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Generic Medicine and Prescribing: A Quick Assessment

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 Review Article

Generic Medicine and Prescribing: A Quick Assessment

Mainul Haque
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur,
Malaysia

Abstract
Generic drugs are copies of brand‑name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration,
risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand‑name
counterparts. The Food and Drug Administration (FDA) describes that generic drugs are essential possibilities that allow better access to
healthcare for all Americans. They are replicas of brand‑name drugs and are the identical as those of brand‑name drugs in dosage form, safety,
strength, route of administration, quality, performance features, and anticipated to use. Healthcare authorities and users can be guaranteed that
FDA‑approved generic drug products have met the same stiff principles as the innovator drug. The company that made Bayer aspirin fought in
court enthusiastically to keep generic versions off the shelves, in the 1920s. The company lost in court, and consumers suddenly had an array
of choices in generic aspirin. The Supreme Court of India uttering ‘the Supreme Court’s ruling will prevent companies from further seeking
unwarranted patents on HIV and other essential medicines.’ Generic medicine cannot be sold at a price higher than the branded medicine, so
it is regularly a low‑priced option. Thereafter, both the end user and the government who pay for part of the price of the medicine under the
Pharmaceutical Benefits Scheme in Australia are benefitted. The treatment of diseases using essential drugs, prescribed by their generic names,
has been emphasised by the WHO and many national health policies. Although there are some improvements in generic medicine prescribing,
it has been advised by the WHO that ‘countries should intensify efforts to measure and regularly monitor medicine prices and availability, and
adopt policy measures to address the issues identified.’

Keywords: Generic, medicine, prescribing

A Brief Description about Generic Medicine
‘Generic drugs are copies of brand‑name drugs that have
exactly the same dosage, intended use, effects, side effects,
route of administration, risks, safety, and strength as the
original drug. In other words, their pharmacological effects are
exactly the same as those of their brand‑name counterparts’.[1]
The Food and Drug Administration (FDA) of the USA requires
generic drugs to have the same quality and performance as
brand‑name drugs. Generic drugs are required to have the
same active ingredient, strength, dosage form, and route of
administration as the brand name product.[2] The FDA requires
that all drugs should be safe and effective. Since generics use
the same active ingredients and are shown to work the same
way in the body, they have the same risks and benefits as their
brand‑name counterparts.[3] The FDA describes that generic
drugs are essential possibilities that allow better access to
healthcare for all Americans. They are replicas of brand‑name
drugs and are the identical as those brand‑name drugs in
dosage form, safety, strength, route of administration, quality,
performance features, and anticipated to use. Healthcare
authorities and users can be guaranteed that FDA‑approved
generic drug products have met the same stiff principles as
the innovator drugs. All generic drugs permitted by the FDA
have the same high quality, strength, purity, and stability as
brand‑name drugs. The generic manufacturing, packaging, and
testing sites must pass the same quality standards as those of
brand name drugs.[4]
Generic Medicine and Court Verdicts
The company that made Bayer aspirin fought in court
enthusiastically to keep generic versions off the shelves, in the
1920s. ‘The company lost in court, and consumers suddenly
had an array of choices in generic aspirin’.[5] ‘The Supreme
Address for correspondence: Prof. Mainul Haque,
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti
Pertahanan Nasional Malaysia (National Defence University of Malaysia),
Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia.
E‑mail: runurono@gmail.com

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For reprints contact: reprints@medknow.com

DOI:
10.4103/AIHB.AIHB_26_17 How to cite this article: Haque M. Generic medicine and prescribing: A
quick assessment. Adv Hum Biol 2017;7:101-8.

