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• Understanding public drug procurement in India: a comparative qualitative study of five Indian states
  Amit Pachal
  Published on: 8 March 2013

• Published on: 8 March 2013

  Understanding public drug procurement in India: a comparative qualitative study of five Indian states

  • Amit Pachal, Pharmacist

  Pharmaceutical procurement is a specialized professional activity that requires a lot of knowledge, skill and experience. It is therefore mandatory that staff involved in key procurement and distribution positions be well trained and highly motivated, with the capability to manage the procurement process efficiently. Pharmaceutical procurement is a complex process, which involves many steps, agencies and manufacturers. E...

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  Pharmaceutical procurement is a specialized professional activity that requires a lot of knowledge, skill and experience. It is therefore mandatory that staff involved in key procurement and distribution positions be well trained and highly motivated, with the capability to manage the procurement process efficiently. Pharmaceutical procurement is a complex process, which involves many steps, agencies and manufacturers. Existing government policies, rules and regulations for procurement as well as institutional structures prove frequently inadequate and sometimes hinder overall efficiency in responding to the modern pharmaceutical market1. There are many steps in the procurement cycle. No matter what model has been adopted to manage the procurement and distribution system, efficient procedures should be in place to select the most cost-effective essential drugs to treat commonly encountered diseases; to quantify the needs; to pre-select potential suppliers; to manage procurement and delivery; to ensure good product quality; and also to monitor the performance of suppliers and the procurement system. Failure in any of these areas leads to lack of access to appropriate drugs and to waste. In many public supply systems, breakdowns regularly occur at multiple points in this process. In India, various organizations follow different operating procedures for effective pharmaceutical procurement. Absence of comprehensive documented, systematic and uniform procurement procedures, guidelines and proper delegation of power become utopian. In some organizations, purchase manual is either unavailable or available at an obsolete state. Even some institutions deploy these procurement staff by having negligible or no training or education leading to procurement system in jeopardy. Staff becomes vulnerable to audit and vigilance issues. In West Bengal, there are no Pharmacists in most of the store purchase section. There are few hospitals in India where a professionally qualified pharmacist heads medical store or Pharmacy Therapeutic Committee determines medical pharmacologist and selection of drugs. We are fortunate to have essential drug list of 348 drugs but it is not in the line of British National Formulary like database. It is quite a tedious process to achieve an unbiased conclusion on different types of branded drug, branded generic drug or the MRP. Non-existence of computerized database, lack of co-ordination and collaboration lead to failure of rational procurement at the most competitive price and in a fair, just and transparent manner. Indian pharmaceutical jungle is flooded with more than 90,000 formulations with having little control on price regulation. A recent study published in Indian Journal of Pharmacology shows that there is no remarkable variation of quality between branded and branded generics in India. Glimpses of study shown in the following chart: Trade name of medicine Pharmacological name, strength and dosage form Manufacturer PTR (1x10) MRP (1x10) Mark-up (retailer) Alerid tablets (B) Cetirizine HCL 10 mg/tab Cipla INR 27.16 INR 35.31 30 Cetcip tablets (B/G) Cetirizine HCL 10 mg/tab Cipla INR 2.24 INR 25.00 1016 Fludac capsules (B) Fluoxetine HCL 20 mg/cap Cadila INR 29.80 INR 37.26 25 Cadflo capsules (B/G) Fluoxetine HCL 20 mg/cap Cadila INR 6.00 INR 28.00 367 Ciprobid tablets (B) Ciprofloxacin 500 mg/tab Cadila INR 54.84 INR 68.56 27 Ciprodac tablets (B/G) Ciprofloxacin 500 mg/tab Cadila INR 15.00 INR 68.56 357 Lanzol-30 capsule (B) Lansoprazole 30 mg/cap Cipla INR 42.36 INR 53.77 27 Lansec-30capsule (B/G) Lansoprazole 30 mg/cap Cipla INR 15.68 INR 47.25 201 Restyl tablets (B) Alprazolam 0.25 mg/tab Cipla INR 11.85 INR 14.82 25 Tranex tablets (B/G) Alprazolam 0.25 mg/tab Cipla INR 2.20 INR 11.34 415 Branded medicine (B) Branded-generic medicine (B/G), Price to the retailer (PTR) Maximum Retail Price (MRP)

