It has been twenty-five years since the passage of the Generic Drugs Act and five years since the Cheaper Medicines Act, but majority of Filipinos, particularly the poor, have not fully taken advantage of the laws` benefits.
Separate evaluations of the Generics Act of 1988 (Republic Act 6675) and the Cheaper Medicines Act of 2008 (Republic Act 9502) by state think tank Philippine Institute for Development Studies (PIDS) and the Department of Health (DOH) confirmed that low consumer awareness was among the reasons for the low take-up. This is compounded by the perception that generics are of poorer quality compared with branded medicines.
The Cheaper Medicines Act is intended to achieve universally accessible, cheaper, and quality medicines by pursuing an effective competition policy in the pharmaceutical sector. Under the law, an executive order was issued imposing maximum retail prices on a number of drugs. The Generics Act, meanwhile, aims to promote, require, and ensure the production, adequate supply, distribution, use, and acceptance of drugs and medicines identified by their generic names.
The PIDS-DOH study titled The Impact of the Cheaper Medicines Act on Households in Metro Manila found there was low awareness of the law, and while many people were aware of the Generics Act, most respondents thought the Cheaper Medicines Act covered mainly generic medicines.
Adoracion Fausto, one of the authors, said during a forum co-organized by PIDS and DOH last February 13, that although the increase in the number of generic drugstores and the use of celebrity endorsers like Vilma Santos and Susan Roces had helped improve the image and acceptability of generic medicines, a more integrated communication campaign by the DOH was needed to promote the benefits of the two laws.
The study found that government physicians have a positive influence on the use of generics because they are required by law to write prescriptions using generic names. However, private physicians, who have an option to write in brand names in addition to generic names, seem to contribute to the generic medicines image of poor quality, especially among higher social classes.
"It is important to study physicians behavior because whatever the doctors say, the patients will follow. In doing so we can develop ways on how to mobilize them and make them advocates of the Cheaper Medicines Act," Fausto said.
To correct consumer perception on the quality of generic drugs, the study said information on why and how drug prices were reduced should be provided by the Food and Drug Administration (FDA), to address quality and efficacy issues.
In response, FDA Acting Director-General Kenneth Hartigan Go said the agency was already implementing several reforms to address not just perception but also real problems. These reforms include strengthening FDAs capacity through recruitment of qualified personnel, so it can expand the scope of its work.
"For example, FDA should be able to do foreign compliance [with] current good manufacturing practices inspection. This way, the FDA can determine where the drugs came from and whether the factory [complied with] current good manufacturing practice," Go stated.
Likewise, FDA will implement a process of risk management planning for drug firms. Drug companies will be required to submit a risk-management plan that explains how they are going to deal with an adverse product reaction and drug recall. The agency will also start using the ASEAN Common Technical Document as sole basis for the submission of pharmaceutical drug applications starting September 2014. Under this scheme, local companies must meet rigorous harmonized requirements of the Association of Southeast Asian Nations (ASEAN).
Meanwhile, another PIDS-DOH study titled Determinants of Consumer Generic Use Behavior: An Evaluation of the Generics Act recommended that DOH come up with a campaign that could influence the behavior of consumers towards acceptance of generic medicines. One of the authors of the study, Dr. John Wong, called for information campaigns targeted on drugstores and consumers, rather than on physicians.
This study, which looked at compliance of doctors, drugstores, and consumers with the generics law, found out that doctors were already compliant, with five out of six drugs prescribed using generic names. However, generic substitution and the use of generics were low, with only two out of five consumers surveyed reporting that they had been offered generic alternatives by drugstores, and only three out of 10 purchasing generic medicines.
"Consumers do not usually ask for generics nor inquire about their prices when buying medicines. There is a need, therefore, to teach consumers to ask for generics and inquire about their prices if drugstores do not offer them," Wong stated.
Anna Melissa Guerrero, DOH director and program manager of the National Center for Pharmaceutical Access and Management, agreed that the DOH had not been able to come up with mass media campaigns such as radio and TV advertisements because of high costs. However, the Health Department has tried other avenues to promote the use of generics, like information and education communication materials on the Cheaper Medicines Act and generics in government hospitals, and the holding of the annual Generics Month.
"The DOH will rather purchase medicines and give them for free instead of spending on information campaigns. In the law, DOH is mandated to spend 90 percent of its PHP 1-billion budget for the provision of medicines and only 10 percent for operations," Guerrero said.