Prime Minister Narendra Modi's announcement that there would soon be a law for doctors to ensure they prescribe generic medicines has caused a lot of confusion, say doctors.
The announcement was followed by a notice by the Union ministry of health and family welfare on April 18, reminding doctors of the guidelines of the Medical Council of India on generic drugs—“Every physician should prescribe drugs with generic names legibly and preferably in capital letters, and he/she shall ensure that there is a rational prescription and use of drugs.” The words “legibly and preferably in capital letters” were added after an amendment last year. Following the PM's statement, the MCI too reiterated that doctors follow this rule “without fail”.
While the order came in light of the PM's push for "affordable healthcare", doctors say that the rule has only caused much "confusion". Until now, doctors would prescribe branded generic drugs based on their experience of which drugs works and which don't.
Dr K.K. Kohli, general secretary, National Medical Forum points out that it is difficult for doctors to write only generic names in certain cases where drugs have either complex or lengthy generic names. "Say if it's a contraceptive, or a cough syrup with more than one chemical, then it is confusing for the patient if we write only the name of the salt," says Kohli, adding that this would leave the field open for the pharmacist to dispense the brand. "We are not the ones who fix the price, so why are we being blamed? The drug regulator should put a price cap on all drugs, just like they did with the coronary stents," says Kohli.
Many doctors such as Kohli insist that doctors only prescribe drugs that are effective, and also offer cheaper alternatives for those who cannot afford. Branded generics, that dominate the drug market, are also important because of the issue of quality—less than .01 per cent of drugs in the country are tested for quality, according to the Indian Medical Association. In addition, a plethora of substandard drugs are freely available in the market, as the March safety bulletin of the Central Drugs Standard Control Organisation found out. In the bulletin, certain batches of popular drugs such as combiflam, cetrizine tablets and Vitamin D3 tablets were found to be of suspect quality.
In that context, doctors insist that they need to retain the right to prescribe branded generics, and writing branded drugs was not "illegal". "Writing a complete and legible prescription does not forbid the medical practitioner from suggesting one or two best quality manufacturers of the drug to ensure quality," says Dr Prem Aggarwal, president of the National Medical Forum.
However, the prescription should be made descriptive, he says. "If a doctor is writing the brand name, then the generic exposition should also be included. The prescription should include generic name of medicine, route of administration, dose and frequency, time of administration and for the duration it has to be taken," he adds. Doctors should also avoid irrational combination of drugs, and medicines should be written in capital letters, clear language, legible and should be dated, timed with the doctor's name and his signature, he added.
