Generics -IPS VIEW

This communication is to address the immediate concern of fellow psychiatrists. The IPS EC is schduled to meet on the 10th May at the IPS HQ to discuss the sequel and impact of the relevant MCI circular. 
The following communication is being released after due approval from the Honb’le President – IPS.


Dear Mr. President, Office Bearers, Members of the Executive Committee and IPS Colleagues 
The IPS Task Force on Psychopharmacology deems it appropriate to attach copy of the recent MCI circular about the mention of generic names in every Physician’s prescription.
Salient features:
The circular mandates that names of the generic drug should be legibly written, preferably in capitals and rational drug use be implemented.

The circular is silent on the mention of Trade names / Generic Brand / Patent Brand names on the prescription.

The term ‘physician’ is not clearly defined on the MCI sites. Presumably it includes all medical graduates, registered with the central or state medical councils
The IPS task force deliberated on this circular and concur as follows.
 Marketed drugs could be divided into three groups: 

(1) Unbranded bulk generics that do not have any trade or brand name and are traditionally supplied in bulk to the buyers. 

(2) Generic Brands, the generics of the original / patented brands, essentially made by local companies that replicate molecules researched by others and market them under their national and sometimes global brand names, when exported. These are the brands that standalone psychiatrists and psychiatrists in structured set up would prescribe to individual patients and 

(3) The Patent Brands, research molecules of the parent company, usually sold under global patented labels. The Patent Brands used to be decisively more costly than the Generic Brands. Of late, several MNCs tend to match the Generic Brand prices.

The said circular is silent on the use / prescription of generic or patent brands. Their prescriptions are NOT banned or discouraged. 

 In this context, any prescription of the Generic Brands, would be quite in accordance with the MCI circular attached to this mail. 

Prescriptions of Patent Brands are NOT Prohibited. The circular is silent on this subject. Hence the prescribing clinician is empowered to prescribe Patent Brands as well, so long as the prescription is justifiable and the generic compound is clearly written in legible capital letters.

The Task Force is of the opinion that our colleagues may prescribe whichever Brand (Generic Brand or the Patent Brand), and clearly mention the generic name of the active molecule legibly on the prescription, preferably in capital letters.

The Task Force is of the opinion that prescribing generics without mentioning a Brand could confuse the drug store staff, fellow physicians, end-users, patients and / or their caregivers.

The drug stores tend to maintain their ledgers and inventories by the brand names. The counter sales persons may not be geared to understand drugs by their generic names and would then be vulnerable to misperceptions or confusion.

Besides the risk of confusion, there is also an apprehension, (attributed to undocumented market gossips), that an unethical drug maker could induce drug stores to dispense a particular brand by offering unspecified incentives, in the context of the perhaps operationally unregulated or poorly regulated market practices.

The Task Force is also of the opinion that the tone and tenor of the circular is probably aimed at curbing misuse of drugs like high-end antibiotics and some other systemic drugs. It does not seem to refer specifically to the use of drugs in mental health sector.

Without prejudice, the Task Force recommends appropriate compliance with the MCI circular, by specifying the active generic content of the Brand that may be prescribed as per the justifiable and rational indications and other factors like the cost and availability of the particular brand of the drug.

The Task Force emphasizes need for awareness against such cautious practices of drug prescriptions that may inconvenience the recipients of our treatments. (At a tangent: A frustrated end-user could be prone to aggressive outbursts!!)

The Task Force invites comments and suggestions (please avoid criticisms without proposing options or solutions) to help us all to sharpen our skills.
Dr. Vihang N. Vahia (on behalf of Dr. Rajesh Dhume and Dr. Sharmila Ghosh)

for The IPS Task Force on Psychopharmacology

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