Access to Medicine in India

Access to Medicine in IndiaFor a wellness brass to be effective, footing of admission to medicines is a critical component. Hence, it is necessary that keen quality medicines ar available and affordable to the people. However, many countries and regions including India face some(prenominal) barriers in expanding access to medicines. According to WHO these includeInefficient and Iniquitous support Mechanisms over the years Indias man wellness dodge is instal to be to a lower place funded. This has conjureed several people to rely magnanimously on OOP to meet their wellness vex needs. Currently, the sh are of public to hole-and-corner(a) wellness disbursement in India is embed to be 14, in which medicates alone transmit with over 71% of all OOP consumption of households.Under-funded public health system turn occur awayed in acute shortages and chronic drug stock-outs at all levels of care making some(prenominal) poor and non-poor financially vulnerable. As a resu lt of this, poor populations are pulled even deeper into poverty (poverty-deepening), dapple a large number of above-poverty transmission line households are subsequently pulled below the poverty line e genuinely year. One can observe an extremely low public spending along with huge variation between states and across districts at bottom a state. From the data of 2010-2011 it is evident that in the states of Tamil Nadu and Kerala about 10-12% of health spending is towards procuring drugs. Where-as in states like Jharkhand, Punjab and Rajasthan it is only 2-3% of health spending that goes into drugs. though there is significant improvement in drug procurement in the state of Bihar overdue to steep rise in the allocated cash (NRHM) during the like period the per capita spending on the drugs is very(prenominal) less (Rs. 8 per capita). kick the bucket Drug PricesFrom a state of very gamy drug worths due to heavy imports in the pre-1970 era, with the aid of effective drug poli cies there was a rapid growth of the indigenous drugs companies which resulted in increased cropion of drugs twain the bulk drugs and the formulations. This has resulted in the improved local availability of drugs and relatively address with lowest drug footings in the world. But, due to the ineffective policy changes the reportage of drug price ascendancy has reduced from 90% of the grocery store in 1970 to 10% of the market in 1995. receivable to these relaxed regulations pharmaceutical industry took an receipts of reaping high profits through complex price setting activities. look for has shown that the price of a same pharmaceutical ingredient under a therapeutic category vary around atomic number 60% between the almost expensive and the cheapest grimes. Further, the variation between the market price and procurement price of similar drugs could range anywhere between 100% and 5000%. Effectiveness of price find is clearly demonstrated by the studies done in the ers twhile(prenominal) few years. From the study done by Sengupta et al. (2008) between the period of 1996 and 2006 it was found that there was nearly 40% increase in all drug prices. During the same period, there was a 0.02% rise in the price of promiseled drugs while the price of EDL (Essential Drug mention) drugs rose by 15%. Whereas, the prices of those drugs which were non controlled and were non included in the EDL increased by 137%. Hence, it is evident that the price control policies of the 1990s have resulted in significant increase of drug prices during the last 15 years.Defective and Incompetent procurement and Distribution SystemsAvailability of drugs in the public health system is vital element in enhancing the access to medicine in the country. Hence, along with adequate allocation of funds it is very important to have an efficient and reliable drug procurement system to maintain the availability and to avoid shortages and stock-outs. Several procurement mechanisms we re identified in different states in India. The states of Tamil Nadu and Kerala adopted a pooled procurement impersonate, Chattisgarh is future(a) a decentralized procurement system, whereas Bihar adopted a blend of the two. Over the last two decades the pooled procurement model of the Tamil Nadu Medical work Corporation (TNMSC) was found to be the most efficient, reliable and transparent model that was replicated in few other states. The different procurement models will be discussed in detail later in this section.Essential Drug List (EDL) also has its effect in enhancing the availability in the public health systems. It was found that the physicians prescribed and dispensed paradoxical drugs in the states where the procurement and dispersal systems did not follow EDL. This resulted in compromising the cost-effectiveness of procurement system which in effect resulted in shortage of drugs. In the state of Bihar during the period of 2008-09, out of 239 drugs procured, only 82 d rugs (34.89%) were found to be on the state EDL (both in-patient and out-patient). Procurement of these eighty two drugs consumed about 71% of the states cipher allotted for drugs. Form the overall states drug cipher 43% was spent on procuring rate contract*(Rate Contract is a contract for the supply of stores at specified rates during the period cover by the contract) drugs and the rest 57% was spent on procuring non-rate contract drugs. This showed that funds were not efficiently utilized in procurement of drugs which has its effect on the availability of the drugs in public health system.Widespread use of senseless MedicinesIndian pharmaceutic market is flooded with about 90,000 formulations with different brand names with uncertain distinction. As per the estimates from the Drug Control General of India (DCGI) in 2007 about 46 banned Fixed Dose Combination (FDC) drugs were creation sold in spite of the ban issued on them. It is the perquisite of DCGI to give the licensing ap proval for marketing of a drug, while the state drug controllers are only require to approve production and sale of these licensed drugs in the state. But the situation is different and the evidence shows that about 1067 FDCs are existence freely marketed with the approval from the state drug controllers, but without the consensus of the DCGI. Most of the study drug makers are involved in manufacturing and marketing the irrational medicines. For example, in the year 