Pakistan is a country where 7.3 out of 1000 people die every year because of non availability of medicines. In the world, medicines play an important role in health systems; however one third of the world population does not have access to essential medicines. We probably have no idea how much medicines really cost. But it can be a lot. Some drugs that have been around for ages are very cheap – aspirin, for instance, costs pence. It’s been out of patent and made by numerous companies competing to undercut each other’s price for decades. But new medicines, protected by 20-year patents, can cost hundreds of rupees a packet and sometimes thousands.
There is an urgent need to ensure that everyone has access to quality treatment at affordable costs. Therefore, among several interventions, one method to control health-care costs is to make sure that medicines are reasonably priced and affordable to the general population. However, affordability of medicines seems to be of low importance to policy makers in Pakistan. In recent months, prices of hundreds of essential and life-saving medicines have increased greatly in Pakistan, making them unaffordable to residents with low and middle incomes. For some of these medicines, a price increase of over 100% has been observed. For example, the price of the frequently prescribed antispasmodic drotaverine has increased by 218%, while that of commonly used cough syrup dextromethorphan hydrobromide, chlorpheniramine, and pseudoephedrine increased by 105%. Additionally, the price of an injection of vitamins B1, B6, and B12 increased by 85%.
Numerous medicines have recently increased in price over 2–3 months, making them unaffordable for patients. The situation is getting out of hand for the people of Pakistan because there is no national health insurance, and most of the health-associated expenditure is an out-of-pocket expense.
A major reason for this uncontrollable price hike is the unsatisfactory performance of the Drug Regulatory Authority of Pakistan (DRAP) and other associated agencies. Medicine prices in Pakistan were officially permitted by DRAP to increase four times between June and August, 2016; however, pharmaceutical companies ignored DRAP's notification and instead raised the prices five times over the 3 months. Shockingly, this illegitimate increase in price was not acknowledged or acted upon by DRAP in Pakistan. Despite the fact that the Ministry of National Health Services, Regulations, and Coordination (NHSRC) admitted that the medicines of some multinational companies were overpriced, no action was taken. Notably, the issue of the price increases was highlighted at the federal parliament of Pakistan in February, 2016, whereby the parliamentarians instructed NHSRC and DRAP to take strict action against pharmaceutical companies who were plundering the masses by increasing prices of medicines unilaterally. Furthermore, a subsidy of medicines that had increased in price was proposed. The price hike was strongly condemned and the Senate's Standing Committee on National Health Services, Regulations and Coordination instructed that no second chances should be given to these companies.
However, no action was taken and patients were left at the mercy of the pharmaceutical companies, so they had no choice but to pay exorbitant prices for medicines that were affordable just a few months before.
Within this context, surely pharmaceutical companies in Pakistan are using various tactics to avoid scrutiny from the regulatory authorities. At the same time, the leniency of the regulatory authorities is also evident. It is time for health authorities in Pakistan to start learning from past experiences. An amendment in the relevant schedule appended to the Drug and Pricing Act is needed that will allow the government to place stern policies on price control, and actions to be taken in case of illegitimate price hikes. Instead of listening to the demands of the pharmaceutical industry, the Pakistani Government should start listening to the people, who are now faced with unaffordable medicines.
A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. These similarities help to demonstrate bio equivalence, which means that a generic medicine works in the same way and provides the same clinical benefit as its brand-name version. In other words, you can take a generic medicine as an equal substitute for its brand-name counterpart. Generic drugs are allowed for sale after the expiry of the patent of the original drugs. Because the active chemical substance is the same, the medical profile of generics is believed to be equivalent in performance. The generic drug has the same Active Pharmaceutical Ingredient (API) as the original, but it may differ in characteristics such as manufacturing process, formulation, excipients, color, taste, and packaging.
Although they may not be associated with a particular company, generic drugs are usually subject to government regulations in the countries in which they are dispensed. They are labeled with the name of the manufacturer and a generic non-proprietary name such as the Adopted Name or international non-proprietary name of the drug. A generic drug must contain the same active ingredients as the original brand name formulation. In Europe, the Food and Drug administration’s requires generics to be identical to or within an acceptable bioequivalent range of their brand name counterparts, with respect to pharmacokinetic and pharma co dynamic properties. When the product coming into the market and the generic medicine get short then manufacturers, wholesalers, insurers, and drugstores do all increase prices at various stages of production and distribution. Although this act disturbs a huge number of people of the thickly populated countries like China, India and Pakistan. Although this is a harsh situation and it should be according to a regulatory constitution sufficiently.
In 2014, according to an analysis by the Generic Pharmaceutical Association, generic drugs accounted for 88% of the 4.3 billion prescriptions filled in the United States. Although it’s a healthy momentum of low price benefit towards the required drug and it is a pure question of literacy rate of a country which purely help the people to ask for the second best option according to their wealth standard.
Large pharmaceutical companies often spend millions of dollars protecting their patents from generic competition. Apart from litigation, they may reformulate a drug or license a subsidiary (or another company) to sell generics under the original patent. Generics sold under license from the patent holder are known as authorized generics. Thus just like brand name medicine, generic medicine must perform the same in the body. This standard applies to all generic medicines. A generic medicine is the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, as well as in the way it is taken and the way it should be used. Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines. The Food and Drug Administration Generic Drugs Program conducts a rigorous review to make certain generic medicines meet these standards, in addition to conducting 3,500 inspections of manufacturing plants a year and monitoring drug safety after the generic medicine has been approved and brought to market.
It can dumbfounded to a person that India is a leading country in the world's generic drugs market, exporting $17.3 billion worth of drugs in the 2017-18 (April-March) year. India exports generic drugs to the United States and the European Union. However, the industry has been promoted under a controversial policy that violates international drug patent rights, leaving it with an uncertain future, especially amid wider global criticism. Meanwhile, competition from neighboring countries and tightened regulation are also posing threats to the country's leading position in the generic drugs sector. Moreover the medicine company use their attitude same with the doctors to fulfill their need in India accordingly.
According to the World Health Organization, 33% of the world’s population still does not have regular access to essential medicines. 74% of AIDS medicines are still under monopoly (under patents). 77% of Africans still have no access to AIDS treatment. The access to medicines in developing countries relies primarily on affordable generic versions of patented medicines.
It is important to note that there will always be a slight, but not medically important, level of natural variability—just as there is for one batch of brand-name medicine compared with the next batch of brand-name product. This variability can and does occur during manufacturing, for both brand-name and generic medicines. When a medicine, generic or brand-name, is mass produced, very small variations in purity, size, strength, and other parameters are permitted.
The value for death rate, crude (per 1,000 people) in Pakistan was 7.34 as of 2015. Over the past 55 years this indicator reached a maximum value of 20.72 in 1960 and a minimum value of 7.30 in 2017.
I strongly appeal to World Health Organization to kindly focus on these monopoly medicines. Kindly take these medicines out of monopoly and make the world a healthy world for those people who are dying on daily bases due to not having sufficient funds programs for country level and not having personal funds to cure themselves from these diseases. Pakistan is a full of poor health population. Doctors should do very much care after recognizing the patient’s wealth condition they should depend upon a generic medicine but they feel proud to write a costly medicine for the patient to precure their visiting fee. It is a psychology; patient feels he is investing more money to cure hiself he feels he is doing exceptionally well for his own. Although the same cure can be performed by a low price formulated (generic medicine) for his better health.
