Proposed switch to generic drugs would improve transparency of medical system, say doctors

A proposal currently under review would allow doctors to provide medication directly from health centers, bypassing the prescription process which often leads patients on a wild goose chase around Male’s pharmacies.

State Health Minister Ibrahim Waheed yesterday announced that the proposal is being discussed with health corporations, and that prescriptions could be ruled out by next June at the earliest.

He further suggested that a large pharmacy would be established in every atoll hospital, and would supply products to other health centers across the atolls.

Health Minister Aminath Jameel reportedly did not respond to most questions posed by MPs regarding health corporations at a committee meeting yesterday. Speaking to Minivan News today she said the proposal fell under the ministry’s remit but that she did not have the details and was unable to comment.

Other officials and offices at the Health Ministry had not responded to phone calls at time of press.

Generic drug-based systems which include hospital-centered distribution are commonly practiced in other countries, sources say.

The World Health Organisation supports the use of generic drugs, particularly in developing countries.

In a speech earlier this year, WHO Director General Dr. Margaret Chan said, “Generic products are considerably less expensive than originator products, and competition among generic manufacturers reduces prices even further. Generics serve the logic of the pocket. An affordable price encourages good patient compliance, which improves treatment outcome and also protects against the emergence of drug resistance.”

CEO of Indira Ghandi Memorial Hospital (IGMH) Cathy Waters said the hospital had not been officially informed of the proposal, but noted that pharmacies were generally not well-stocked and that there were multiple available brands.

Medical Director at Male’ Health Service Corporation Dr Robert Primhak said he “would welcome an improvement in pharmaceutical supply and prescribe system.”

According to Primhak, doctors currently prescribe drug brands rather than generic medications. Shifting to a generic drug-based system would mean that a list of nationally-approved drugs would be available for the first time in hospitals, clinics and pharmacies, a “major improvement” that would improve the medical system’s transparency.

However, such a shift would also require “robust quality control” and a centralised import and supply system, Primhak said.

These reforms could take the edge off of the medical import and supply business.

“There’s no business advantage in stocking medications that are not commonly used,” Primhak explained. “For example, a baby who is born with a heart problem needs a specific drug to keep a vessel open. We might get that case three times a year. But instead of stocking these specialised drugs which are only rarely used, the retailers prefer to stock common drugs and brands that will sell, because they know that they can get a turnover.

“The drugs that are imported are the ones they want to sell, not the ones we want to prescribe.”

MPs yesterday voiced concern that the proposed system would incur huge losses for pharmaceutical importers.

Minivan News asked Primhak if medical decisions in the Maldives were driven by business interests and ought to be re-directed towards serving the people. “Yes, to both points,” he said.

Chief Operating Officer at ADK Hospital and former head of the Center for Community Health and Disease Control (CCHDC), Ahmed Jamsheed, believes the proposed change would engender a stronger monitoring system by default.

“The new system would move towards generic drugs which would make it easier to monitor drug quality and standards, and bring down the price,” he said.

It would also improve patient convenience. “Now, a medication prescribed by a doctor in ADK may not be available in the hospital pharmacy, so the patient has to hop around to different pharmacies to get the prescription filled.”

Jamsheed believes the change would benefit the Maldives’ medical system but agrees that the focus should be on people, not corporations.

“Currently, there is a big network of pharmacies, most of which are privately owned. It is known that most pharmacies are poorly monitored, and the authorities are unable to control them. Many prescription-only drugs not meant for over-the-counter sale are actually available to anyone who asks. That carries a huge risk for the patient community.”

Usually, Jamsheed said, a small country like Maldives only needs one or two sources for importing the drugs. But he said the MPs have a point: standardised markets don’t foster high profit margins. “But at the end of the day, the government has to consider whether the system is best for the country and its people,” he observed.

Under the proposed 2012 state budget, Rf2 billion is allocated to the health sector; Rf638 million of that amount is to be used for developing mechanisms providing easy access to health care. Another Rf543 million is designated to developing atoll health centres under Public Private Partnership.

The budget also allots R720 million to the universal health insurance scheme, due to take effect in January 2012, while Rf100 million is to be spent on health corporations’ capital investments, which are made to improve their services.