How to cut your medicines bill?

Misc | admin | August 3, 2011 at 6:59 am

How often have you questioned the medicine prescribed by your doctor? Or challenged the cost of the medicine? In all probability, never. The blind faith in the physician, compounded by the patient's ignorance, makes for a potent combination. Often, this is the prescription for fuelling your medical bills. This need not be the case as there are ways to cut your medical bill by nearly 90% in some cases (see table).

The question this begs is, why do we pay such heavy bills? The logic is easy enough to understand. You pay for a medicine that has been prescribed by your doctor, who, in turn, is wooed by several drug manufacturers to buy their brands. The medicine he picks is the one he prescribes to you. The costlier the drug, the bigger your bill.

Why do some medicines cost more than the others?

Saroj Shah, a Mumbai-based housewife, was asked by the doctor to purchase an antacid, Entac, which cost her Rs 67 for a pack of 10 tablets. However, she could have bought another medicine, Lantac, which would have worked just as well for as little as Rs 3.60 for the same number of tablets. The price difference—Rs 63.4 or an incredible 94.6%. Can one actually buy drugs that are as cheap but equally effective? If so, how does one explain the price difference? Here are some of the reasons why there is a wide variation in the drug prices:

Branded vs generic drugs: A branded drug is one which has been developed by a particular company after a lot of research and development. Hence, it is protected by patent laws and is marketed under the manufacturer's name. However, once the patent period expires, other drug manufacturers jump into the fray, increasing the competition and lowering the prices.

This is because these companies do not incur the cost of testing and developing the medicine from scratch, only that of production. Such medicines are called generics or generic drugs. They have the same active ingredients as the original medicine, identical dosage, strength and efficacy as well as the manner of administration, but are sold under the chemical name instead of the manufacturer's name. As Dr Deepak Ugra, head of department, paediatrics, Lilavati Hospital, Mumbai, says, "The cost depends on whether the original molecule was developed by the company after research because, in this case, it will want to recover the cost of research and development."

Big brands vs small player: The cost of the medicine can also depend on whether it has been produced by a big player or a small, local manufacturer. The bigger manufacturer will factor in the cost of marketing and advertising and, hence, the medicine will cost more. On the other hand, smaller players who do not incur such costs can afford to sell their drugs at much lower prices. Similar is the case with medicines that are manufactured and packed abroad and sold in India, which are more expensive, compared with those that are developed abroad, but are packed and sold in India. For the same reason, imported medicines come at a higher price.

Price control: There's another reason that the cost of drugs varies. "Medicines can be categorised into two types: the ones whose prices are controlled by the government, and those whose prices are not. So the companies are free to fix the prices of non-controlled drugs without any restriction," says Dr Chandra M Gulhati, editor of the Monthly Index of Medical Specialities (MIMS), a pharmaceutical reference journal.

Since branded drugs or those produced by big pharma manufacturers are pushed hard by salespersons to the doctors, these are the ones that are prescribed and, hence, by default, stocked by pharmacists. In other words, drug stores stock the brands that sell more, and since the low-priced or generic medicines are hardly prescribed, they are not stocked. Of course, pharmacies too have a vested interest in stocking and selling high-value brands because they earn higher margins on more expensive medicines.

Poor quality or lure of lucre?

Why do doctors prescribe costly drugs? Several doctors insist that they opt for brands rather than medicines from small manufacturers because of quality issues. Says Ugra: "These manufacturers pay less attention to quality control and offer medicines at a lower cost. I prescribe drugs from multinational companies and some Indian ones. I change the brand names if I am convinced that one company is more reliable than the others."

Does this mean that if you opt for a cheaper brand of medicine, it is ineffective, less effective than the costlier one, or even likely to cause damage? "No, because producing sub-standard drugs is a criminal act punishable under the Drugs and Cosmetics Rules 1945," says Gulhati.

"As the manufacturing of a drug is monitored by the state or central drug controller, the effect of various brands having the same generic (active ingredients) will have to be the same. So, if there are 10 brands of a particular generic, one can buy any as there is no difference in the effect," says Dr Madan Mittal, who started the website, www.medguideindia.com. The site helps people increase their awareness about drugs and has information about 90,000 brands of drugs available in the country, along with their price, manufacturer's name and the ingredients used in the medicine.

In effect, there is little difference between a branded and a generic drug, or medicines by big brands and small players. The cheaper versions are likely to cause damage or be ineffective only if they are counterfeits.

However, there's another reason that more expensive drugs are prescribed by doctors. As Gulhati puts it plainly: "It's because of the inducements that are offered to doctors by manufacturers, which include cash commissions, free foreign travel, expensive white goods, etc."

Though doctors claim that it is their trust in a particular brand, not the commissions and gifts that influences their prescriptions, Dr Vinay Garg (name changed), a Mumbai-based practitioner, explains the conflict of interest. "Every drug manufacturing company's website carries the details of how much it spent on various expenses, including the amount on marketing a drug to the doctors. If the company has sponsored a doctor's trip and paid for personal expenses, it becomes his moral duty to prescribe the company's drug. Though the final decision rests with the doctor, he cannot deny the conflict of interest," says the doctor.

What should you do to ensure smaller medical bills?

Since one has little control over the above-mentioned factors, how can one ensure that one is not saddled with a fat medical bill? Once a doctor has prescribed a medicine, instead of rushing to the nearest pharmacy, try to find comparative prices through the following options.

a) Check the Internet: The Internet is probably the easiest option for finding information on generic drugs, with sites such as medguideindia. com, medindia.net and medclik.com serving the purpose well. These sites give information on price, different brands for generic drugs, composition, etc. However, as Mittal says about his site, medguideindia.com: "Though the data is uploaded quarterly, there may be a slight variation in the costs of some medicines. The data is collected through various chemists and pharma dealers as we failed to get the updated information on a regular basis directly from the pharma companies. This, despite approaching various government authorities dealing with the pharma sector." For quicker access, a mobile version of the website is also in the pipeline.

b) Ask your doctor/chemist: If you swear by your doctor's recommendation and do not want to take the risk of self-scrutiny, simply ask your physician to prescribe a low-cost drug instead of an imported one. "It is every patient's right to ask about the brand of his choice with the same ingredients instead of the one suggested by the doctor," says Mittal.

Usually, doctors too don't have qualms about suggesting a cheaper version. Says Ugra: "A patient can ask me to suggest a medicine that is not too expensive since I have no idea about the patient's purchasing capacity. I prescribe the drug that is reliable and if I am not comfortable with a particular drug, I don't prescribe it."

Another option is to ask your trusted chemist or pharmacist. Concurs Gulhati: "The most practical option is to ask the neighbourhood chemist, who is well-known to the patient, for a less expensive brand. Though the patients who have access to the Internet can search for low-cost variants, one may not always get the desired information."

c) SMS facility: Though the government had launched a drug information helpline to offer cheaper medicine options to the public, it failed to take off. In a renewed effort, the National Pharmaceutical Pricing Authority (NPPA) is set to launch a mobile SMS service for round-the-clock information on drugs. "The patient can SMS the name of the drug to a particular number, and he will immediately be sent a list of the medicines by other companies with comparative prices," said Srikant Kumar Jena, Union Minister of State for Chemicals and Fertilisers recently.

Caveat

Remember, however, that the lure of cheaper medicines should not lead you to spurious ones, especially when it comes to life-saving drugs. Confirm with your doctor or chemist that the small player whose cheap medicine you have picked is not a counterfeit. Also, do not surf just any site for information as all of these may not be reliable.

Source: Economic Times