JEANNE MADDEN AND ANITA KOTWANI

J. Madden

A. Kotwani

THE most recent WHO/HAI medicine prices survey was conducted in Rajasthan, India, by the Delhi Society for the Promotion of Rational Use of Drugs, and their survey used the revised methods for looking at availability. The Rajasthan team surveyed three different sectors - public facilities, private pharmacies, and an NGO sector of limited-profit cooperative outlets. They looked at 20 outlets or locations in each sector, and gathered data on 36 different substances. These included 27 substances on the current WHO/HAI core medicines list, and nine locally-selected substances. The other three substances on the core list were not looked for in the field because these substances (or strengths) were known to be unavailable in the region. As usual, for each substance, price and availability data were gathered on the originator/innovator brand, on the most popular generic version in the region, and on whatever happened to be the lowest-priced generic version in the outlet.

Results are shown in Figures 1 - 3 and for each product category they have been grouped into four levels of availability. Some products were never found in the sector; some products were hard to find in the sector (<50% of outlets); some were seen in most places (>=50% of outlets had the product in stock, but <90%); and, finally, other products were almost always available in the sector (90% or more of surveyed outlets).

It is fascinating to compare across sectors and types of products. Only in the private sector could all 36 medicines be found in a generic version in at least some outlets (Figure 1). In other words, there were no medicines that were found in none of the private sector outlets. Most of the medicines (25 out of 36) were found in at least 90% of surveyed private pharmacies. In contrast, in the public sector, there were seven generic medicines that could not be found in any public outlet. Availability of generics appears to have been highest in the private sector, lowest in the public sector, and in-between in the NGO cooperative facilities.

The drugs that were unavailable in the private sector were captopril, fluphe-nazine injection, hydrochlorothiazide, indinavir, losartan, lovastatin and nevirapine. The survey team reports that HIV/AIDS medicines and lipid-lowering medicines are not on the current Rajasthan Essential Drugs List, and therefore do not appear in local facilities. HIV/AIDS medicines are, however, approved for distribution to poor patients at the main public teaching hospital in the capital, Jaipur. It should be noted that in any WHO/HAI price survey, it is possible that some drugs that appear to have been unavailable were actually available in strengths other than the standard one sought.

Figure 1. Availability of any generic version: results for 36 medicines

Figure 2. Availability of innovator brand product: results for 36 medicines

Figure 3. Availability of most sold generic version: results for 36 medicines

When the Rajasthan surveyors looked for specific named products (the originator brand and the most popular generic version), similar patterns were found among sectors. Availability results in Figures 2 and 3 show that availability was consistently highest in the private sector, and somewhat lower for the NGO sector. The public sector, on the other hand, never provided the originator brand version of any of these 36 essential medicines (Figure 3). There were just two products (beclomethasone inhaler and salbutamol inhaler) whose most-sold generic version was found in the public sector, and then only in a handful of outlets (Figure 3). The remaining 34 most-sold generic medicines never appeared in the public sector.

The figures also illustrate the strength of the generics market in India. In both the private and NGO sectors, consumers are much more likely to encounter generic products, including the single most-sold version, than they are to find originator brand products for these essential medicines. In both sectors, half of the medicines (18 out of 36) were never available in the originator brand name. With a couple of exceptions, these were the same set of medicines in the two sectors.