Prescribing brand names vs generic names of medicine: A dilemma and debate
While challenges exist, steps towards mandating generic prescriptions and ensuring drug quality through bioequivalence tests can pave the way for more affordable healthcare
Recent reports have revealed a significant rise in medicine prices in Bangladesh, with increases ranging from 30 to 40 percent. While inflation and fluctuations in the dollar exchange rate play a role, experts point to aggressive marketing tactics by pharmaceutical companies as a major contributor.
Medicine prices are typically influenced by several factors, including manufacturing costs, government policies, market dynamics, and healthcare regulations. However, in Bangladesh, the recent dramatic price hikes are largely due to the aggressive marketing strategies of pharmaceutical companies, according to experts. These companies conduct intensive marketing campaigns, often incentivising doctors to prescribe specific brands.
According to guidelines, doctors can receive samples and informational materials to understand the drugs better, but these incentives often extend to gifts, cash, and other lucrative rewards. This practice affects not only junior doctors but also well-established senior doctors, who receive allowances, cars, pleasure trips, and more to prescribe certain products, as we have widely heard.
Many lesser-known companies offer high commissions to drugstores, compromising standards. This situation is alarming because medicines are essential, and ultimately, health service seekers bear the cost through higher prices, raising questions about access to medicine.
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A potential solution is the mandatory prescription of generic drugs instead of branded names. Writing the generic name of drugs can reduce the influence of aggressive marketing and foster healthy competition in the market. In many countries, including neighbouring India, it is compulsory for doctors to use generic names in prescriptions. This practice lowers costs and promotes fairness in the pharmaceutical market.
According to the Food and Drug Administration in the USA, generic drugs typically cost less than their brand-name counterparts due to reduced upfront research costs. Although generic medicines have the same therapeutic effect as branded ones, they are sold at substantial discounts, estimated at 80 to 85 percent less than the price of brand-name medicines. When multiple generic companies market a single product, increased competition typically results in lower prices for patients.
In Bangladesh, the absence of regulations mandating the use of generic names means patients continue to bear the high costs of branded medicines. Experts estimate that promotional costs account for approximately Tk10 billion out of Bangladesh's total medicine market of Tk40 billion. This significant expenditure ultimately burdens health service seekers.
A critical aspect of this debate is the bioequivalence test. If all drugs on the market pass the bioequivalence test, ensuring similar quality, doctors can confidently prescribe generic names. In such a scenario, a pharmacist could dispense any brand of generic drug, knowing it meets quality standards.
Without this test, pharmacists become responsible for suggesting a quality product, a challenging task given that many pharmacies in Bangladesh do not employ trained pharmacists. If generic names are written in prescriptions, the power shifts from doctors to pharmacy owners or salesmen. Since they are not as educated as pharmacists in other countries, they may push low-standard drugs because substandard companies offer them higher incentives and commissions.
A significant concern is the influence of pharmaceutical companies on doctors and pharmacies in rural areas, where non-graduate doctors and semi-literate pharmacy owners serve a wide population. This raises doubts about the feasibility of prescribing generic names in Bangladesh currently. Small, lesser-known companies currently offer high commissions. If generic names become mandatory, large companies might also increase commissions, shifting incentives from doctors to those connected to drug stores. This is a potential risk of creating partial complications in the health and economic sectors.
To address this issue, multidisciplinary experts propose several recommendations. Ensuring that all pharmaceutical companies produce quality medicines by requiring bioequivalence studies is crucial. Although challenging, employing registered pharmacists aims to ensure that pharmacies are staffed by qualified professionals.
Some experts recommend a comprehensive reform of the health sector in Bangladesh. While this is a good suggestion, it requires strong political will, courage, a clear action plan, and leadership. Rather than waiting for uncertain, comprehensive reforms, the government can take immediate steps to mandate the use of generic names in prescriptions. This could be implemented gradually, starting now.
Simultaneously, an awareness campaign to educate healthcare professionals and the public about the benefits of writing generic drugs into prescriptions is essential. Incorporating this practice into medical education curricula is also crucial. If included in medical curricula, future doctors will adopt this practice and mindset when providing healthcare services.
In conclusion, the debate over prescribing brand names versus generic names in Bangladesh is complex, involving issues of cost, quality, and influence. While challenges exist, immediate steps towards mandating generic prescriptions and ensuring drug quality through bioequivalence tests can pave the way for more affordable and fair healthcare, particularly for low- and middle-income groups.
Saikat Biswas is a development practitioner.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
