Patients caught up in fight over generic drugs

The long simmering fight over generic medicine in Kenya has finally burst into the open. And it could get messy.

Madison insurance has told its health-seeking clients to take generic drugs or else pay the price difference for branded drugs. The insurance firm has consequently advised doctors to prescribe accordingly.

“Ignore the directive. This is not your problem but the patients,” said Ouma Oluga, Secretary General Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU).

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Unbowed by the threat, Madison has promised to issue guidelines on the new policy. Madison seems to have done what the Ministry of Health has failed to achieve for eons.

Past deadline

The ministry in the Kenya Health Sector Strategic and Investment Plan 2013-2017 had promised to have 100 per cent of medicines in the whole health system prescribed by generic names. “We shall promote generic medicines use throughout the whole health system through legal and administrative interventions and achieve 100 per cent by 2017,” said the plan.

A year past the deadline this has not been achieved even in public hospitals. A study published last year by Dr Margaret O Ambetsa of the University of Nairobi showed about half of prescriptions at Kenyatta National Hospital (KNH) was by brand names.

The study published in the African Journal of Pharmaceutical and Therapeutics found prescription by brand names was as high as 61 per cent among medical interns at the hospital.

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This, the study said was way below the 100 per cent World Health Organisation’s recommendation for generic prescribing.

The study blamed the high prescription rates by brand names partially to promotional activities by pharmaceutical companies among clinicians.

In an earlier study at Mbagathi District Hospital in Nairobi, Dr Gratia Muyu reported that up to 45 per cent of prescriptions were by brand names.

Dr Muyu said prescribing practices at the facility were unacceptable as depicted by too many drugs per patient and prescription by brand names.

These findings contradict Dr Simon Kigondu, Secretary General of Kenya Medical Association who on Wednesday told KTN News that doctors in Kenya only prescribe by chemical names and not brands.

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A survey on the cost and availability of medicines published in July for the German Agency for International Cooperation (GIZ), found highest distribution of non-generics to be in private practice and retail chemists. On average the study found Kenyans paying 63 per cent higher for imported branded drugs over generics in the private sector.

Researching for this article on Wednesday we were sold one generic tablet of the popular painkiller diclofenac at Sh10. This was against Sh100 for a branded version at the same pharmacy along Outer Ring Road.

Asked why the huge price difference the attendant who said was a trained pharmaceutical technologist, said branded medicines were of higher quality. But this view contradicts her ‘supervisor’ the Pharmacy and Poisons Board (PPB) on generic medicines.

“When a generic prescription drug has been authorised for sale by the PPB, it is as safe and effective as the original brand-name drug and works the same way,” says the board’s registrar Dr Fred Siyoi in their current newsletter.

David Makumi, chairman Kenyan Network of Cancer Organisations tells of a deliberate campaign, led by multinational drug companies to discredit generics. “Generics are saving lives in Kenya but should be well regulated and their integrity protected against vested commercial interests,” said Mr Makumi.

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Last year, a section of MCAs in Samburu County accused the local government of “discriminatively” providing some communities with generic drugs while preserving originals for perceived supporters.

“We are only buying generics because they are good, economical and that is what we are giving everybody,” Dr Alex Mungai, the County Chief Pharmacist had explained at a departmental meeting in Nakuru.

During the current debate, some callers-in to local TV shows have claimed that generics are only being prescribed to the low paying informal sector members of the National Hospital Insurance Fund.

This, while the original brands, the callers allege are preserved for higher capitated NHIF members from the formal sector.

While we could not verify these claims, a study by the Kenya Medical Research Institute recently reported members of NHIF from the informal sector being asked by private hospitals to buy medicines elsewhere. “The whole practice of pharmacy attendants asking clients whether they want original or generics drugs is subjective,” said James Kamau, chief executive at Kenya Treatment Access Movement.

6000 patients

The client, Kamau said will automatically think the more expensive the better, which is misleading. But the whole debate Kamau said is a red herring. “More than a million Kenyans are alive today courtesy of generic ARVs.”

The introduction of generic ARVs around 2003 saw the cost of treating HIV drop from about Sh1 million per person per year to about Sh20,000. This alone scaled up use from about 6,000 patients to about 1.3 million in Kenya today.

Dr Kigondu said what Madison Insurance is doing is outrageous and interfering with the doctors’ sacred autonomy.

“But such interference has worked in the UK, US and other countries,” said Dr Ambetsa in her study.

By using deliberate tools to promote generics such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland, on average use of generics is about 80 per cent in these countries. “A shift to local generics could reduce the cost of health care by more than half. We will not achieve universal health coverage with originals,” said Vimal Patel the Managing Director at Cosmos Pharmaceutical Limited.

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