LOCOST/JSS
Vadodara/Bilaspur
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Impoverishing the Poor:
Pharmaceuticals and Drug Pricing in India
LOCOST/JSS
Vadodara/Bilaspur
September 2004
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First Edition: January 2004
Second Edition: September 2004
This publication is brought out in public interest by Low Cost Standard Therapeutics
(LOCOST), Vadodara, and Jan Swasthya Sahyog (JSS), Bilapsur, India.
Emails: locost@satyam.net.in, jss_ganiyari@rediffmail.com
Web addresses: www.locostindia.com, http://www.geocities.com/jss_ganiyari/
Mail address: LOCOST, I Floor, Premananda Sahitya Sabha, Dandiya Bazar, Vadodara
Guajarat 390 001, India. Ph: 0265 2413319/2830009
Jan Swasthya Sahyog, I-4, Parijat Colony, Nehru Nagar, Bilaspur, Chhattisgarh 495 001,
India. Phone/Fax: 07752-247966
Jan Swasthya Sahyog is a team of health professionals, many of whom were trained at
the All India Institute of Medical Sciences, New Delhi who are running a women health
worker based community health program in 35 tribal forest-related villages of Bilaspur
district of Chhattisgarh. Their actvities include running a community health centre based
at village Ganiyari that provides low cost curative services to over 1000 villages of the
district. Other activities of JSS include development of low-cost health related
technology, field based action research on major public health problems, training and
advocacy (see also www.geocities.com/jss_ganiyari/ ).
LOCOST and JSS are members of the All-India Drug Action Network (AIDAN).
AIDAN was founded in 1982. AIDAN member-organisations have been active in the
campaign for a rational, people-oriented drug policy. Members of JSS and LOCOST are
also active in the Medico Friends Circle (MFC), an all-India network active since 1975 of
socially concerned health action individuals, medical and health professionals and health
researchers and academics from all over India (see also www.mfcindia.org)
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page 3
Preface
We are happy that India can boast of a pharmaceutical industry that is one of the largest
in the developing world. It has demonstrated the ability to provide low-cost but quality
generic drugs for HIV and other diseases to the world outside and has the capacity to
meet our entire drug needs. The Indian Patents Act 1970 ensured the growth of an
indigenous pharmaceutical sector and the Drug Price Control Order protected the
consumer from irrational drug prices. We would like the Government to safeguard the
precious pharmaceutical sovereignty that we have won over the last three decades rather
than sacrifice it at the altar of international agreements.
We would have been however happier if the conditions, which compelled the publication
of this book, had not existed:
The reality is very different and grim. Severe and growing inequities across classes and
regions ensure that India’s health indicators are anything but shining.
Drugs are overpriced and unaffordable – let there be no mistake about it, even though
some of them may be ‘cheapest’ in the world. The margins are extremely high as we
show in the following chapters. We even show that the same Indian drug companies, in
an ironic twist, sell the same medicines cheaper in neighbouring Sri Lanka.
More ‘players’ have not resulted in lower prices of drugs in India or for that matter lower
cost of health services. So what have the people of India gained by a world-class (or soon
to be one) drug industry? Asking this question is as infuriating as asking why are many
people going hungry to bed when our food godowns are overflowing and food stocks
have to be destroyed every year.
Chaos Unbound
The Indian drug industry is the freest in the world in a wholly negative sense of the term.
It is okay to conduct clinical trials of an anticancer drug with embryotoxic potential as an
ovulation inducer in infertile women without permission. Consider some other facts:
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• Hazardous drugs, long since banned in the rest of the world, continue to find
place in our shops.
• Tonics of dubious therapeutic value abound that fritter away the patient’s hard-
earned money, leaving none to buy real medicines.
• Drug controllers in different states go on giving licenses to irrational
preparations that add only cost but no value to the prescription.
• The Drug Controller of Karnataka (and it might be true of most other states)
passes substandard drugs, looks the other way when violations of price control
occur, and even collects bribes on a regular basis from his own subordinates.
• Nearly 40 children die of renal failure after consuming paracetamol syrup
contaminated with ethylene glycol, the same substance that killed fourteen people
in Mumbai twelve years ago, and this time too the drug-testing laboratory doesn’t
find anything amiss.
• Companies are free to set the margin of profits for themselves and the
pharmaceutical trade. Doctors are free to prescribe medicines as they wish with
no concern for indication, cost or rationality.
• The Medical Council of India and the Indian Medical Association cannot yet
decide whether it is appropriate for a doctor to receive a car or an airline ticket or
an air conditioner from a drug company. Chemists without the most elementary
qualification are free to sell all kinds of drugs without a prescription.
Which has good historical precedents: from 347 essential drugs in the late 1970s to
seventy-four by the late nineties and now probably to around 30 if the 2002 policy is
implemented. The kinds of drugs that would be left under price control are mostly
irrelevant to public health. Even the Drug Price Control Order of 1995 conspicuously
omitted drugs for anemia, diarrhoea, the majority of drugs for tuberculosis, hypertension
and diabetes, and all drugs for cancer.
