Re: improving access to medicines

[Guest guest]

Dear Madam,

One problem could be doctors writing rare brand names which are available only at selected pharmacies. When there is an emergency, it is like torturing the patient's attenders to get that particular brand of medicine.

Other could be lack of education. Patient might purchase and take antibiotic only for a day, or preserve left over medicines or future use.

Prescription, dispensing should be patient friendly.

-Anupama

From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Wednesday, 10 December, 2008, 10:00 PM

Hello All,

The last topic has ended on a very good note with the assurance that we as members of health care will finally be able to actively take part in giving meaningful health care. I would like to discuss access to medicines as a part of rational use of medicines.

Why this topic of access to medicines is being discussed?

There are several aspects which can be brought forth on this issue. In most economically developed countries the patients get medicines from national health services. It is the less developed countries where the access to medicines is a problem since the patients have to pay out of pocket for their health needs. And because of this reason the patients do not get the medicines that are needed by them.

But is price the only hindrance for accessibility? What other factors affect the accessibility of medicines to the needy?

Is it education, understanding, lack of proper procurement, distribution, storage or legal framework? I do not want to discuss the WHO stand, the national policies or the reports from net which are sometimes very impersonal. I would like to make this discussion a bit different. Give us findings from your own hospital, workplace, institution about the accessibility of medicines to the common man Let us have your own views, experiences, on this subject. And then probably we would come to some conclusion as to what is lacking and how it can be rectified.

kunda.

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[Guest guest]

Dear Dr. Kunda and Dr. AnupamaYour start is nice and you raised two important pointsThe prescription of rare branded medicines is not new to our community. Many patients face difficult in procuring such medicines which are available only in selected pharmacies (particularly those attached to a hospital or clinic)This might be due to the delights offered by the companies manufacturing the so called brands. Or the huge margins to the selected pharmacies offered by the companies may also tend create this problemAs Dr. Kunda told, it is right that many of the BPL people have not been issued the Cards that will be helpful for them not only in hospitals, but in many occasions. This might be due to frequent moving of the BPL families from one place to other. The issue of such BPL card by Central Government instead of State

Government may solve this problemIt is right that in most developed countries the public get medicines from national health services, or the insurance companies will pay much for the cost of medicines as well as tretment expenses. In developing countries like India, very less percentage of public are insured for their health and it is not possible to get proper medicines required and they have to pay from their pockets. But how many of the public are capable of paying from pocket. If they can, they will comprimise at some moment thinking that is it necessary to buy all the medicines. My father is running a pharmacy since 1985 and I observed many people asking me whether all the prescribed medicines are essential? or can they skip some of them. If enough awareness is created and insurance is provided many people will be benefited.One more thing is the patients particularly BPL people will not buy the total course of

medicines. Usualy they will ask medicines for 3 days even though the doctor prescribed for 5 or 7 days. They will use the medicines and if their problem subsides, they will not buy the further course of medicines. Hence the patients needs education in this aspect. Indian Pharmaceutical Association is conducting National Pharmacy Week celebrations every year in the month of November and we have celebrated in the last month on the topic "Ask Your Pharmacist: For Safe Use of Prescription Medicines". Many colleges all over the country participated and conducted various programmes on this theme.To my knowledge, the distribution and availability of medicines is not a problem in India. Since there a large number of brands available for each drug, one can get one or other brand in a pharmacy.Dr. SrisailamContact: Office: Dr. Srisailam Keshetti, Associate

Professor, Vaagdevi College of Pharmacy, Ramnagar, Hanamkonda, Warangal - 506001, AP, INDIA, Ph. +91 870 2455111(O), Fax +91 870 2544949. Residence: Dr. Srisailam Keshetti, H.No. 5-11-531, Naimnagar, Hanamkonda, Warangal - 506009, AP, India, Ph. +91 98493 05115, +91 92468 94465 Alternate email id: ksrisailam@... Permanent Address: Dr. Srisailam Keshetti, H.No. 2-10-2095, Bhagya Nagar, Karimnagar - 505001, AP, India. Ph: +91 878 6504465From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Thursday, 11 December, 2008, 8:53 AM

Hello All

A very good morning to you.

