Drugs’ price control: Look for ways to minimise disadvantages rather than rejecting it outright

During the last two to three decades successive governments, their health ministers and health authorities were criticised for not controlling the prices of medicinal drugs in Sri Lanka. So much so that some believe this paved the way for the defeat of a powerful President of the country. On October 21 , an extraordinary gazette notification was made by the incumbent Minister of Health listing the maximum retail price of 48 medicinal drugs. Within days roles reversed. The media is full of material criticising price control of drugs now. Those who castigated branded drugs for their exorbitant prices have started to highlight the virtues of branded drugs (see page 8, Sunday Times, October 30).

Those who were already using low cost generic drugs are disappointed that their drug bills are not slashed as promised. Media who criticised the government for delays, now complain why this new mechanism was brought in a hurry without much discussion! Some think an alternative proposal made by Prof. Balasubramanium would have been better. Vociferous critics want to have the cake and eat it too.

Although Karl Marx was voted as the greatest thinker of the last millennium by BBC listeners over Albert Einstein (second) and Isaac Newton (third), most countries in the world today practise open market economic policies to varying degrees because controls promote corruption and inequality. However one may argue that medicinal drugs are a special group of consumables where such equations should not apply. I am sure those who devised the present mechanism to decide on a maximum retail price for medicinal drugs would have taken into consideration many of the ramifications of the process diligently. Therefore what we need to do now is to look for avenues to improve the proposed system minimising its disadvantages rather than criticising and rejecting it outright. Then the process would evolve into a mechanism which could resolve most of the contentious issues and society at large will be the final beneficiary. We may even develop a model that can be used by other developing countries with success. Looking at it with negativism, impatience and hatred will only worsen the situation.

Reducing the cost of drugs at the user level should be a multi pronged process. The effect of having a maximum price is just one aspect only. Already the government has informed that a quality control laboratory for drugs will be established in the country shortly. We need to follow this up as it is a much needed prerequisite to provision of quality drugs at a low price. Another important aspect of minimising the cost of drugs is to educate all stake holders about the importance and relevance of minimising the final cost of medicinal drugs to the patient. Medical personnel and media must continuously devote time and space to educate all stakeholders including pharma companies on this. The pharmaceutical industry is a hugely profit-making industry the world over and some of these giant companies are known to behave selfishly to boost their profits at the expense of helpless patients. However it is the mem- bers of the same fraternity who invest in new inventions, produce cheap alternatives and make us live longer. Therefore it is important to engage them constructively to further the cause while being aware of their scandalous behaviour.

Avoiding prescribing unnecessary drugs is also an important step in reducing the cost of drugs. In this regard, not only doctors are at fault. It is common for the patients to ask for some tablets when they are told that they do not have an illness requiring medicine! Many others do not pay attention to lifestyle measures (avoiding obesity, alcohol and smoking; having adequate rest when sick) but rely on doctors and medicinal drugs to solve their problems. Some go to the extent of believing that expensive drugs are better than cheap drugs as a rule of thumb.

According to the National Medicines Regulatory Authority Bill enacted in Parliament in 2015, every medical practitioner should write the generic name of the medicine in every prescription issued by him. While implementing this clause, we can allow Rajya Osusala outlets to have a special counter to sell branded products above the maximum retail price for those who really want it and can afford the price.

Another point of contention is allocation of funds by pharmaceutical companies for use by doctors. Many of the proponents of price control of medicinal drugs assume that it would minimise this omnipresent scourge. In a world full of consumerism and commercial interests this can never be eliminated completely. It will be like expecting a newspaper to be published without advertisements promoting products having a negative effect on health! However medical doctors and institutes are expected to abide by a special code of ethics. Hence it is important to make the process transparent. One way to make this funding process transparent is to make it compulsory for the pharmaceutical companies to declare the funds allocated to all recipients publicly. We can have a link to a webpage from the National Medicinal Drugs Regulatory Authority website so that those who are interested can judge on any possible conflicts of interest. At the end we must remember that expecting a utopian society is only asking for disappointment and unhappiness. Dr. Anuruddha Abeygunasekera Kalubowila