Medical professionals at the launch of partnership between Kenya’s ACE Pharmaceuticals and a Bangladeshi firm for the supply of generic drugs. PHOTO | FILE
Addiction to expensive branded medicine prescriptions driving up the cost of treatment for patients and health insurance providers.
The medical insurance companies are bearing the brunt of huge medical bills and suffering outright underwriting losses.
Prescription of branded drugs has been partially blamed for their ill fortune.
Kenyans have more recently had intense discussions around the role of generic drugs in the all-important arena of healthcare provision.
Health insurance providers have come out strongly, advising that they will only pay for generic drugs and not branded prescriptions.
The insurers are pushing for rules that will require hospitals to prioritise dispensing generic drugs over branded medicines to patients as part of the plan to tame rising cost of medical insurance.
The Association of Kenya Insurers (AKI), an industry lobby, is calling for a legal framework that will ensure doctors do not prescribe the brand name but only write down the chemical make-up of the drug.
AKI chairman Patrick Tumbo reckons that drugs make up about half or an average of 45 per cent of patients’ hospital bills, and the ratio is even higher in health facilities that dispense branded medicines.
The medical insurance companies are bearing the brunt of huge medical bills and suffering outright underwriting losses. Prescription of branded drugs has been partially blamed for their ill fortune.
As reported in The East African on August 17, 2017, Kenya leads in the use of branded drugs, even as the region shifts towards the use of generics.
In Kenya, prescription of branded drugs stands at a whopping 70 per cent, as compared to 37 per cent in Tanzania and 33 per cent in Uganda. Strict anti-counterfeit laws and policies in these two countries have led to a thriving use of generic drugs, and massive cost saving.
According to Catherine Karori, the Head of Medical at Jubilee Insurance, more than half of medical claims go into drugs, at the expense of other expenses necessary to treat various ailments. Many patients are also depleting their cover before the cover period is up, and having to pay out of their pockets.
The patient is caught in the middle. Are these drugs safe? Do they actually work as intended? Are they “fake”?
As a long-standing medical practitioner now in the insurance industry, I feel well placed to discuss this issue both from an insurance and clinical perspective.
A generic drug is a copy of a brand-name drug. The rules of naming drugs require that brand names are capitalised while generic names are not. The generic name is usually the name of the active ingredient that causes the therapeutic effect.
Generic drugs have exactly the same dosage, clinical uses, side effects, and drug interactions, route of administration and risks as the original branded drug. Their effectiveness should match that of their branded name counterparts.
Sometimes generic versions of a drug have different presentations, in terms of colour, flavour and inactive ingredients.
Generic drugs, which meet the same exacting safety standards as original drugs, should be distinguished from counterfeit or fake drugs, which are harmful to patients as their safety and efficacy cannot be guaranteed.
Like all other counterfeit products, these should be condemned. The Pharmacy and Poisons Board is mandated to ensure that only high quality medication is available for purchase.
If the two products are identical, why is it that generic drugs are significantly cheaper than branded drugs? Have quality and effectiveness been compromised to make a cheaper product?
The answer lies in the drug development process. To bring a new drug onto the market, a company must spend a significant amount of money on research, development and marketing of the product.
It also takes a very long time. Depending on the therapeutic use, drug manufacture can take 5-10 years or more, and costs millions of dollars.
To protect the financial investment of drug companies, patents are granted upon registration, which allow the manufacturers to market the product exclusively for a number of years.
During this time, it is expected that they can recover the cost of manufacture, research and development.
Manufacturers of generic drugs do not bear the heavy research costs. Because of competition, the retail price tends to be even lower. Therefore, generic drugs are an effective and affordable option.
In the US, a very large volume of prescriptions are filled with generic drugs. This is replicated in India, and other international centres of excellence in healthcare.
In April, Indian Prime Minister Narendra Modi announced a new health policy, which compels doctors to prescribe generic medicines as first treatment, and only resort to branded ones in specific unique cases where cheaper alternatives are unavailable.
For patients on long-term medication for chronic illnesses like diabetes, hypertension, arthritis and cholesterol problems, as well as those on chemotherapy for cancer, generic drugs have proven to be a life saver because patients can afford the cost of therapy for prolonged periods of time.
Thanks to the use of generic drugs, treatment for HIV, tuberculosis and malaria is provided free by the government.
If the patients have medical insurance, generic drugs facilitate better use of the cover, which serves the patient for a longer period of time.
So where is the disconnect then? If these drugs are as good as is claimed, why do we still have such a high rate of prescription of branded drugs?
Consumer education is wanting. Patients need to be enlightened that generic drugs are effective and affordable and can be used safely and with confidence.
Physicians need to be convinced that these generic drugs work. As the prescribers of these drugs, they are key to instilling confidence in generic drugs. Continuous medical education and testimonials are essential to demolishing myths about generic drugs.
Branded drug companies have huge budgets, and invest heavily in engaging doctors on their products. There needs to be counter-education from the payers of healthcare services, so that physicians understand the effects of their habits on the common public.
The government needs to enhance regulation, like is done in other countries, to ensure that high quality generics are available for the public, and to control the use of branded products to manage medical costs.