Anupama, as usual the early bird, has given a few reasons for patients not having access to medicines.

I cite a coulpe of my own experiences.

1. Patient X needs L-Asparginase. 10000 U costing approx.INR 1400-. He is denide medicne from public hospital because he does not have a below poverty line certificate (BPL) though he cannot afford it.

2. A patient though a BPL card holder is denied medicine because he is from adjoining state.

Now where does the fault lie?

kunda

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[Guest guest]

A warm good morning to all,

An ideal topic of the hour and a great

opening given by our Dr.Kunda mam,Dr.Anupama and Dr.Srisailam.I feel

the most important aspect for improving access to medicines is

HEALTH EDUCATION to the patients and public.As Anupama has mentioned

how patients needs to run to differnt medical shops n search of a

partcular brand of medicine prescribed by the doctor.So who is at

fault here??

Most of the medical shops would procure low quality

medicines so that they are easily available for patients who cant

afford the costly medicines.So isit the patient denied quality

medicines??

Dr.Santosh

In netrum , " Dr. Keshetti Srisailam " <ksrisailam@...>

wrote:

>

> Dear Dr. Kunda and Dr. Anupama

> Your start is nice and you raised two important points

>

> The prescription of rare branded medicines is not new to our

community.  Many patients face difficult in procuring such

medicines which are available only in selected pharmacies

(particularly those attached to a hospital or clinic)

> This might be due to the delights offered by the companies

manufacturing the so called brands. Or the huge margins to the

selected pharmacies offered by the companies may also tend create

this problem

>

> As Dr. Kunda told, it is right that many of the BPL people have

not been issued the Cards that will be helpful for them not only in

hospitals, but in many occasions.  This might be due to frequent

moving of the BPL families from one place to other.  The issue of

such BPL card by Central Government instead of State Government may

solve this problem

>

> It is right that in most developed countries the public get

medicines from national health services, or the insurance companies

will pay much for the cost of medicines as well as tretment

expenses.  In developing countries like India, very less percentage

of public are insured for their health and it is not possible to get

proper medicines required and they have to pay from their pockets. 

But how many of the public are capable of paying from pocket. If

they can, they will comprimise at some moment thinking that is it

necessary to buy all the medicines.  My father is running a

pharmacy since 1985 and I observed many people asking me whether all

the prescribed medicines are essential? or can they skip some of

them. If enough awareness is created and insurance is provided many

people will be benefited.

>

> One more thing is the patients particularly BPL people will not

buy the total course of medicines.  Usualy they will ask medicines

for 3 days even though the doctor prescribed for 5 or 7 days.  They

will use the medicines and if their problem subsides, they will not

buy the further course of medicines. Hence the patients needs

education in this aspect. Indian Pharmaceutical Association is

conducting National Pharmacy Week celebrations every year in the

month of November and we have celebrated in the last month on the

topic " Ask Your Pharmacist: For Safe Use of Prescription Medicines " .

Many colleges all over the country participated and conducted

various programmes on this theme.

>

> To my knowledge, the distribution and availability of medicines is

not a problem in India.  Since there a large number of brands

available for each drug, one can get one or other brand in a

pharmacy.

>

> Dr. Srisailam

>

> Contact: Office: Dr. Srisailam Keshetti, Associate Professor,

Vaagdevi College of Pharmacy, Ramnagar, Hanamkonda, Warangal -

506001, AP, INDIA, Ph. +91 870 2455111(O), Fax +91 870 2544949.

Residence: Dr. Srisailam Keshetti, H.No. 5-11-531, Naimnagar,

Hanamkonda, Warangal - 506009, AP, India, Ph. +91 98493 05115, +91

92468 94465 Alternate email id: ksrisailam@...   Permanent

Address: Dr. Srisailam Keshetti, H.No. 2-10-2095, Bhagya Nagar,

Karimnagar - 505001, AP, India. Ph: +91 878 6504465

>

>

> From: kunda gharpure <gharpurekunda@...>

> Subject: improving access to medicines

> netrum

> Date: Thursday, 11 December, 2008, 8:53 AM

>

>

>

>

>

>

>

>

>

>

>

> Hello All

> A very good morning to you.

