Why the doctor will sell you the most expensive medicine

A silent war between health insurers and drug manufacturers has given a hint into what drives up the cost of your medical bill. Drugs make up 40 per cent of the majority of Kenyans medical costs and has been growing by the day, pushing up the cost of healthcare.

Insurers, suffering losses claim that drug makers have been pushing doctors to prescribe originator brands which sell at a cost that is three times that of its generic counterpart.

They are also claim that the originator brands are behind studies that are out to paint generic drugs as inferior, counterfeited and ineffective.

“When a drug manufacturer discovers a new drug they are given a patent, after 10 years other manufacturers are allowed to develop their own versions called generic drugs which have the same efficacy, quality and safety standards as the branded drugs,” a source from the insurance sector who did not want to be named so as not to jeopardize company relations in the sector told Financial Standard.

Last month, a study published by Scientia Pharmaceutica — Open Access by the Journal, by School of Pharmacy, University of Nairobi and National Quality Control Laboratory cast doubt on the quality of generic drugs sold in Nairobi chemists.

The study which collected 14 samples of generic pneumonia drug and compared them with originator brand Klaricid® and Klacid® which were obtained from Bordon Hampshire, England, for comparison purposes.

The study reportedly found that some of the samples did not dissolve at the same rate as the originator brand.

“In this study, it was noted that a significant percentage of clarithromycin generics did not comply with the specifications of similarity factor with respect to innovator products despite yielding comparable single-point dissolution results,” the study by Rebecca Manani, Kennedy Abuga and Hezekiah Chepkwony read.

Six tablet and capsule samples were found to be pharmaceutically equivalent to Klacid®, translating to a 50 per cent success rate. However, three samples were non-equivalent to Klacid® on account of higher percentage total clarithromycins dissolved, three samples were non-equivalent due to lower dissolution rates.

“The gist of this is that, some generics proved to be pharmaceutically equivalent to the innovator product, while some did not; hence the need for more discriminative tests as described in two above before the products are allowed in the market,” Dr Manani said.

Generics suffer the reputation of lower drug quality which although they are supposed to be approved by Pharmacy and Poisons Board , this is often flouted.

“Generic prescribing is a world-wide practice, adopted for most countries as an important cost-saving measure in provision of healthcare,” Dr Manani said.

“As we noted, this study was based on one molecule. We propose these findings to be a pointer to the need for extensive studies between other generics and their innovator counterparts. Such studies will ensure the consumer is exposed to only quality products from the shelves of our pharmaceutical outlets.”

The survey however admitted that it was limited and that single-point dissolution tests are insufficient demonstration of equivalence between the generic and innovator products which would require further tests.

Chemical formulae

Insurers claim that there is a deliberate effort to paint generics as ‘fakes’ and originator brands as ‘original’ motivated by huge brands. They claim that medical representatives, the sales people of originator brands entice doctors to prescribe the brands rather than generics and award targets with trips and conventions abroad.

Data seen by Financial Standard shows that 70 per cent of all prescriptions by hospitals were originator brands and only 30 per cent were generic.

“Doctors are supposed to prescribe the chemical formulae of the drug so that when you go to the chemist you will be given options but now they are out rightly giving specific brands which cost three times as much as the generic equivalent,” the source said.

Doctors however say they have the option of prescribing specific drugs in cases where they deem it best to treat the patient. “We can prescribe amoxilin and when the patient gets the drugs dispensed, they can choose between the generic or brand. However prescription is at our discretion depending on available drugs and personal preferences,” a doctor who spoke to Financial Standard said.

Insurers say they have been pressuring hospitals to relook the approach which has seen the ratios come down to 57 per cent originator brands, 43 per cent generic drugs. This is not a new accusation.

Since 2012 pharmaceutical group GlaxoSmithKline has been fined $3 billion (Sh300 billion) after admitting bribing doctors and encouraging the prescription of unsuitable antidepressants to children.

In the UK, the competition authorities have been hard on big pharma including Pfizer, Flynn and GlaxoSmithKline over delaying cheaper generic drugs or charging “excessive and unfair” prices.

In India, Prime Minister Narendra Modi’s said he wanted to bring a law to ensure that doctors prescribe only generic names of drugs so that patients can access cheaper versions of branded drugs.

Insurers having to foot huge medical bills while running into losses have discovered that medical fraud which they have blamed for many years is not the biggest threat but brand prescription might be responsible for their ill fortune.

Figures from Insurance regulatory Authority show the health sector paid Sh17.6 billion in claims for the last quarter of 2016.

During the period, the insurance firms made a modest Sh90 million in earnings with nine companies out of the 20 that offered medical insurance making outright losses while the rest made only modest gains.