As a reporter covering the passage of the then “Cheaper Medicines Bill” in 2007, one of the contentious issues that I had to follow during the congressional debates was the provision disallowing doctors to write brand names of medicines on prescriptions. The logic behind this, according to proponent lawmakers, was to give patients the option to purchase cheaper generic medicines and to increase awareness on the use of generic drugs.
Doctors’ groups, however, objected to this proposal saying generic drugs are not as potent and effective as their branded counterparts. Eventually, when the bill was passed in August 2008, the law required both private and public medical practitioners to use generic terminology in prescribing drugs but were given the option to include brand names “if so desired.” Despite some flaws that stakeholders pointed out, Republic Act 9502, at the very least, hoped to give poor families more access to cheaper medicines, a problem that has caused millions of Filipinos to remain sick or die of otherwise treatable diseases.
The Progress So Far
A lot has changed since the bill became law almost 10 years ago. Many pharmaceutical companies, despite being known for branded drugs, have branched out into manufacturing generic medicines which target lower-income families. Generic drug store chains also started to mushroom all over the country, with perks and other come-ons, such as free blood pressure reading, to entice patients to patronize and purchase generic medicines. It seems the law has made strides to achieve this goal. Just this March, the Department of Health (DOH) reported that 65% of drug sales across the country are of generic medicines.
But consumer watchdogs, a congressional oversight committee looking into quality affordable medicines, and even the Health Department say much still needs to be done. The Philippines still has one of the highest drug prices around the world. There are still millions of poor Filipinos who forego drug treatment because they cannot afford it. In particular, medicines for asthma, arthritis, diabetes, cancer, hypertension and kidney disease, as well as vaccines for flu and pneumonia remain expensive. That is why the Philippine Senate is looking at amending the decade-old law, to ensure that Filipinos can avail of the medicines they need.
The Generics Stigma
In truth, when one looks at the health care situation in the Philippines, the solution to disease treatment seems to be simple: use generic medicines, which are now widely available in the market, to treat diseases of poor Filipinos who cannot afford drugs or cannot sustain a treatment regimen. But why do many Filipinos still skip medication or go untreated?
One problem is still perception. While 6 out of 10 Filipinos now use generic drugs, there will still be reservations about the use of them. For one, some people think generic drugs are less potent than their original or innovator counterparts simply because generic drugs are mainly produced by less reputable pharmaceutical companies. Again, the good news is that more and more established pharmaceutical companies are manufacturing generic drugs, allaying fears that these drugs’ efficacy is compromised.
Another problem is sourcing. Drug busts or raids conducted by law enforcement agencies in the past yielded backyard factories repacking expired innovator drugs or revealed drugs made of starch that somehow make their way to small retail drug stores. To dispel this fear, the law has enshrined mechanisms for parallel importation of branded drugs that are manufactured at a fraction of the cost. (The perennial example of this is India, which manufactures say a drug for diabetes at P2.00, versus the same drug in the Philippines, which costs P50.00. Even if drugs were subject to standard duties, they would still come out way cheaper.) Amendments to the patent law have also allowed reputable pharmaceutical companies to produce generic drug counterparts which they couldn’t otherwise do under stricter intellectual property regulations. Resolving the problem of sourcing means restoring more confidence among consumers in the use of generic drugs.
One last problem is awareness. While there are now more and more advertisements on television, print, and radio about the prevalence of generic drugstores or medicines in the country, many still do not seem to know how readily available generic drugs are and how invaluable they can be in disease treatment and maintenance courses. One solution being proposed by the DOH and some lawmakers in their meeting earlier this year is to institute the generics-only prescription and dispensation of drugs by both private and public healthcare professionals --- the contentious provision that was eventually stricken off in the 2007 cheaper medicines bill congressional deliberations. This will obviously spark another debate; but then again, this may be one of the more sustainable solutions to increase the use of generic drugs in the country.
To reiterate, generic medicines are drugs that are equivalent to branded drugs in terms of dosage, strength, quality, mode of administration and use and are manufactured after the patent of the original or innovator drug has expired. These days, however, generic drugs seem to have taken on a new meaning and have been re-invented as “branded generics.”
One of the working definitions of “branded generics” is that they are off-patent drugs that are manufactured as equivalents of existing branded medicines, but more importantly, they are marketed by a known pharmaceutical company, with all the quality and reputation that come with the company name. “Branded generics” can also be live or current patent drugs, whose manufacture have been authorized by an innovator company, even before the patent for the drug has expired. Loosely put, branded generics are common, non-innovator drugs that have basically been lent a pharmaceutical company’s trustworthy name.
The branded generics market emerged around the world as a consequence of laws that protect the patents of innovator drugs or mandate generics-only prescription of medicines, among other regulations. While initially seen among pharmaceutical companies as a threat to the industry, it is now perceived as an opportunity to reposition oneself in the market and as a way of generating more revenue. Top drug-makers are now producing drug maintenance lines for hypertension, diabetes, or cardiovascular disease that are cheaper and yet as effective as branded medicines.
While generic drugs are obviously priced less, the rise of branded generics has stirred renewed competition among drug companies, pushing them to make cheaper high-quality drugs to attract Filipino consumers. This new competition gives an opportunity for pharmaceutical companies, whose sales have otherwise been affected by stiffer regulations, to recapture the drug market. In a way, branded generics have provided a win-win solution for both the Filipino patient and the drug manufacturer, both of which need to “survive” --- one from a disease and the other from revenue losses.
Relying on generics alone, however, may not be enough to guarantee affordable drug pricing. While most countries aspire to reach a market economy status, government intervention is needed to ensure the rights of individual citizens and businesses. Intellectual property laws, while they may be pro-innovation and beneficial to inventors, may impede the realization of quality, affordable and accessible medicines for all.
Meanwhile, price control mechanisms imposed by governments to regulate medicine prices may result in losses for small and medium scale drug retailers. In the end, all stakeholders in the healthcare system must chip in not only to make the drug industry healthy but to ensure that Filipinos will remain fit and have access to safe and reasonably-priced medicines for years to come.