> Anupama, as usual the early bird, has given a few reasons for

patients not having access to medicines.

> I cite a coulpe of  my own experiences.

> 1. Patient X needs L-Asparginase. 10000 U costing approx.INR 1400-

.. He is denide medicne from public hospital because he does not have

a  below poverty line certificate (BPL) though he cannot afford it.

> 2. A patient though a BPL card holder is denied medicine because

he is from adjoining state. 

> Now where does the fault lie?

> kunda

>

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[Guest guest]

Dear Dr. SantoshTo my knowledge, no patient wants to purchase low quality medicine. If the price of one brand differs from other, the patients particularly regular patients like diabetics, hypertensives etc may buy low cost (not low quality) medicines of some other brandDr. Srisailam

> From: kunda gharpure <gharpurekunda@ ...>

> Subject: improving access to medicines

> netrumgroups (DOT) com

> Date: Thursday, 11 December, 2008, 8:53 AM

>

>

>

>

>

>

>

>

>

>

>

> Hello All

> A very good morning to you.

> Anupama, as usual the early bird, has given a few reasons for

patients not having access to medicines.

> I cite a coulpe of my own experiences.

> 1. Patient X needs L-Asparginase. 10000 U costing approx.INR 1400-

.. He is denide medicne from public hospital because he does not have

a below poverty line certificate (BPL) though he cannot afford it.

> 2. A patient though a BPL card holder is denied medicine because

he is from adjoining state.Â

> Now where does the fault lie?

> kunda

>

> Add more friends to your messenger and enjoy! Invite them

now.

>

>

>

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>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> Get your preferred Email name!

> Now you can @ymail.com and @rocketmail. com.

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[Guest guest]

At the pharmacy we notice that many times patients do not buy the sufficient quantity of an essential medicine prescribed, because along with it, some non-essential (and useless) medicines are also prescribed. SOme of these very costly unessential medicines are tonics, and the latest fad is the dietary supplements costing 3, 5, 10, or even 15 Rs per cap.

AFter being " drained " of some of the money in his pocket at the doctor's clinic, the patient comes to the pharmacy with the prescription. The general tendency is to buy " all " the listed medicines prescribed by the doctor, but because there is no sufficient money in hand, patients buy " some " quantity of each.. . SInce a bottle of tonic cannot be bought in " some " quantity, patient takes the whole of it, and there goes the majority of the money. This is one of the reasons why patient buys only a few of the antibiotics...and then never completes the course.....

The non-essential medicines thus are one of the reasons why the access to essential medicines gets blocked.

Public education is the corner stone for promoting rational use of medicines.

Raj VAidya

Community Pharmacist

Goa

On 12/11/08, Dr. Keshetti Srisailam <ksrisailam@...> wrote:

Dear Dr. SantoshTo my knowledge, no patient wants to purchase low quality medicine. If the price of one brand differs from other, the patients particularly regular patients like diabetics, hypertensives etc may buy low cost (not low quality) medicines of some other brand

Dr. Srisailam> From: kunda gharpure <gharpurekunda@ ...>> Subject: improving access to medicines

> netrumgroups (DOT) com> Date: Thursday, 11 December, 2008, 8:53 AM>

> > > > > > > > > > > Hello All > A very good morning to you.> Anupama, as usual the early bird, has given a few reasons for patients not having access to medicines.

> I cite a coulpe of my own experiences.> 1. Patient X needs L-Asparginase. 10000 U costing approx.INR 1400-. He is denide medicne from public hospital because he does not have a below poverty line certificate (BPL) though he cannot afford it.

> 2. A patient though a BPL card holder is denied medicine because he is from adjoining state. > Now where does the fault lie?> kunda> > Add more friends to your messenger and enjoy! Invite them

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[Guest guest]

Dear madam,

It is pathetic because BPL certificated are possessed even by those who have all the BPL appliances at home. So, there should be a strict criteria for giving BPL certificates.

