Branded medicines over generic: How the market is putting patients in a bind

Doctors prescribing branded medication instead of general medicine to patients has been a persistent issue. Clause 1.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, prescribes that every physician should, as far as possible, prescribe drugs with generic names. It is to be written legibly and preferably in capital letters and he/she shall ensure that there is rational prescription and use of drug. Similarly, as per the Medical Council of India (MCI) guidelines (2016) and National Medical Commission (NMC) advisory (2022), doctors must prescribe medicines by their generic names rather than brand names. 

For 26-year-old Lakshmi, a construction worker from north Karnataka currently residing in Uttarahalli in Bengaluru, finding medication for her three-year-old who had a viral infection became Herculean task. The reason was that a brand of medicine prescribed by a general physician in the area was not available in any of the neighbourhood medical stores.

“My daughter had a fever and cold for which the doctor prescribed syrup and injections. While we got most of the medicines, one syrup was very hard to find. My husband went to at least eight medical stores in the area and it was not available. After three days we went back to the doctor saying it was not available, and he changed the name of the medicine. We got it immediately,” Lakshmi said.  

Doctors prescribing branded medication instead of general medicine to patients has been a persistent issue. Clause 1.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, prescribes that every physician should, as far as possible, prescribe drugs with generic names. It is to be written legibly and preferably in capital letters and he/she shall ensure that there is rational prescription and use of drug. Similarly, as per the Medical Council of India (MCI) guidelines (2016) and National Medical Commission (NMC) advisory (2022), doctors must prescribe medicines by their generic names rather than brand names. 

To tackle the issue, the NMC, India’s regulatory body guiding medical professionals, has been constantly issuing guidelines to doctors. A notice by the NMC in 2023 said that doctors must prescribe drugs with generic, non-proprietary, pharmacological names only, but in the case of drugs with a narrow therapeutic index, biosimilars, and similar other exceptional cases, this practice can be relaxed. The notice also advised hospitals and local pharmacies to stock generic drugs, prescribe only those generic medicines that are available in the market and accessible to the patient. It also advised encouraging patients to purchase drugs from Jan Aushadhi Kendras and other generic pharmacy outlets. 

However, despite multiple guidelines and notifications doctors and clinics are continuing to prescribe branded medications, said many patients and attenders from across the city that The Hindu spoke to.

Anil B., a resident of Sarakki, said that he found his mother struggling to find medicine prescribed by a general physician and the issue was resolved only when he intervened. “My mother had fallen sick recently and went to the doctor herself as all of us at home were busy with a family event. A week after the event, she continued to be sick, and when I asked her what happened she said she was not able to find a tablet the doctor had prescribed. She mentioned that she went to two of our regular pharmacists and was not able to find it,” he said. 

He looked up the medicine on the internet and found out that it was a regular antibiotic for cold. “I got the combination of the tablet and went to a pharmacy and immediately got it for her. It is very difficult for older or uneducated patients to find medicines that are new or do not have a generic name. Sometimes, I am away from family, travelling for months, and it is worrying to know that medicines are not easily accessible for my parents,” he added.