Most of the following information comes from Mr. Gurbani, a former secretary of the Essential Drug List Committee for the Rajasthan state government.
Something is moving in India regarding access to medicines. In 2011 the northern Indian state of Rajasthan began supplying free generic drugs to its 68 million people. The program aims at ending price manipulations of private pharmacies and manufacturers in coalition with some doctors. Tamil Nadu, a state of 72 million people, is also providing free medicine for all. Karnataka state is also building on these models.
As more than 350 essential generic drugs are being distributed free of cost to over 200.000 people. As a consequence the number of outpatients has increase by 60 percent and inpatient admissions are up 30 percent, despite public health facilities are overcrowded and understaffed, and many people have to travel long distances to reach one.
The Rajasthan program means to be a pilot for a similar scheme throughout India.
Currently the access to medicines in India depends greatly on the kind of medicine prescribed by the doctor or recommended by the pharmacy. Many pharma laboratories produce different kinds of medicines with the same ingredients, though not always the same quality. Cipla, for example, produces three kinds of ‘cold’ tablets, with the same chemical ingredients. The generic drugs are sold to pharmacies at a wholesale price of about 0.03 US$ per ten-tablets-pack but sells the branded drugs for 0.42 US$ per pack. Chemists sell all three drugs for anything between 0.50 to 0.72 US$ as per the printed price. Patients with lifelong conditions like diabetes or heart disease – have great difficulties to buy their medicines. As an example, a particular brand of medicine used for diabetes costs 2.17 US$, but 10 tablets of the same generic medicine can be bought for 0.036 US$. The difference in pricing does not depend on the efficacy and quality. To fight this practice, the government buys generic drugs directly from the manufacturers and hands them over to patients through the 13,874 (approved) drug distribution centres.
In India medical expenses are the second most common cause of rural indebtedness. The expenditure on drugs alone constitutes between 50 to 80 percent of healthcare costs. More than 40 percent of those hospitalised in India needed to borrow money or sell assets in order to afford treatment, pushing 35 percent of patients below the poverty line. Unaffordable healthcare has prevented over 23 percent of the sick from consulting a doctor.
India considered as the “world’s pharmacy” has the third largest pharmaceutical industry in the world. In 2012 it exported medicines worth 13.2 billion dollars and domestic sales amounted to 12 billion dollars. Yet two-thirds of the population do not have regular access to essential drugs.
To move towards universal health coverage (UHC) by 2017 and provide free drugs to 52 percent of the population, India has budgeted nearly 55.9 million US$ to fund the programme. The central government will fund 75 percent of the programme, with states delivering out the rest. India’s proposed Universal Health Care plan contains a centralised procurement, regulations to ensure that doctors prescribe cheap generic drugs rather than branded medication, a list of “permitted” drugs and distribution limited to official government health centres.
Despite the enthusiasm there are serious challenges to expanding the programme nationwide. The public health system is under-resourced and will have difficulty to face the universal health coverage (UHC). Some states may have difficulties to implement the program for lack of infrastructures and it will be difficult to test the quality of drugs between the 12.000 medicine manufacturers in India.