Alternatively, we can have 3 different categories:

Rich and upper middle class-no concessions given

Lower Middle class and poor-50% concession

Ver poor- 100% free medicines

Division of state is only for easy administration, not for health division, When WHO says "health and medicines for all", why do states come in between?

-Anupama

From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Thursday, 11 December, 2008, 8:53 AM

Hello All

A very good morning to you.

Anupama, as usual the early bird, has given a few reasons for patients not having access to medicines.

I cite a coulpe of my own experiences.

1. Patient X needs L-Asparginase. 10000 U costing approx.INR 1400-. He is denide medicne from public hospital because he does not have a below poverty line certificate (BPL) though he cannot afford it.

2. A patient though a BPL card holder is denied medicine because he is from adjoining state.

Now where does the fault lie?

kunda

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[Guest guest]

Dear Dr. KundaIt is true that Ephedrine and other controlled substances can be maintained in a pharmacy after meeting the required regulations and proceduresIf a hospital is unable to meet the regulatory requirements, one should go for alternate drug in generalIf that is not possible, one has to simply procure from other stores or send the patient to other stores which possess such license and stockMaintaining all the medicines in each pharmacy is a difficult task and one has to cope up with it.Coming to the availability of basic medicines like analgesics, antimalarials etc., many hospitals do procure the stock, but due to the heavy inflow of patients for these medicines, the stock will exhaust early. And you know no state government in India is in a position to allot sufficient funds to purchase each and every medicine that to

in enough quantities. Very few and rare medicines like those you mentioned (propofol, neostigmine etc.) will remain in the shelves and ultimately the pharmacist will approach other pharmacies to utilize the stock.Dr. SrisailamFrom: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Friday, 12 December, 2008, 8:53 AM

Hello All,

I will reply to each post one by one but before that I have one more experince to share with you. We have seen some problems which are responsible for lack of access to medicines. There is yet another aspect related to the access to controlled medicines. In our hospital there was a demand from one of the departments for a product of ephedrine. Ephedrine is one of the controlled medicines which requires specific licensing for purchase, storage and use. Our hospital store does not meet the regulatory requirements and as such we could not fulfill the said demand

Where does the problem lie? We have a rich post from Dr Srisailam , Anupama and Santosh wherein they have shared thier experiences . Yes, patient education, poverty and irrational prescribing are few problems evidenced from these posts.

I could further go on like this enumerating several actual experiences. But I need to know whether other states, countries are also facing such day to day problems. Macro level situations and their solutions are aplenty but what about the micro level? Kunda

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[Guest guest]

Dear Kunda mam,

Every state in India is facing the same problems

accounted by you.We at tertiary centers also face problems when

medicines are transported from distant and remote PHCs .I agree with

mam raegarding the need of such medicines when the doctors posts

remain vacant.Here in Kerala we often run short of Anti rabies

vaccine in government sectors.Recently we had an incident where

around 10 people were attacked by a rabid dog.They were then

transported to the district hospital where the vaccine was out of

stock which led to lots of hue n cry.So procurement of medicines

should take into account the actual requirement and not some vested

intersts.

Dr.Santosh

In netrum , kunda gharpure <gharpurekunda@...> wrote:

>

>

>  Hello All,

> I will reply to each post one by one but before that I have one

more experince to share with you.

> We have seen some problems which are responsible for lack of

access to medicines. There is yet another aspect related to the

access  to controlled medicines.

> In our hospital there was a demand from one of the departments for

a product of ephedrine. Ephedrine is one of the controlled medicines

which requires specific licensing for purchase, storage and use. Our

hospital store does not meet the regulatory requirements and as such

we could not fulfill the said demand

> Where does the problem lie?

> We have a rich post from Dr Srisailam , Anupama and Santosh

wherein they have shared thier experiences . Yes, patient education,

 poverty and irrational prescribing are few problems evidenced from

these posts.

> I could further go on like this enumerating several actual

experiences.. But I need to know whether other states, countries are

also facing such day to day problems. Macro level situations and

their solutions are aplenty but what about the micro level?

