PGI doctors prescribing non-generic drugs not available at govt-run stores

Tribune News Service

Naina Mishra

Chandigarh, September 7

Despite launch of the Jan Aushadhi Scheme (JAS) by the Government of India offering cheaper drugs, doctors at the PGI continue to prescribe non-generic medicines, which are often not available at these centres, aggravating the plight of patients who have to visit private drug stores in and around the campus to procure the medicines.

Margin at play at premier institute

• Owing to ‘nexus’ with private pharmacies, doctors often prescribe branded medicines, instead of generic ones, that are available only at select shops
• Private chemists stock up brands offering higher margins, thereby compromising with quality of medicines, apparently seen in deaths linked to Propofol batch
• Private chemists pay hefty rents on the PGI campus vis-à-vis government-run stores, suggesting their role in pushing branded drugs
• In 2017, the UT Health Department had asked the doctors to prescribe only generic medicines, but it seems to have failed to deter them from prescribing branded medicines to patients

Amid five deaths at the institute on September 1 following use of an anaesthetic procured from a private chemist on the campus, the practice seems to continue unabated, hinting at an alleged nexus between doctors and private pharmacies, which influence prescription of medicines by doctors.

At the time of surgery, doctors further provide a long list of items to be procured from pharmacies. These are mostly not available at the subsidised medical stores, forcing patients to fetch these from private chemist shops.

Pvt players pay hefty rent

• Emergency Block store Rs 1,57,31,297
• New OPD Block store Rs 35,51,786
• APC chemist shop Rs 11,35,000
• NSC chemist shop Rs 8,11,000

Rent paid by Amrit Pharmacy

• ATC pharmacy Rs 2,22,328
• AEC pharmacy Rs 1,27,500
• Ramp B store Rs 99,250
• New OPD store Rs 80,783
• ACC pharmacy Rs 77,017
• APC pharmacy Rs 39,500

While the PGI has Amrit (Affordable Medicines and Reliable Implants for Treatment) Pharmacies and Jan Aushadhi stores, patients are left with no option but to buy medicines from private pharmacies due to non-availability of medicines at the subsidised stores.

However, some doctors from the institute say generic drugs are of poor quality and do not have the required composition needed for effective treatment. “In order to benefit patients, the government needs to get involved and cap the price of essential drugs by including branded medicines as well in the list,” said a PGI doctor.

Available at certain stores

Some doctors prescribe branded medicines available at particular pharmacy only. A robust mechanism is needed to ensure patients get drugs at affordable rates from Amrit Pharmacy. —A senior PGI doctor

Generic drugs of poor quality

Generic drugs are of poor quality and lack required composition for effective treatment. Government needs to step in and cap price of essential drugs by including branded medicines. —A PGI doc

“Last week, my mother underwent surgery to remove kidney. I had to purchase surgical items from a private chemist for Rs 3,000 as some of the items were not available at Amrit Pharmacy,” said a patient.

Sources say there is a “cozy nexus” between medical practitioners and private pharmacies. Branded medicines offer hefty margins on the maximum retail price (MRP). Many a time, doctors prescribe branded medicines, instead of generic ones, that are available only at select shops.

In 2017, the UT Health Department had asked doctors to prescribe only generic medicines in their prescription card to end the practice, but it seems to have failed to deter them from prescribing branded drugs. There are seven Amrit Pharmacies, two Jan Aushadhi stores and four private chemist shops on the PGI campus. Six more private chemist shops are currently vacant and not in use at the PGI.

The Amrit Pharmacy network offers drugs, implants, surgical disposables and other consumables at average discounts of up to 60% of the MRP. Patients going to private chemists are often charged MRP. Launched in 2008 by the Department of Pharmaceuticals, the JAS initiated by the Centre seeks to make generic medicines available at affordable prices.

Private chemists are paying hefty rents on the PGI campus vis-à-vis government-run stores, suggesting their role in pushing branded drugs with higher profit margins.

“A file was moved to replace a private chemist shop at the Emergency centre, paying Rs 1.57 crore rent, to get it replaced with Amrit Pharmacy, but no action was taken," said a senior PGI doctor.

“There is no denying the fact that some doctors prescribe branded medicines available at a particular pharmacy only. A robust mechanism is need to ensure patients get drugs at affordable rates at Amrit Pharmacies itself,” the doctor added.

Another doctor said: “The PGI drug committee selects 6-7 brands of quality drugs and ensure these are stocked by pharmacies. The institute can ask Amrit Pharmacy to stock up these brands only.”

Private chemists stock up brands that offer higher margin and thereby compromising with the quality of medicines, which was apparently seen in the case of Propofol. “Private chemists should be evicted from the PGI. Their touts even discourage patients from going to Amrit Pharmacy and suggest them to visit their shops,” the doctor added.

Asked why doctors are reluctant to prescribe generic medicines, which are easily available in government-run stores, and what steps the institute is taking to ensure adequate availability of medicines at Amrit Pharmacy, PGI Director Prof Vivek Lal chose not to comment.

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