  Findings of the present study indicate that both the branded and branded-generic versions of the five paired medicines had identical quality and they fulfilled all the criteria prescribed by the Indian Pharmacopoeia. Hence, the general notion and doubt regarding the quality of the branded-generic version of medicines need to be erased conducting more such studies and publishing them widely. Suitable changes in the drug price policy may be adopted to lower the prices for branded-generic versions. Transparency in fixing the MRP by the manufacturer and clear guidelines for mark-ups at least for branded-generics is required in pharmaceutical trade. Availability of generics or branded-generics in the market with lower price tag and assured quality is the need of the hour to make the medicines affordable3. The government must conduct more and more promotional events in favour of generic drug, arrange general awareness programs on quality of generics to increase confidence amongst prescribers, pharmacists, and consumers.

  The corrective measures as follows: Easy availability of valid Good Manufacturing Practice Certificate (GMP), approved product list and loan license details for the manufacturers whose products are produced elsewhere. A procedure to have knowledge on more number of brands available for the same medicine Open access of last purchase rate of different organizations More stringent provisions in tender documents relating to 'liquidated damages', 'pre-qualification norms', 'packaging', 'performance security', 'warranty period', 'imposition of penalty for delay in supply, 'remaining life' and 'bid security', etc. Updated list of substandard drug in the website of CDSCO(Central Drug Standard Control Organization/India) and state drug control Appropriate time-frame at each stage of procurement and accountability of staff involved in procurement procedure Central Public Sector Enterprises may be more encouraged to manufacture all essential drugs at low cost Enhancement of quantity and quality of approved drug testing labs Steady flow of government funding towards procurement of drug Either the allotted fund may be spent in the stipulated year and the unspent fund may be carried forward to the next year Increased monitoring on performance of distributors and manufacturers Decentralization (fragmented drug procurement in different levels- district, state, central, public sector undertaking etc.) of procurement Unbiased market information on product availability, comparative pricing, product quality and supplier performance Incentive and out of turn career development in procurement section Increased exposure to latest market situations for tackling different crisis Strengthening the existing regulatory system especially for enabling more detailed and universal classification of drugs and chemicals between branded generic and generic. Strengthening the public information system to reach out more consumers for simple drugs.

  When and where needed, pragmatic and rational procurement and inventory management always ensure choice of right drug in right quantities, doses and formulations, good quality, safe and efficacious. All organizations should prepare codified purchase manuals, containing detailed purchase procedures, guidelines and also proper delegation of powers, so as to ensure systematic and uniform approach in decision-making areas pertaining to procurements.

  1. Chapter 13: Managing procurement. Management Sciences for Health (MSH) in collaboration with the World Health Organization, Action Programme on Essential Drugs. Managing drug supply, second edition. Edited by J.D. Quick, J. Rankin, R. Laing, R. O'Connor, H.V. Hogerzeil, M.N.G. Dukes and A. Garnett. Hartford, CT: Kumarian Press; 1997. 2.A comparative evaluation of price and quality of some branded versus branded-generic medicines of the same manufacturer in India-G.L. Singal, Arun Nanda, Anita Kotwani, Indian Journal of Pharmacology | April 2011 | Vol 43 | Issue 2 131 3. Department-related parliamentary standing Committee on health and family welfare Fifty- ninth report on the functioning of the central drugs standard control organization (cdsco) (presented to the rajya sabha on 8th may, 2012) (laid on the table of the lok sabha on 8th may, 2012)

  Conflict of Interest:

  I am a Procurement Pharmacist in Indian Railway

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  Conflict of Interest:
  None declared.

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