> Kunda

>

>

> Add more friends to your messenger and enjoy! Go to

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[Guest guest]

Respected Mam,

From the current knowledge,around 13 % of all treatments have good evidence and further 21 % are likely to be beneficial.medicines are the primary tool for treating patients.Medicines are the only things in which patient does not have any power what to buy at what cost.The doctor prescribes and patient pays.As government spends very small proportion of budget for medicine procurement.Patients without having insurance or social security suffer most(new proposal for 24 hours generic medical stores in every district is quite praisable.

The same drug in the same strength manufactured by two renownded companies can vary from 2 times to 20 times in their price.Expensive medicines sell more because of agressive marketing policy by firms(Principle of 3C-Convince if possible,confuse if necessary and corrupt if nothing else works).Moreover pharmaceutical jungle is flooded with " me too " drugs.Of late it is rare to find any prescription of Cimetidine(apart from antiandrogenic effects)and Co-trimoxazole(Sulfa allergy.Common antidote charcol or simple ORS without any flavour or colour you can not find in any drug store.

If " Big Pharma " is evil!! They don't show any interests in essential drugs as do not get good returns from their investment.The Global Forum for Health Research estimates that only 10% of the world,s health burden receives 90% of total biomedical reserch funding.Big pharma companies neglected diseases of developing countries.(lack of money & corporate interests).

Ecalmpsia cause 50,000 deaths in pregnancy around the world each year.The best tretment is cheap,unpatented magnesium Sulphate (High doses I.V).Though Magnesium had been used to that eclamsia since 1906,its position as the best treatment was established with the help of WHO (because there was no commercial interest.Same incident repeats with Chagas disease(25% of Latin America suffer) and trypanosomiasis(300000 cases a year but in Africa).

Amit Pachal

Pharmacist

South Eastern Railway

Gardenreach

Kolkata-700043

pharma691@...

[Guest guest]

Dear Dr. Santosh and allThis is not only the problem in KeralaEven in Andhra, particularly in rural areas the shortage of antirabies and anti-snake venom drawn the attention of many newspapers and TV channels sometime backWhen I inquired with some of the rural PHC staff, I was surprised with their reply saying that it is difficult to procure these items and still much more difficult to store them properly due frequent power failures which shuts down the refrigeratorsDr. Srisailam

>

>

> Â Hello All,

> I will reply to each post one by one but before that I have one

more experince to share with you.

> We have seen some problems which are responsible for lack of

access to medicines. There is yet another aspect related to the

access  to controlled medicines.

> In our hospital there was a demand from one of the departments for

a product of ephedrine. Ephedrine is one of the controlled medicines

which requires specific licensing for purchase, storage and use. Our

hospital store does not meet the regulatory requirements and as such

we could not fulfill the said demand

> Where does the problem lie?

> We have a rich post from Dr Srisailam , Anupama and Santosh

wherein they have shared thier experiences . Yes, patient education,

 poverty and irrational prescribing are few problems evidenced from

these posts.

> I could further go on like this enumerating several actual

experiences. . But I need to know whether other states, countries are

also facing such day to day problems. Macro level situations and

their solutions are aplenty but what about the micro level?

> Kunda

>

>

> Add more friends to your messenger and enjoy! Go to

http://messenger. / invite/

>

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[Guest guest]

Dear madam,

To encourage medicines for orphan diseases, US govt has made them tax free. Indian companies should also be given this tax free facility for medicines of orphan diseases.

-Anupama

From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Friday, 12 December, 2008, 6:31 PM

Hello,

One more factor has emerged from the posting of Dr. Srisailam , that of storage of medicines.

To maintain the potency we all agree that proper storage is necessary. How many public hospitals ( primary , secondary level) have ideal conditions of storage? In a big hospital such as ours, we have a cold storage room but in case of electrical fault, we do not have any stand by facility.

The news that 24 hr. pharmacy with generic medicines in each district as informed by Amit Panchal is no doubt a welcome step. What in addition I would suggest is- insurance cover for economically backward classes.

The pharma industry, as rightly said by Amit does no research in neglected diseases.

Santosh has a point when he says that commonly used medicines are availble .It is the less frequently used medicines whose accessibility is a problem.