We have appended certain documents in the Documents section quoting chapter and
verse literally from Government Committees that reinforce views expressed by the
authors even as the PP 2002 tries to sing a different tune.
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Hope in a New Government
It is hoped the new UPA government would examine the matter afresh and reformulates a
new pharmaceutical policy that gives hope to poor Indians that they too matter. Indeed
the Common Minimum Programme (CMP) of the new Government in the country says,
inter alia, “the UPA Government will take all steps to ensure availability of life-saving
drugs at reasonable prices. Special attention will be paid to the poorer sections in the
matter of health care. The feasibility of reviving public sector units set up for the
manufacture of critical bulk drugs will be re-examined so as to bring down and keep a
check on prices of drugs.”
The new Government must mean business and see wisdom in keeping essential drugs
outside the vagaries of market forces and vested interests. It would be in good company if
it indeed did so. Price control and/or some form of strict regulation of drug prices are the
norm in all developing countries (with the possible exception of the USA).
The immediate context of the booklet is the case pending in the Supreme Court in which
LOCOST, Jana Swasthya Sahyog (JSS), All India Drug Action Network (AIDAN) and
the Medico Friend Circle (mfc) are co-petitioners. We have filed a series of affidavits in
the matter1 questioning the wisdom of the criteria for drug price control in
Pharmaceutical Policy 2002 (PP 02). It is our submission that the policy will increase the
price of medicines and therefore have a long-term effect, for the worse, on the health of
people, especially poor people. The related SC order of 10/3/2003 says, “… We direct
that the petitioner shall consider and formulate appropriate criteria for ensuring essential
and life saving drugs not to fall out of price control..."
This litigation is also occurring at a critical juncture where India’s state of public health is
still grappling with old diseases while new ones like HIV/AIDS, diabetes and
cardiovascular problems have got added on to the disease burden. Complicating this issue
is the impending regime of WTO/TRIPS effective Jan 2005.
While final hearings are slated for sometime later in the year 2004, we felt it necessary to
share with the wider public the grave issues in the matter affecting all people in India.
These issues stand whatever be the outcome of the litigation.
This publication addresses pricing and related issues of the drug industry in India. It
draws upon the experiences and insights of people, who have, over the past 25 years,
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Namely SLP(C) 3668/2003 filed by Union of India asking for impugnment of the order of the Karnataka
High Court dated 12.11.02. The latter order ( in WP No 21618/2002 Lt Col (Retd) Gopinath and another
versus the UOI) stayed the operation of that part of the Pharmaceutical Policy 2002 that affected drug price
control.
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consistently engaged the government to ensure access to less expensive, safer, and more
rational medicines.
We hope that it would enlarge the circle of public-spirited individuals and organisations
that are concerned about these issues and drive them to do something about it. In this
sense, it is not a book. It is a plea for action to do something.
Acknowledgements
Authors (AB and SS) wish to acknowledge the support of Mira Shiva, C.Sathyamala, our
co-petitioners, and our lawyer Colin Gonsalves and his team for continued and
appropriate legal advice. We also wish to acknowledge the support and encouragement,
direct and indirect, of Anant Phadke, P.K.Sarkar, Wishvas Rane, Sunil Kaul, Ravi
D’Souza and many others in the health sector and in the print media.
We thank Dr Chandra Gulhati, Editor, MIMS India, for contributing Chapter 3 and mfc
bulletin for permission to reproduce the same. We have acknowledged sources wherever
possible and inadvertent omissions in this regard are regretted and may be brought to our
notice.
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Contents
Page no.
1. Missing the Woods for the Trees: Drug Price Control and Pharmaceutical Policy 2002
5. What They Could Be? Drug Costs in Treatment of Common and Important Illnesses
and Affordability of Treatment Costs
6. Pharmaceutical Policy (PP) 2002 and National Health Policy (NHP) 2002:
Discordance in Perspectives and Content
7. Price Control Policy and Public Health: Irrelevance and Danger of Applying only
Economic Criteria
11. Anomalies in Drug Pricing and Sale of Drugs: A Look at Drug Prices in a
Neighbouring Country and an Analysis of What Sells the Most in India
12. Prevention Better Than Cure? Issues of Concern in the Pricing and Marketing of
Vaccines in India
Documents
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Some Important Links
6) Approved L1 rates for the supply of Drugs & Medicines for the Period from 01-
11-2003 to 31-03-2005
http://www.tnmsc.com/system.htm
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(Second cover and third cover)
PRAYER2
In the facts and circumstances, stated herein above, it is MOST RESPECTFULLY prayed
that this Hon’ble Court may be pleased to:-
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(Prayer of petitioners in the case filed by AIDAN and ors. versus Union of India in the
Supreme Court – WP (Civil) 423/ 2003)
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Drug Authority in accordance with the recommendations of the Drug Policy
of 1986 and 1994.
(Prayer of petitioners in the case filed by AIDAN and ors. versus Union of India in the
Supreme Court –WP (Civil) 423/ 2003)
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