The following is the conclusion of reporter JANELLE DE SOUZA’s examination of the issues surrounding debate between generic and brand prescriptions in TT. Her report was first published in yesterday’s issue.
JAMEEL Rahaman, a pharmacist for over three decades, believes some in this field are supposed to be the gatekeepers of drugs but many times the life-saving medicines are inaccessible. He said that often, a patient would go to the pharmacy and the clerk or technicians handled the customers while the pharmacists were in the back or behind a glass case, or there was no privacy to speak to the pharmacist.
He said ten to 20 years ago, the pharmacist was the most trusted medical professional in the country but that is not the case anymore because there is little engagement with customers. He said in some countries, it was the law that patients were counselled and given proper instructions by pharmacists the first time they buy drugs for a condition. He added that since drugs did not affect everyone in the same way, there should be follow up with the patient for up to six months to determine whether or not the drug was working.
He said when doctors write subscriptions, generic substitutions should be allowed. Doctors, he said, should make a note on the subscription or the pharmacist should call the doctor and ask if they could substitute the generic.
CULTURE CHANGE NEEDED
He also suggested a counselling room in each pharmacy where pharmacists could talk to patients; a pharmacy call centre where patients could call to get information or advice on medication; and an integrated system where both doctors or pharmacists could access a patient’s history.
Rahaman said he also noticed cases where each pharmacy had a different price for the same drug, and in some cases the mark-ups were extreme. He said there should be a drug formulary to give customers the cost price and suggested retail prices of various drugs; that government should have price controls on pharmaceuticals; and there should be testing to determine if drugs were counterfeit. In this way, he said, successive government failed to address the needs of the patient.
However, president of the Council of the Pharmacy Board, Andrew Rahaman, told Newsday that government regulates drug prices with a fixed percentage mark up, between 25 to 30 per cent, from the distributors’ price. He said any price differences would come from the different cost prices of the same items from different manufacturers or distributors, as well as suitcase traders.
He gave the example of nifedipine, used to manage high blood pressure and other conditions. He said there was no distinctive brand name so people call it by the drug’s name. He said there were nine or ten brands of the drug, all manufactured in different places, and so had a wide range of prices from pharmacy to pharmacy.
“That being said there are places that might be marking up their prices less than others. In the control, for some drugs the mark up is 30 per cent, which makes it illegal to go higher. Or a law might say the mark up is a maximum of 30 per cent which makes it legal to go below.”
SOME SOURCES NOT APPROVED
Some drugs, he said, did not come from approved sources. These were much cheaper and could be counterfeit even though they have the right brand names. “These are some of the items we are trying to weed out from the system because there is some difficulty determining whether or not these were manufactured to the correct standards.”
He admitted that it was a common practice with pharmacies to purchase from suitcase traders who import and distribute drugs when supply was not available from authorised agents. He said the practice was supposed to be regulated by Customs and Excise Division.
“Those items are not supposed to be released to the importer unless they can show their authorisation from the Chemistry, Food and Drug Division to import. What needs to happen is proper enforcement.” With respect to prescribing drugs, he said it was the law that doctors in the public health system write the name of the drug, the chemical, so that the pharmacist or the patient was allowed to choose between brand and generic. He agreed with Rahaman that, if a doctor prescribed a brand that the patient could not afford, the pharmacist should call the doctor to authorise a change.
“I take the view that, while some generic drugs might not be of the exact standard as brand names, it might still be better to get 50 per cent of a drug than zero per cent. So prescribing the drug, rather than the brand and then the pharmacist doesn’t have it, might be a life-saving approach.”
Andrew also agreed that there should be random, after-registration testing for drugs. He said at the moment checks and balances were at the importer registration stage. He explained that pharmacies were supposed to have documentation that included the source and country of manufacture of all the drugs they carried. Pharmacies were supposed to continue sourcing the drugs from the same importer but, as mentioned above, they sometimes got their supply from suitcase traders.
Therefore, he said a lab for dug testing would be prudent. Unfortunately, he said the lab in TT did not have the technical or scientific capability to test drugs. He added that, even if the lab was fully operational, randomly checking drugs at pharmacies would be difficult because of a lack of manpower at the Chemistry Food and Drug Division. He said that was why it was important to stop suitcase trading of drugs at the ports of entry.