I have a strong opinion about this factor. Procurement of medicines should be done taking into consideration the economic principles and good inventory management . This is a very developed field and where ever possible, before deciding upon the inventory to be maintained by any public hospital the experts in the management field should be consulted to minimise the stock out periods and over stocking which again wastes valuable resources due to unnessesary stock holding.

And by experience I can say that an expert's opinion does make a difference in availbility and accessibility.

kunda

Accessibility is directly related to finance.When we talk of finance as a prime factor we should consider the NPPA stand and its scope .

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[Guest guest]

Dear Kunda Madam and all,

Patent law of the country, takes a very prominent role for the accessibility of the drug.

Before 2005, India developed a world-class generic-drug–manufacturing sector, spawning major generics firms such as Ranbaxy, Cipla, and Dr. Reddy's, in addition to hundreds of smaller firms. India boasts more drug-manufacturing facilities that have been approved by the U.S. Food and Drug Administration than any country other than the United States. Indian generics companies, for instance, supply 84% of the AIDS drugs that Doctors without Borders uses to treat 60,000 patients in more than 30 countries

India's membership in the World Trade Organization (WTO) means that for the first time in 35 years, drug products (the pharmaceutical compositions themselves, rather than merely the processes for making them) must be considered potentially patentable in India.

The Indian government supports the expanded availability of patent protection as a catalyst that may enable India's enormous drug-manufacturing sector to evolve.

Immediate concern for all was “Will India's patenting of medicines put patients around the world at risk of losing a critical source of lifesaving generic drugs?”

However, our government has imposed price controls on essential medicines since 1970, and it may be expanding the list of drugs that are subject to such controls. More to the point, a number of safeguards have been built into the new patent law itself.

Trupti Swain

Orissa

From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Saturday, December 13, 2008, 8:14 AM

hello,

We are still looking at some of the factors responsible for not having access to medicines.

Role of NPPA It is found that when an essential medicine is under price control, the production of other non-scheduled medicine in the same therapeutic category increases. There is a practice by pharma industry to substitute ingredient in existing brand when an ingredient is brought under price control, with another ingredient from the same therapeutic group that is outside price control.Case of Disprin plus is well known.

It is therefore logical to monitor the production and pricing of the entire therapeutic group when an ingredient is brought under price control.

This will make access affordable in the private sector. What is your opinion about role of FDA in making medicines acccessible?

kunda

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[Guest guest]

Dear madam,

There should be rules for classifying drugs as OTCs. Banned medicines, prescription medicines should not be available as OTCs

-Anupama

From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Sunday, 14 December, 2008, 9:13 PM

Hello,

We have seen a number of actual cases where access to medicines are denied to patients. let us now see what remedial measures can be taken .

1. Majority of medicine supply should be through public sector so that poor patients do not have to pay for medicines. It should be borne in mind that this solution takes for granted that all medicines in the state EML are available at the primary, secondary and tertiary care facilities.

2. Keeping in view the disease profile of the state /country, the EMLshould be revised every two years and these medicnes should be under the price control.Again in this suggestion it is implied that the prices of the entire therapeutic class of medicines would be monitored.

3. Strict norms for licencing new drugs should be formed . The rules should be such that it should be possible to prevent entry of irrational products in the market. There should be a code of conduct for promotional activities by pharma companies.

These are some solutions at the macro level.

We would further discuss some suggestions at the micro level.

KUNDA

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[Guest guest]

Hi,

Well said. I would like to carry the point further.

India has its own EML.

India also has Drug and Price Control Order (DPCO)to control the

prices of select medicines.

Both are from Govt of India.

Then why the price of only handful medicines is controlled and not

all EM?

Does that mean that the medicines which are out of DPCO are useless

but still included in EML?

If the prices of EM are not controlled in the country then how will

the access to these improve?

Vijay

>

> From: kunda gharpure <gharpurekunda@...>

> Subject: improving access to medicines

> netrum

> Date: Friday, 12 December, 2008, 6:31 PM

>

>

>

>

>

>

>

>

>

>

>

>

> Hello,

>  One more factor has emerged from the posting of Dr. Srisailam ,

that of storage  of medicines.

