the right decisions could be taken!
- Mandate Drug companies to reveal on their website how much they spend on doctors. This is already being done in USA. Why not in India? This one step, coupled with effective enforcement by regulatory agencies, will go a long way in breaking the unholy nexus between Doctors and Pharmaceutical Companies, the reason behind high prices of drugs!
- Ask Doctors to prescribe generic drugs. This mandate should not remain on paper but should be properly enforced by the State Medical Councils and Medical Council of India (MCI).The Medical Council of India (MCI) was set up to regulate medical profession. It has to be ensured that instead of being mute spectators, they actually act on their mandate!
- ‘Access to Affordable Drugs’ may be included as a stand-alone Goal in the post-MDG agenda being considered for finalization under the aegis of United Nations. Efforts to combat diseases and reduce mortality are closely linked to access to affordable drugs. This goal should include suitable policy interventions by individual Governments to ensure easy access to affordable drugs. India should use its persuasive power to make it happen!
Further details may be seen on following link :-