Generics at 25

President Corazon Aquino commented in Filipino, “We have suffered for a long time; every time we get sick, we are forced to pay high prices for medicines.” Health Secretary Alfredo Bengzon declared, “Today, we create history. The unanimous passage of the bill by the people’s representatives truly makes it a people’s bill.”

The date was Sept. 13, 1988 and the event was the signing of the Generics Act, its full name being “An Act to Promote, Require and Ensure the Production of an Adequate Supply, Distribution, Use and Acceptance of Drugs and Medicines Identified by their Generic Names.”

The long name reflects how extensive the bill is, with provisions covering everything—from requiring drug companies to produce generics, to labeling with the generic name boxed and in larger font than the brand name, to physicians’ prescribing drugs by generic names. Drugstores are also required to offer generic versions.

As Secretary Bengzon noted, the bill was passed unanimously in Congress, but not without many battles and skirmishes. Support for the bill came from the Philippine Drug Action Network, a coalition of health nongovernment organizations (during a time when NGOs were still generally honest and often took strong political activist roles). I was with that coalition, and I recently went back to reviewing “The Drug Monitor,” a newsletter put out by one of the NGOs I was connected with, where there were monthly blow-by-blow accounts of the long process to get the Generics Act approved.

Opposition was fierce, coming mainly from multinational drug companies and the Philippine Medical Association (PMA). There were all kinds of legal threats directed against the Department of Health; and even after the bill was passed, there were many attempts to block the implementation.

The multinational drug companies argued that generic drugs were inferior, and that the required production of generic drugs was violating their rights. They warned that the market would be flooded with substandard and fake drugs.

The PMA sang a similar tune, saying generic drugs were inferior. Its members also argued that the required prescribing by generic names (with an option to add a brand name) was a violation of their rights.

Brand name loyalties

The reality then, and still to some extent today, is that the prescribing, dispensing and use of medicines were built largely on brand name loyalties that came about through advertising and strong promotions to doctors, the costs of which were passed on to consumers. The brand-name orientation also led to a flooding of the market with all kinds of “me-too” products, new brand names for old medicines.

The emphasis on brand names also meant patients and their families were often not fully informed about what medicines they were taking. Let me give just one example here of a household helper who came to me one day with difficult breathing and rashes. I asked if she had any allergies and she said no. Then I asked if she had just taken any medicine and she said, “Alaxan,” quickly adding that she had been taking the medicine for many years but without any problems. I had to explain to her that the contents of Alaxan had been changed and now contained a product, ibuprofen, to which some people have allergies. This incident came after the Generics Act had been passed, so I asked her to show me the packet of medicines and I told her to always pay attention to the box where the generic name appeared. I advised her to be careful in the future not to take any medicines with ibuprofen, or aspirin. I also told her to tell her doctor or the pharmacist clerks that she was allergic to “NSAIDs” (nonsteroidal anti-inflammatory drugs), which include ibuprofen and aspirin.

I remember, during the debates on the generics bill, physicians argued that generic names were hard to remember and made prescribing more difficult—something I found almost amusing because medical schools teach students pharmacology using generic names, not brand names. Of course, it was all an excuse to evade generic names and to go for the more profitable brand names. That was a time when physicians would sometimes get carbonized prescription pads so they could show drugs sales representatives, with incentives for these prescriptions, the number of times they pushed a particular brand name to patients.

The doctors also claimed consumers would get confused with generic names. Well, that household helper I just mentioned came to me a few months after her drug reaction and told me how impressed the pharmacist clerk was when she told him not to give her ibuprofen, aspirin or NSAIDs. I’ve since heard other lay people, sometimes with very little formal education, talking about their experiences with medicines, using generic names.

Educating the public (and physicians) on generics has been slow but I do see changes. More people, even people with very little formal education, now know what generics are and will ask for generic versions in drugstores. The smarter drug companies have also gotten on the bandwagon. Unilab has a sister company, Rite-Med, concentrating on generics and people sometimes now interchange “Rite-Med” with “generics” when they buy medicines.

There are also many more drugstores devoted to generics, including the Generics chain. Their prices are very competitive and it’s interesting how their suppliers include multinational companies, especially Sandoz. In fact, I sometimes worry that local generic manufacturers will lose out because there are now so many multinationals doing generics, with more attractive packaging and formulations.

Radical law

We still have a long way to go to make medicines more affordable, but the Generics Act was radical in taking the bull by its horns. In May 1988, at the height of the debates over the Generics Act, the American Chamber of Commerce (AmCham) wrote Secretary Bengzon with a thinly veiled threat, about how the proposed bill would have a “chilling effect on the entire foreign business community and a devastating effect on the possibilities for job generating investments by foreign concerns.”

Bengzon was curt in his reply, noting that while multinational pharmaceutical companies had a role in the Philippines, “left to their own accord it is in their nature to maximize sales and profits even while the poorest, sickest and most remote people have virtually no access to good therapy. . .”  Further on, he noted that 86 years after AmCham was established “we continue to be import dependent; no real technology transfer regarding basic manufacturing has happened.”

More than brand name emphasis, our high costs of medicines are tied to a weak manufacturing sector not just for pharmaceuticals but for so many of our basic necessities.   There’s some hope here. Again I have to mention Unilab as an example, with their willingness to challenge multinationals even for newer drugs by invoking something called compulsory licensing. But that’s for another column in the future.

Meanwhile, we should appreciate what the Generics Act has done, and what it can still do for Filipinos.

(E-mail: mtan@inquirer.com.ph)