> To maintain the potency we all agree that proper storage is

necessary. How many public hospitals ( primary , secondary level)

have ideal conditions of storage? In a big hospital such as ours, we

have a cold storage room but in case of electrical fault, we do not

have any stand by facility.

> The news that 24 hr. pharmacy with generic medicines in each

district as informed by Amit Panchal is no doubt a welcome step.

What in addition I would suggest is- insurance cover for

economically backward classes. 

> The pharma industry, as rightly said by Amit does no research in

neglected diseases. 

> Santosh has a point when he says that commonly used medicines are

availble .It is the less frequently used medicines whose

accessibility is a problem.

> I have a strong opinion about this factor. Procurement of

medicines should be done taking into consideration the economic

principles and good inventory management . This is a very developed

field and where ever possible, before deciding upon the inventory to

be maintained by any public hospital the experts in the management

field should be consulted to minimise the stock out periods and over

stocking which again wastes valuable resources due to unnessesary

stock holding.

> And by experience I can say that an expert's opinion does make a

difference in availbility and accessibility.

> kunda

> Accessibility is directly related to finance.When we talk of

finance as a prime factor we should consider the NPPA stand and its

scope .

>

>

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[Guest guest]

Hi,

The editorial of Times of India, the leading newspaper of India, has

been on record to state that FDA stands for Friends of Drug

Adultrators ! Do you mean they will improve the accessibility?

Vijay

>

> hello,

> We are still looking at some of the factors responsible for not

having access to medicines.

> Role of NPPA

>  It is found that when an essential medicine is under price

control, the production of other non-scheduled medicine in the same

therapeutic category increases. There is a practice by pharma

industry  to substitute ingredient in existing brand when an

ingredient is brought under price control, with another ingredient

from the same therapeutic group that is outside price control.Case

of Disprin plus is well known.  

> It is therefore logical to monitor the production and pricing of

the entire therapeutic group when  an ingredient is brought under

price control.

> This will make access affordable in the private sector.

> What is your opinion about role of FDA in making medicines

acccessible?

> kunda

>  

>

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[Guest guest]

Hi,

Yes, India is the pharmacy of third world, one of the largest

producer of generics, yet nearly 60% of its own population does not

have access to EM. Darkness below the lamp!

Do we produce for other countries and not own population?

Vijay

>

> Hello,

> We were on the point of discussing role of FDA.

> As is true with all legal issues , the rules if implemented in the

true spirit , we will definitely see benefits.We have been

discussing under several topics about the proliferation of

pharmaceutical substances in the market and the number of me-too/

irrational  medicines. If we stick to our NEML, the resources would

be judiciously used for their manufacture which would be available

at affordable costs.

>  I went thru  information on net and came across an exhaustive

paper by world bank on improving access to medicines in developing

countries.The economics of production, procurement, distribution are

discussed in depth but since most of it may not interest our group I

desisted from posting it as attachment.

> Just  a few salient points from that paper follow, some of those

would definitely boost our morale.

>

> In India there are many thousands of pharmaceutical manufacturers,

most of which are small and have quite a specialized technology base.

> Leading Indian companies are undoubtedly more advanced in terms of

their technical and managerial capabilities

> The main difficulties domestically lie in myriad layers of

bureaucracy and associated corruption.

> Chemicals industry has been able to develop highly specialized

manufacturing

>   capabilities, covering almost the entire range of modern

medicines from basic antibiotics to HIV/AIDS drugs and Viagra.

> §          Leading companies, such as Ranbaxy, Dr

Reddy’s, Sun Pharmaceuticals and Lupin have patiently invested in

manufacturing facilities that meet the exacting EU and US Good

Manufacturing Practice (GMP) and built strategic alliances with US

and EU generic marketing companies achieving dramatic growth in

export sales of active ingredients to the USA and Europe.

> §           India has almost 62 USFDA approved plants

and 35 drug master files.

> When we consider the huge potential of pharma industry, we wonder

why still our patients do not have access to medicines. The fault

lies not in production, but definitely lies in management,

distribution, policy framing and implementation, and information

dissemination.

> More posts are invited on areas where corrective measures can be

taken.