2004 alone around hundred in the buff drug FDCs were introduced into the market which contributed to the market share of Rs. 130 crore. Drugs manufacture in this way are to be sold to the consumers. Hence, manufacturing companies spend a large amounts in promoting the irrational cabals which ad up to the cost of the drug. This results in the physician prescribing these irrational combination violating the standard treatment guide lines and consequently increasing the cost of the prescription(prenominal) making du gs unaffordable and unapproachable. The evidence shows that during 2008-09 more than 25% of the industrys yearbook turnover was spent on promoting the manufactured drugs when compared to meager 7% on research and development.Stringent Product Patent RegimeAfter the cartel on Trade Related Intellectual Property Rights (TRIPS) since 2005, India changed its pharmaceutical indubitable policy from process patent to product patent. This brought a lot of funny furtherm in the price and access to medicine. The process patent enabled the manufacturing of most of the drugs and thus increasing the availability in the market at a very low prices. Change over to product patent has its own vested interests in creating a market monopoly for the manufacturers and giving them the whole and sole right to the manufacturer to sell the drug. This has created a barrier to access the drugs by making them unaffordable and inaccessible to the common population. These patented medicines do not even hav e well-nigh substitutes to treat the condition and hence, the consumer is forced to buy these patented medicines which are of high cost to meet the health care needs. These patented medicines are priced so high that even middle class people are far away from reaching these medicines. TRIPS its self provides the rights to the nations to safeguard and protect the nations public health by providing flexibility in patent legal philosophys in the form of dictatorial licensing. But India was not successful in utilizing the flexibility in the law until recently in 2012 where Natco pharma was given rights to manufacture the anti-cancer drug under the brand name Glievec patented by Bayers. Because of this the cost of the treatment has inject down from lakhs to aroung nine thousand and later Cipla also started selling the product at a cost of about six thousand.Insufficient investigate Development FocusUnder-funding of public health research institutions, alongside a general lack of foc us on priority diseases by private sector, hinders current drug research efforts in the country. The evidence shows that during 2008-09 more than 25% of the industrys yearbook turnover was spent on promoting the manufactured drugs when compared to meager 7% on research and development.1.3 Price control in IndiaPrice is an important component in determining the purchasing position of any good. This is true in case of most of the consumer goods. But, the prices of consumer goods like food, Pharmaceutical products (drugs), etc. with high public relevance are to be controlled in order to make them accessible to the general public. As mentioned earlier expenditure on drugs is the significant contributor to the total healthcare expenditure both in public and private healthcare. Studies also revealed high drug prices push households into poverty. Hence, drugs are one of the most important commodities whose prices are to be controlled in order to make them accessible.Drug price control in India has a long history. The first price control order was issued in 1963 in the wake of Chinese aggression to control the rising prices of drugs under the disaffirmation of India Act. Next in the year 1966 other order was issued by the giving medication introducing a system of increasing prices making it mandatory for the manufacturers to obtain approvals in the first place hiking the prices. Drug price control order 1970 was a mile lapidate in bringing down the price of essential drugs by keep the excessive profits and safeguarding the interest of consumers. Simultaneously, the product patents in 1970 brought an era of cheaper drugs in India. Since then DPCO was amended four times the last being in 2013. In 1979 DPCO was issued to fix the maximum sale price of the pharmaceuticals based on the supposition of Maximum Allowable Post manufacturing Expenses (MAPE). In this 347 drugs were under control which were categorized into four categories, lifesaving, essential, less ess ential and non-essential drugs respectively. Later, in the year 1987 another amendment was made in the wake of drug policy 1986 where the number of drugs control were cut down to 142 with reducing the categories into two and increasing the MAPE to 75% and 100% respectively. Later in 1995 the number of drugs under control were reduce to 74.Due to the increase in the prices of medicines government took a decision of forming a be of experts to deal with the fixation of medicine prices which resulted in the National Pharmaceutical price Authority (NPPA). This authority was also given the task of reviewing the list of essential medicines which should come under the price control and also monitor the prices of drugs which are not under control. NPPA came into effect and became fully functional with effect from twenty-ninth Aug. 1997. Last amendment DPCO 2013 was made after several hurdles when government of India notified the new National Pharmaceutical Pricing policy (NPPP) 2012 which i s based on the concept of market based pricing. The main objective of the policy as give tongue to in the gazette released is .to put in place a regulative framework for pricing of drugs so as to ensure availability of required medicines essential medicines at reasonable prices even while providing sufficient opportunity for innovation and competition to support the growth of industry, there by conflict the goals of employment and shred economic well-being for all.According to this, ceiling price of a drug would be determined by adopting the simple median(a) price of all the brands having market share (on the basis of moving annual turnover) more than and twin to 1% of the total market of that medicine. Now the manufacturers would be free to fix any price below or equal to the ceiling price. This claims to reduce the prices of drugs and make the medicines available and affordable which may not be true in the practical sense.