Since other Asian countries have proven that it is possible to lower the price of prescription drugs and increase accessibility, the accusatory finger in the Philippines now points to its government. Experts agree that there are three areas of action the government needs to focus on in order to alleviate the current situation:
Revise the Intellectual Property Rights Code to allow for parallel importation of drugs, and to activate the early working agreement of the Bolar provision (stated in the Doha Declaration on Public Health). This will allow for compulsory licensing of drugs as well as set the length of patents and what objects may be placed under patent. (See Sidebar)
Reform the Department of Health (DOH), Bureau of Food and Drugs (BFAD), and the Philippine Health Insurance Company (PhilHealth) to empower them to perform their duties. Improve the DOH and BFAD facilities and their access to medicines for patients and generics manufacturers. PhilHealth programs should be improved to effectively respond to the public’s needs. Policing for counterfeit and illegally imported medicines must also be strengthened.
Revolutionize the national drug industry, one that isn’t dominated by foreign pharmaceutical companies. Of the 3,000 generics available in the market, 80 percent are off-patent already and local Filipino manufacturers can only produce 100 of those.
The first point is a short-term solution to making medicines more accessible and affordable to us. The last two points are long-term goals which are crucial to developing a healthcare system that can actually address our needs.
Patient Education is Key
We have a generics law, but it is peculiar. Doctors are required to prescribe generics, but they can suggest branded medicines in parentheses. This shows why our generics aren’t flourishing like in the US, where half the medicines sold are of the unbranded kind.
Enter the medical representatives of big pharma. “Malaki rin yun pressure,” relates Dr. Nisperos, referring to med reps. “Hindi lang sa ospital, aaraw-arawin (ang doktor). Bibigyan (sila) nang kung anu-anong pabuya.” All that effort is in order for doctors to put their products’ name in that valuable space between those parentheses. So what do we do? We buy the medicine the doctor suggests. Why? Sociologically, the patient-doctor relationship is that of a layman and a professional. Doctors have power over us as patients, and that degree hanging on his office wall serves as a reminder. Another reason is that generally, patients don’t know any better.
Educating the public needs to be promoted by everyone involved. Drugstores should publicize generics more openly instead of trying to sell the branded medicines. Doctors need to be more professional and prescribe the most cost-effective medication and not pander to pharmaceutical companies and their powerful marketing machinery.
Ultimately, we need to be proactive. We need to trust generics and parallel imports from reputable retail outlets and ask for them. We have to know that the differences between generics and branded, off-patent versions are the marketing budget spent on the branded ones, and the R&D spent by the drug traders. The previous patent-holders had long profited from that and are banking on brand recognition now. Quick, name as many kinds of mefenamic acid you know. Just one? There are at least 25. Know that you have choices.
If you think that the presence of counterfeit medicines has too much bite, companies like Unilab do have a pharmacoeconomics program which provides cheaper, yet equally effective alternatives for the consumer. One particular example is simvastatin, a drug for high cholesterol. It was priced lower than competing drugs, causing multinational pharmas to respond with lower prices of their own. They also have a generics arm, RiteMed that produces the off-patent medicines previously mentioned.
If ignorance of the law excuses no one, then with our role as patients, we are as responsible for our treatment. Patients have power, too. We just have to realize it. Assigning all fault on the supply chain is narrow-minded. They are in the business of delivering medicines to those who need it. But keep in mind that it’s still a business, and market conditions shift and swirl like the currents of the sea. Blaming government is beating an old horse; whatever measures they need to undertake will be for the long haul. Patient education is primary because it leads to immediate awareness. Awareness leads to better health. That’s what the medicine is for, after all.
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Men's Health Philippines - May 2007 Issue
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The chasm that lies between a patient and his doctor is rooted in a difference in perspective. The patient is sick; the doctor is the provider of health. The result: The patient does exactly what the doctor ‘orders.’ Take heed of these useful reminders and be an active participant in your wellbeing.
Insist on generics.
When the doctor pulls out his ‘scrip pad,’ tell him you want generics. By law, doctors are required to prescribe generics if they are available for the type of drug. They can ‘recommend’ a branded one. Always buy the generic one. They are generally safe and as efficient. When you get to the pharmacy, ask again to see a list of generics. If the list isn’t updated, educate yourself. Get a MIMS Annual copy (National Bookstore, P850) and check out the comprehensive list of drugs. The book is the definitive resource for information on medicines.
It might cost less to get a second opinion.
Let’s say a doctor prescribes azithromycin for acute bronchitis. Ask him if there is an alternative, cheaper antibiotic. The treatment might last longer–as may symptoms–but if it’s not yet a danger to your life, the doctor usually relents in prescribing the alternative. If it’s maintenance medication for asthma or hypertension, get a second opinion from another doctor. The medicine he prescribes might be cheaper and as effective as the more expensive ones you will be using everyday.
Finish your medicine!
You might feel better after three days of medication, but if the doctor tells you to take it for seven days, you better finish the cycle. Doctors write down prescriptions to serve as guidelines for the pharmacist and you to follow. You may be symptom-free, but you can’t be the judge whether or not the medicine has eradicated the source of the symptoms. Stop taking it or take it the wrong way and you might end up worse-off prior to medicating.
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