Same medicine, different price

Three weeks ago, when Geetha BR, 49, a banking professional, was down with typhoid, her family physician advised her to take Cifran 500, which costs Rs98.50 for a strip of 10 tablets. Geetha was not aware that Cifran is the brand name of the antibiotic ciprofloxacin, and that cheaper brands of the same medicine are available, costing half the price.

Only when her daughter Nisha, 20, a pharmacy student, noticed the Cifran strip at home, was she informed that cheaper alternatives, but of the same quality, are available. “I shelled out double the amount than necessary,” rued Geetha.

Ciprofloxacin belongs to a category of drugs the prices of which are controlled by the government, precisely the National Pharmaceutical Pricing Authority (NPPA) under the department of pharmaceuticals. Still, the variation in price of various brands of the same drug is immense.

Price control drugs are essential medicines, such as antibiotics and painkillers, and drugs used for the treatment of diseases such as cancer and asthma. Such medicines contain bulk drugs, or raw material, whose prices are controlled by the NPPA; manufacturers cannot hike prices on their own. However, 90% of drugs are outside price control in India. In 1979, the prices of 347 bulk drugs and formulations containing them were controlled. That control was reduced to 142 in 1987, and 74 in 1995.    

“Of the 74, about a dozen is no longer in use. So, effectively, of the 500 bulk drugs used to produce medicine formulations, 90% is outside price control,” said CM Gulhati, editor of the medical reference journal Monthly Index of Medical Specialties (MIMS).

Concerns have been raised about the fact that in a poor country like India (according to World Bank estimates, over 456 million people in a population of a billion live below the global poverty line of $1.25 per day) there is such weak drug price control. NPPA chairman SM Jharwal was not available for comment.

Still, the NPPA has charged companies like Cipla, Ranbaxy, Dr Reddy’s Laboratories and Wyeth for overcharging. The NPPA is trying to recover Rs2,000 crore in overcharged amount.
According to S Srinivasan, managing trustee of Locost, a Baroda-based NGO, cost differentials between brands have got nothing to do with the quality of the medicines, but occur due to marketing and promotional expenses.

ENT surgeon Gopal Dabade, co-convenor, All India Drug Action Network (AIDAN), says medicines cannot be up for free pricing as they are an item where the decision to buy is not determined by the consumer, but by doctors and at times chemists. “The need to buy medicines is immediate and involuntary, unlike other items. Government control of drugs is essential.”