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By Sherryl Anne G. Quito, Senior Reporter
SOME people addicted
to conspiracy theories are beginning to ask: Did the pharmaceutical
lobby insert the generics issue as an apple of discord in the House
of Representatives’ Cheaper Medicines Bill?
The issue made the doctors and their Philippine
Medical Association so mad that they threatened to go on
strike—though they called it a “holiday.”
An amendment to the existing, two-decade old
Generics Drug Act—the enforcement of which the Department of
Health describes as “dismal”—is preventing the bicameral
conference committee of the Philippine Congress from coming up with
the unified version of the Cheaper Medicines Act (or if the Senate
title is retained, the Quality, Affordable Medicines Act).
President Gloria Arroyo wants to sign it into
law as soon as she gets it.
The generics provision is sponsored by Iloilo
Congressman Dr. Ferjenel Biron. He is being accused by detractors
supporting the pharmaceutical lobby of sponsoring the amendment
because he was the top honcho of a leading generic medicine
manufacturing company.
The Biron provision would amend the existing
Generics Act of 1988 and the Pharmacy Law to require doctors to
write only the generic names of drugs in the prescriptions they give
their patients.
First in Asia
The Philippines is the first country in Asia to
enact a Generics Drug Act. It was the government’s first
legislative move to provide greater access to safe and affordable
medicine. The Generic Drug Act of 1986 allows the production of
unbranded drugs, using the same active ingredients and processes as
the ones used in branded drugs, thus bypassing the patent system.
The law makes essential medicines, such as
antibiotics, available at lower prices. A provision of the law
requires pharmacies and physicians to support lower-priced,
unbranded or generic drugs to solve the problem of millions of poor
Filipinos unable to buy expensive branded medicines.
After two decades, the consensus among health
sector people—and the public—is that the implementation of the
landmark Generics Act has been a great disappointment.
Defective law
“Enforcement has not been all that good. In
fact, it’s somewhat dismal,” says Health Undersecretary
Alexa-nder Padilla. He also says the law itself is defective,
because he sees it as bearing the mark of the strong pharmaceutical
lobby that insists on the right of doctors to continue prescribing
branded medicines.
“While the law compels doctors to issue
generic prescriptions,” says Padilla, “it also allows them to
continue prescribing the branded equivalent of their choice, the net
effect of which has been to nullify generics altogether, “ Padilla
explained.
Dr. Eduardo Banzon, a health economist, agrees
with Padilla that the Generics Law has suffered from weak
enforcement. While consumers are now familiar with the generic names
of several popular over-the-counter branded medicine such as Tylenol
(paracetamol) and Ponstan (mefenamic acid), he says that most people
still do not ask for the generic equivalents. “How we’ve
implemented the law hasn’t empowered consumers enough,” he says.
“We need to push for it more.”
But can a new Cheaper Medicines Bill really
lower the prices of medicine?
The Philippine Medical Association (PMA), the
national organization of medical practitioners in all areas of
specialization—is at the forefront of the menacing hospital strike
threat to fight the Biron provision.
PMA president Dr. Jose Sabili said that the
Cheaper Medicine Act is a positive development. But compelling
doctors to write only the generic name of medicine they prescribe
will put the health and safety of consumers at risk.
The doctors only want to remove Iloilo
Congressman Biron’s provision. The passage of the Cheaper
Medicines Law is okay by them.
Sabili explains, “The patient-doctor
relationship is based on trust. The medicines that we prescribe to
our patients are based on careful study of their illness and medical
history. Our paramount concern is their safety and we cannot
compromise this at all cost.”
In other words, even if a generic medicine is
exactly the same as the branded one that comes from the foreign
pharma company that they trust, the doctor must not be forced to
prescribe the generic.
Sabili contended that this provision “violates
the doctors’ rights to protect their patients” and take care of
their health.
The Cheaper Medicines Bill has been lauded as a
breakthrough that will lead to the lowering of the price of
medicines and encourage local drug manufacturers and distributors to
market quality and affordable drugs.
