Jan Aushadhi and affordability and accessibility of medicines in India

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The pharmaceutical industry in India ranks third in the world in terms of volume and 14th in terms of value. According to the Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, the total turnover of India’s pharmaceutical industry between 2008 and September 2009 was US$21.04 billion. Hyderabad, Mumbai, Bangalore, Visakhapatnam and Ahmedabad are the major pharmaceutical hubs of India. The domestic market was worth US$13.8 billion in 2013.

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Branding pharmaceuticals in India is somewhat controversial because each formulation with single or multiple ingredients, such as a fixed dose combination (FDC), is available under multiple brand names. One of the main causes of the variety of brands arises due to the fact that multiple licensing agencies, for example, each state-wise drug control department are able to grant licences for branded medicines. These licensed brands are then eligible to be sold across India.

On the other hand, there is no quantitative definition for generics in India. The descriptive nature of the interpretation of generics is usually misleading and confusing. For example, generics may be any formulations that are available at the lowest price among similar products in the market. Such products are usually sold in bulk packaging, for example, 500 to 1,000 tablets in a jar. Marketing for generics is limited and they are labelled with the name of the active pharmaceutical ingredient, for instance, aspirin is labelled as Aspirin IP and amoxicillin as Amoxicillin IP.

In 2008, the Government of India enacted the Jan Aushadhi Act. The main objective of this act is to provide quality medicines at an affordable price and control the prices of branded medicines. The Jan Aushadhi Act allows for products manufactured directly by the government to be made available for patients in exclusive Jan Aushadhi outlets. Medicines are available at a very fair price. For example, soluble Insulin IP (r-DNA origin) is available at 71 INR (US$1.102) for 10 mL, whereas branded soluble insulin cost 140 INR (US$2.173). Jan Aushadhi medicines are exclusively sold in 1,000+ Jan Aushadhi retail outlets, which is the major hurdle for accessibility to the Jan Aushadhi essential medicines for patients. Although the Indian Government has said that it aims to set up a 3,000 Jan Aushadhi pharmacies by the end of 2017 this compares to the 500,000 pharmacies already existing in India [1].

In India, the product-centric marketing was thriving where companies are focused on building the brand image for pharmaceuticals in a similar way to fast-moving consumer goods. The modus operandi is to focus on prescribers by making the products attractive and by promoting and luring prescribers using unethical means. Prescribers were paid kickbacks and gifts in order to prescribe specific brands. This scourge of irrational prescribing has caused great suffering and has caused healthcare practices to make medication errors and duplications in prescriptions as a result of the ‘look alike and sound alike’ brand names.

The rationality of prescriptions was never questioned and there was no auditor or documentation. Now, the Government of India has made it mandatory to write all prescriptions using generic names.

Public health bodies and health consumers in India are impressed by the Jan Aushadhi scheme. However, medicines should not be compared with fast-moving consumer goods, the quality, efficacy and safety of medicines, along with the price, are more important. It is very much evident that the private pharma industry has a huge capacity and is indispensable for the supply of medicines. Hence, the Government of India should develop an attitude to convince the pharma industry of the importance of medicine prices in the country from the viewpoint of affordability and accessibility. The Government of India should use more advocacy than regulation to help patients in India instead of confronting the pharma industry [2, 3].

Conflict of interest
The authors of the review paper [2, 3] declared that there was no conflict of interest.

Abstracted by Professor Anantha Naik Nagappa, SCS College of Pharmacy, Harapanahalli, India.

Related article
Indian Government to launch own brand of generics

1. GaBI Online - Generics and Biosimilars Initiative. Call to phase out branded drugs in India [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2018 Jan 5]. Available from: www.gabionline.net/Generics/General/Call-to-phase-out-branded-drugs-in-India
2. Nagappa AN, Kavya HB, Chikkamath V, Naik V. Brand v/s generic – value based pricing for pharmaceuticals in India. JOJ Case Stud. 2017;4(3):1-6.
3. Chikkamath C, Nagappa AN. Pradhan Mantari Jan Aushadi Kendra - demonetarization of medicine prices in India. J Gen Pract. 2016;6(4):1-5.

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