While market based pricing can potentially reduce pricing for two-third essential medicines, there are several critical medicines that are not in the “essential medicines” list. Several Diabetes, TB, HIV, Cancer drugs are not under DPCO 2013 even though WTO lists them as essential

According to Drug Price Control Order (DPCO) 2013, the ceiling of prices is fixed based on the simple average of the prices of all brands of that drug that have a market share of at least 1%. The national list of essential medicines lists 348 bulk drugs, which are sold as 650 formulations. DPCO 2013 itself covers only 14 %-17% of the Rs75,000 crore pharma market, which means only a small subset of the market will be impacted. It is bizarre that many “essential” medicines are actually not in the current National List of Essential Medicines (NLEM) 2011. What constitutes “essential” and “unessential” drugs should not be much of a debate.

Read - Medicine prices: Encouraging profiteering from essential drugs – Part1
 

Read -Medicine prices: DPCO loopholes will deny cheaper essential drugs–Part2
 

NGO All India Drug Action Network (AIDAN) has filed PIL (public interest litigation) in SC contending that market based pricing (MBP) is never used for any price regulatory purposes and under the new policy simple average ceiling prices are in many cases higher than the market leader price.
 

According to Dr Anant Phadke who is associated with AIDAN, “Very commonly used essential oral anti-diabetic medicines like glimeperide and glicazide are not classified as essentials; very commonly used anti-asthmatic medicines like salmeterol and montelukast too are not in essential medicines list.”
 

 S Srinivasan, managing trustee, LOCOST (Low Cost Standard Therapeutics) has a strong case for several drugs that need to be considered as essential medicines. There are many essential medicines which are excluded from the current NLEM 2011 and they will continue to remain priced/ overpriced by letting the market decide.
 

Here are facts elucidated by Mr Srinivasan -
 

Multi-drug resistant tuberculosis (MDR-TB) - While the World Health Organisation (WHO) Essential Medicines List (EML) includes  capreomycin, cycloserine, ethionamide, kanamycin and para-aminosalicylic acid for treatment of multi-drug resistant tuberculosis (MDR-TB), the NLEM 2011 does not mention any of these. Drugs for MDR-TB are highly expensive, and only a fraction of the patients with MDR-TB are under the government’s DOTS-Plus treatment.
 

Vaccines - While the WHO EML mentions 21 vaccines, the NLEM 2011 mentions only nine vaccines. It is another matter that most of these other vaccines are available in the market; they are costly, and prescribed by doctors who should have known better about their need and utility.
 

Diabetes - India has the largest number of diabetics in the world. Many important and widely used anti-diabetics are missing in the NLEM 2011 and therefore will be out of price regulation. The only anti-diabetics in the NLEM 2011 list apart from insulins are glibenclamide and metformin. Glime piride, the widely used alternative to glibenclamide, has a lower risk of hypoglycemia (low blood sugar levels) but has been excluded – even as it’s top-selling brand Amaryl 1 mg is priced at a 3,000% margin. Not a single medicine out of the seven-eight commonly used anti-diabetics belonging to four different chemical groups are included in the NLEM 2011 and hence would remain out of price control.
 

If insulins were excluded from calculations, 90% of the anti-diabetics market would be out of price regulation. Even among insulins, imported insulins have been allowed a higher price than those manufactured within India. But after the DPCO 2013 takes effect hopefully the same ceiling prices will be applicable to imported insulins also – as para 4 (2) of the  DPCO 2013 says that the ceiling prices notied by the government will be applicable to scheduled imported formulations also.
 

HIV/AIDS, Cancer, Asthma, etc - Likewise many other commonly used critical care medicines for  HIV/AIDS, cancers, mental health, chronic non-communicable diseases like asthma, rheumatoid arthritis, etc, which are costly and not in NLEM 2011, will be out of reach and be a glaring denial of the right to life.
 

In the fourth part of the article, we will look at examples of drugs wherein ironically the DPCO 2013 ceiling price is higher than the market leader MRP (maximum retail price). Can we see price increase for these medicines?

Read-
Drug Abuse
 

Will you really get cheaper medicines?

New drug pricing policy may increase prices of essential medicines