Most expensive medicines
The Philippines has the most expensive medicines
in Asia, the prices here next only to those in Japan. According to
the Philippine International Trading Corporation, the cost of
medicine in the country is higher by 40 percent to 180 percent than
other Asian countries.
As a result three out of five Filipinos get sick
without being able to see a doctor at all. In 2005, Filipinos
spending for medicines dropped by 2.2 percent while prices of
medicines went up by 10 percent, according to the PITC.
For many Filipinos, buying drugs accounts for as
much as 45 percent of the total health expenditures. Such a pattern
is not seen in the US where drug expenditure accounts for a much
lower 10 percent of health expenditures.
Citing an Asean survey, the PITC says the retail
prices of medicine in Indonesia, Malaysia and Thailand are 40
percent to 70 percent lower than in the Philippines. Five out of
every nine medicines in the Philippines cost more than in Malaysia
or Indonesia. Some, like one brand of antibiotic, cost more in the
Philippines than in the United Kingdom or Canada.
Former PITC President Roberto Pagdanganan says
generics they are as efficacious and safe as branded medicines. A
2003 study showed that the utilization of generic medicine in Poland
was 86 percent; United Kingdom, 60.06 percent; United States, 85.6
percent; Germany, 67.97 percent and Canada, 77.4.
In the Philippines today generics only
account for 10 percent to 20 percent of medicine sales.
Under our Generics Law, doctors are required to
write the generic name of a drug on the prescription. The branded
medicine that they prefer must be written inside a parenthesis.
“People feel that ‘cheap’ generic
medication is not going to do them any good so either they buy the
expensive stuff or don’t bother to take medication at all,”
Pagdanganan pointed out. Based on his experience with the PITC, he
said it is not poor quality that makes generic medication cheap, but
the add-on costs like marketing.
The PTIC, together with the Department of Health
and the Bureau of Food and Drugs, are at the forefront of the
government’s thrust to provide Filipinos with affordable medicine.
“In order to do that we need to be able to provide them with more
products and more venues or stores, as well as an educational
campaign that corrects their wrong assumption about ‘cheap’
medication,” he said.
But the pharma companies keep publishing adds
subtly suggesting that people must be careful with generic drugs
because, who knows, these might be fake or in other ways unsafe?
Generik Botika Inc., a very young and versatile
organization addressing the issue of the common people’s lack of
access to good medicines, said in a statement: “There are only
very few players from manufacturing to distribution in this 120
billion peso industry, where the multinational companies (MNC’s),
corner as much as 70 percent of the total market.
The pharmaceutical business grows by no less
than 10 percent every year either by price increase or volume. This
very lucrative business has been out of sight from local
entrepreneurs because of the many myths that haunts the mind of
prospecting investors.”
The local price of the leading mefenamic acid
product is P21.82 compared to P2.61 in India and P1.38 in Pakistan.
(Mefenamic acid under the brand name Ponstan costs P20.98 here, but
only P2.80 in India and P1.46 in Pakistan). A 5-mg anti-hypertensive
pill costs P44.75 in the Philippines. In South Korea, the same brand
costs only P22.25, while in India and Thailand, the pill costs only
P5.15 and P29.85, respectively. (an anti-hypertensive pill under the
brand name Norvasc costs P44.75 here, but only P6 in India). The top
anti-asthma drug sells for P406.75 while India and Thailand sells it
for only P83.88 and P230.54, respectively. While a drug against
respiratory tract infection costs P17.75 while it only costs in P.51
in India and P4.63 in Thailand.
The Philippine College of Physicians (PCP)
echoes the PMA’s concerns. In a statement, PCP said that
disallowing doctors to write a brand name will not make medicines
cheaper but will rather put their profession at risk because of
unqualified and uncontrolled substitution at the pharmacy level.
“We urge legislators to recognize that the therapeutic
equivalence, palatability and safety differ among the various brands
of prescribed drugs,” the statement said.
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