Prime Minister Narendra Modi’s resolve to ensure that doctors prescribe only generic medicines is being undone by some creative interpretation of the Medical Council of India’s (MCI’s) “code” for doctors, which ostensibly makes it mandatory to prescribe using generic names. Reacting to the MCI injunction that doctors should prescribe generic drugs, the Indian Medical Association (IMA) said “should means may and may means optional or preferable”.Meanwhile, doctors demanded that the PM ban companies from manufacturing any generic medicine with a trade name and ensure they produced only high-quality generics. Though the PM said he would bring a legal framework to prescribe generics, there is as yet no new law, either for the pharma industry or for doctors and chemists.
All that has happened after his announcement is that MCI has issued a notification reiterating an existing clause in its code of ethics regulations. The clause, which had earlier stated that “every physician should, as far as possible, prescribe drugs with generic names” was amended in October 2016 to “every physician should prescribe drugs with generic names”, indicating the intention to make it mandatory. However, the IMA has pounced on the fact that the letter of the clause uses “should” instead of “shall” to argue that it is not mandatory. IMA president K K Aggarwal’s statement on the issue further pointed out that the clause did not say doctors can prescribe “only” with generic names. So, IMA has advised doctors that they can write the generic name and add the name of the company that manufactures the drug.
“Nobody can stop you choosing the company for quality assurance,” said the IMA statement. IMA advised doctors to choose drugs from the National List of Essential Medicines (NLEM) as they are cheaper and of assured quality. “When writing non-NLEM, take consent. When prescribing, write the cheapest available medicine and that will always be the generic version of that company,” advised IMA.
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The All India Drug Action Network (AIDAN), a civil society group working on drug pricing and accessibility, issued a statement pointing out that the proposal to make prescribing generics mandatory for doctors would be a useless, counterproductive step as a standalone measure. “This is because in India no manufacturer markets medicines in the retail market under generic names and hence medicines are not available under generic names in the Indian retail pharmacy shops,” it pointed out.
AIDAN said that unless manufacturers (except those who are marketing medicines still under patent protection) are made to market medicines under generic names for the retail market, consumers would not get the benefit of “generic medicines”.