Healthy Skepticism Library item: 8

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Publication type: news

Dobade G
Drug price control: no relief for poor
Deccan Herald 2003 Dec 09

Full text:

The number of drugs under price control has come down drastically over the years, seriously affecting public health

In the last few months the media has been so much seized with the issue of substandard and “spurious medicines”, including the sensational news about death penalty for spurious medicine manufacturers that major issues concerning medicines seem to have been totally sidelined. In fact the issue of medicine pricing is much more scandalous and invites equal or even much greater attention.

Medicine pricing and its policies have only at times attracted global media attention. The best known example is that, when an Indian drug company, Cipla brought down the prices of the much needed medicines for AIDS/HIV. The price came down from $1000 per person per year to just $ 350 per person per year.
Even at these prices it has been guessed that Cipla would have made a profit of 200 %. This act by an Indian drug company exploded the global myth (often perpetuated by giant multinationals drug companies, most of them being American and Europe-based) that good and quality medicines cannot be manufactured at low prices. The need for these medicines is immense and urgent as in Sub-Saharan Africa where the disease is rampant.

Though India has contributed its might to the global challenges of medicine pricing, back at home in India the picture is not one of contentment especially for the common man and the poor. Because with decreasing government spending on health, increasing deregulation of drug prices, the private expenditure on health has increased tremendously.

Foothold of equity
The National Pharmaceutical Pricing Authority (NPPA) set up in 1997 was established by Government of India to monitor the compliance of the DPCO (Drug Price Control Order). It is observed that through these bodies in general the number of drugs under price control over the years has come down drastically.

The concept of Essential Drugs was realised by the World Health Organisation during the year 1977 and was strongly based on the foothold of equity which is central to public health and ensures that the people who need the drugs the most are not denied access to them. This concept has been widely applied and many developing countries have drawn up their Essential Drugs lists. Essential Drugs are those that satisfy the health care needs of the majority of the population; they should be available at all times in adequate amounts and, in appropriate dosage forms, with assured quality and reliable information, and at a cost that the community and individual can afford.

This concept of Essential Drugs of WHO is extremely relevant in the Indian context, where millions of people within this country are the below poverty line and many more around it. Medical care has emerged as the second commonest cause of rural indebtedness. And also it is estimated that major part of the family’s expenses on drugs and diagnostics goes to non-essential or hazardous medicines.
This is estimated from 60% (the most conservative) to over 90%. Given these situations it becomes extremely important that the government implement the Essential Drug Policy on the guidelines of WHO. The pricing of drugs should not be left to market forces.

Half-hearted gesture
Let us look at the DPCO of 1995, in which the Government of India came out with a list of drugs for price control in response to the various emerging public health problems. Unfortunately the DPCO does not dwell on these major health issues, but on the other hand the list includes drugs that are useless and even some hazardous ones. For example the DPCO does not mention any price regulation drugs for iron deficiency anaemia, HIV/AIDS, filariasis, coronary artery disease, rheumatic valve heart disease. It also does not mention price regulation for oral rehydration salts, cancer drugs and many vaccines (for rabies etc). It also looks half-heartedly at TB by including just one drug (which is Rifampicin)!

The list on the other hand contains many drugs which are totally unessential like Vitamin E, Vitamin B2, Naproxen (an outdated pain killer) and Sulphadimidine (an outdated anti-infective) so on so forth as the list is quite exhaustive. To add to the misery the list includes even few drugs like Analgin (a pain killer) that are even hazardous.

Successive DPCOs from 1979 onwards have only reduced the number of drugs under price restriction. During 1987 the number of price controlled drugs were 142 and was reduced to 76 in 1995 and in 2003 it is expected to slump to a mere couple of dozens, the reason being that there is immense pressure from drug manufacturers. These companies have a good excuse, as the Government of India has to change its patent laws by 2005. And the multinational drug companies are after the government to change its Patent Act, so that they can make more profits.