> kunda

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[Guest guest]

Hi,

Shortage of medicines, low medicine budgetary allocation, results in

rationing of medicines in public hospitals where required medicines

in required full dose and for needed duration are not issued. What

good is such accessibility?

Vijay

>

> Hello,

> We have seen a number of actual cases where access to medicines

are denied to patients. let us now see what remedial measures can be

taken .

> 1. Majority of medicine supply should be through public sector so

that poor patients do not have to pay for medicines. It should be

borne in mind that this solution takes for granted that all

medicines in the state EML are available at the primary, secondary

and tertiary care facilities.

> 2. Keeping in view the disease profile of the state /country, the

EMLshould be revised every two years and these medicnes should be

under the price control.Again in this suggestion it is implied that

the prices of the entire  therapeutic class of medicines would be

monitored.

> 3. Strict norms for licencing new drugs should be formed . The

rules should be such that it should be possible to prevent entry of

irrational products in the market. There should be  a code of

conduct for promotional activities by pharma companies.

> These are some solutions at the macro level.

> We would further discuss some suggestions at the micro level.

> KUNDA

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[Guest guest]

hello,

its a long time since you appeared on Netrum. for others , Bashaar has given some valuable inputs to the suggestions for improving access.

I particularly appreciate the point 'impose control on demand for drugs'.I did overlook this significant aspect which definitely contributes to accessibility.

We all must have come across several instances where the patient demands a particular medicine and knowing very well that it is not essential for his prticular problem, we must have given in to the demands of the patient.We in our hospital do enforce rationing of medicines in some form or the other.

As regards Bashhar's posting of 2008 December, Vijay and myself were a part of the project by Laing, mentioned in the aarticle . what I would like to point here is that though medicines in India are cheaper than those in other EU countries, the per day income that was used to calculate the affordability in this project was not true reflection of our country.This indicates that though the medicines are cheaper, they are not affordable to people. Lets leave it at that since it is beyond our capacity to discuss and improve national policy of minimum wages act.

I also appreciate the inputs of Dr.Srisailam,Dr.Santosh, Trupti,Amit Panchal,Raj vaidya. Anupama, and Vijay. I will soon put up the report for inclusion in the newsletter.For Anand Shah I am sending the file which he desired.

From: kunda gharpure <gharpurekunda@ .co. in>Subject: improving access to medicinesnetrumgroups (DOT) comDate: Tuesday, December 16, 2008, 7:10 AM

Hello,

On the last day I would like to suggest few solutions to problems of accessibility as seen in actual practice.

When we take into consideration the factors responsible for accessibility, one by one, we can also come to apt solutions to each of them. These are some of the solutions from my point of view. 1. Rational selection – this takes into consideration the selection of EML at the national level and should percolate down to the primary level where the local needs should be the selection criteria.Once the EML is prepared it should be the responsibility of all players to see that they are available to everyone irrespective of the economic status, or state boundaries. 2. Rational use –this involves the user who should be informed by the manufacturer, the prescriber and the dispenser. Rational use will entail expenditure on medicines only where it is essential. Unnecessary expenditure on nutritional supplements tonics life style drugs can be checked. Patient education is the key factor here. 3. Affordable price – Role of NPPA and the implementing authority cannot be overlooked. They play a very significant role in making medicines accessible when medicine price has to be paid out of pocket..All medicines in EML should be under price control along with monitoring of same therapeutic class medicines .Remember Disprin Plus ? 4. Responsive health system- The manufacturers, the physicians the pharmacists, the nursing staff, and the policy makers are all equally responsible for medicine accessibility. Uniform policies, proper implementation, ethical practicing will all together lead to better accessibility. The health system will not only be responsible but responsive to the patient sufferings.Health system is for improving health of the individual, so feel the sufferings and dont alienate yourself from the pain. 5. Reliable supply system- Reliable supply takes into consideration the non stop supply as well as good quality. The supply system also pre-supposes good manufacturing practice by the pharma. Industry.Factors of proper storage conditions and , transport are a part of the supply system. 6. Sustainable financing-.At the national level, the provision of medicines in the public sector is utterly important, backed by continuous flow of funds to maintain adequate medicine supply. any more additons are welcome. kunda

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