© 2017 Advances in Human Biology | Published by Wolters Kluwer - Medknow 101

 Haque: Generic medicine
Court ruled on Monday that generic drug manufacturers could
not be sued by patients who claim that drugs they took were
defectively designed. The decision is a significant victory for
the generic drug industry, but further narrows the recourse for
people who are injured by such drugs’.[6] The Indian Supreme
Court supported a portion of India’s patent law critical to
conserving the nation’s generic drug industry when it ruled that
the Swiss pharmaceutical company Novartis should not receive
a patent for its leukemia drug Gleevec®. This verdict was
being supported by one consumer group and congratulate the
Supreme Court of India uttering ‘the Supreme Court’s ruling
will prevent companies from further seeking unwarranted
patents on HIV and other essential medicines’.[7] The U.S.
Supreme Court has refused to re‑assess a case that emphasised
the combative concern of ‘product labelling and the extent
to which generic drug makers are able to independently and
quickly act to provide consumers with risk information’.[8]
Advantages of Generic Medicine
Costlier propitiatory medicines can now and again upset
people’s financial capability to rigorously stick to the dosage
schedule prescribed by the doctor, especially when there are
many repeats and the medicine has to be procured on multiple
times. The foremost benefit of generic medicine use is the
cost‑efficacy benefit. Generic medicine cannot be sold at a
price higher than the branded medicine, so it is regularly a
low‑priced option. Thereafter, both for the end user and the
government who pay for part of the price of the medicine under
the Pharmaceutical Benefits Scheme in Australia are benefitted.
Hence, patients can adhere their medications as prescribed
by the doctor.[9] As soon as a pharmaceutical industry designs
and develops a new drug, it gains a patent for that drug. The
patent safeguards the developer’s investment in developing
the drug, and no one else can lawfully vend the meticulously
same drug for a period up to 17 years. That patent‑protected
drug is the innovator drug. Therefore, when patients, hospitals,
communities, or government purchase that particular medicine
actually paying for the ‘research costs, the costs incurred in
proving it is safe, the costs to market and transport the drug,
and a premium if it is the only available drug for a certain
symptom, disease or condition’.[10] Those costs can patent
drugs very expensive to purchase by patients or government
at many occasion. The industry thinks that the price is the
way to recover its development overhead expenditures. The
moment that patent‑protected time has expired, any other
company can produce and market that drug with the same
ingredients as the branded one. Nonetheless, the FDA ensures
that the product will be exactly ‘identical, or bioequivalent,
to a brand‑name drug in dosage form, safety, strength, route
of administration, quality, performance, characteristics, and
intended use’[11] and also asserts that a generic drug must
be given a new name. Since the company that manufactures
the generics did not incur the costs of the original research,
testing, or marketing, the cost is lower’.[10] Another study
reported that the principal advantage of low cost of generic
102 Advances in Human Biology  ¦  Volume 7  ¦  Issue 3  ¦  September‑December 2017
medicine is that it saves as high 90% over the cost of brand
medicine. Generics on an average save 40%–60% than
proprietary medicine. That is a real plus point especially for
geriatric population on a fixed income who take numerous
medications.[12] In a systematic meta‑analysis which includes
47 studies (38 of 47 were randomised controlled trials) covering
nine subclasses of cardiovascular medications (beta‑blockers,
diuretics, calcium channel blockers, antiplatelet agents, statins,
angiotensin‑converting enzyme inhibitors, and alpha‑blockers),
no evidence of superiority regarding efficacy and safety of
brand‑name drugs versus generics was found. Even with those
having narrow therapeutic index drugs such as antiarrhythmic
agents and warfarin show 100% clinical equivalence.[13]
Many people in both developing and developed countries
apprehend that generic medicines are somehow inferior in
quality, but essentially this is not true. Unlike generics, any
other products, such as cereal, soap, or canned goods, where
the brand is indeed claimed better, are not applicable for
generics. As generic medicines are exactly same molecule
and produced following the identical procedures like that of
branded-proprietary medicine. Thereafter, generic medicines
obtain approval from the FDA, or any other drug regulatory
authority rules require generic drugs to have the same active
chemicals as the original brands.[14]
Generic Medicine and Low‑income Countries
Medicines account for 20%–60% of global health expenses,
somewhat more in low‑ and middle‑income countries, and
therefore, constitute a most important part of the budget[15,16]
and 18% in countries of the Organization for Economic
Co‑operation and Development.[16] Up to 90% of the people in
developing countries consume medicines through out‑of‑pocket
payments,[17] making medicines the major family‑spending
item after food. Thus, medicines are unaffordable for large
sections of the global population and are a major burden
on government budgets.[16] The Trade‑Related Aspects of
Intellectual Property Rights (TRIPS) agreement, completed
in 1994, transformed global patent law by necessitating the
standardisation of intellectual property law among all WTO
member countries by early 2005. Instantaneously, there raises
apprehension that the TRIPS agreement would minimize public
health facilities in low‑ and middle‑income countries.[18] TRIPS
threats to the supply of generic antiretroviral medicines from
‘India are coming at a time when the prospects of antiretroviral
therapy scale up are already cloudy’.[19] Thereafter, the
provision of generic medicine is one of the best operational
means of bringing lifesaving therapeutics and vaccines to
the low‑income countries and marginalised communities
throughout world (Editorial).[20]
Generic Medicine Promotes Rational Prescribing
The treatment of diseases using essential drugs, prescribed
by their generic names, has been emphasised by the WHO
and the National Health Policy of India.[21,22] Code of Ethics
Regulations 1.5, 2002 of Medical Council of India describes
 Haque: Generic medicine
the uses of generic names of drugs: ‘Every physician should,
as far as possible, prescribe drugs with generic names and
he/she shall ensure that there is a rational prescription and
use of drugs’.[23] Therefore, to promote rational prescribing,
it has been resolutely advocated to use the generic name, for
example, omeprazole instead of zegerid. Thereafter, prescriber
does not express any inclination towards any particular
proprietary brand of the drug.[24] Against the background
of such strong law, the actual scenario was something very
deplorable. It was found that the prescription of generic drugs
ranged from 3% to 20%.[25] Another study conducted in Delhi,
India, found generic prescribing in outpatient department to
be 6.32%–25.14% which was quite similar with an earlier
study.[26] After few years, one more additional study in a
major teaching tertiary‑level public hospital found that there
was quite higher  (73.4%) generic prescribing.[27] The drug
prescribed by generic name was 48.5% in overall situation in
Madhya Pradesh, India. Medicines prescribed by generic name
in primary health centres (PHCs) were higher as compared to
civil dispensaries (CDs) which were statistically significantly
higher (P < 0.001). The drugs prescribed from Essential Drug
List (EDL) of Madhya Pradesh (India) were 66.9%. Yet again,
PHCs were prescribing is statistically significantly (P < 0.001)
higher in number from EDL as compared to CDs.[28]
One multicentre study in eight cities of South and Midwest
of Brazil reported that most drugs (86.1%) were prescribed
by generic name.[29] Nonetheless, irrespective of the level
of healthcare delivery system, prescribing drugs by generic
name reduces duplicity, improves access to medicines, and
subsequently, escalates patient compliance with drug therapy
and disease control. It is expected that emphasizing to medical
students about generic medicines will improve and promote
rational prescribing.[29] The percentage of generic prescribing
was 100% in all four hospitals of United Arab Emirates as
recommended by the WHO. The success of generic prescribing
was because of electronic prescribing systems in healthcare
services.[30] One Cambodian study conducted in three health
centres reported that prescribing by generic names was 99.8%.
It was really encouraging against the background of reducing
the irrational use of drugs at the health centre level which
remains a major challenge.[31] Although many other issues of
rational prescribing and healthcare still exist in Cambodia,
the percentage of drugs prescribed by generic name and
from an essential drug list in Hawassa University Teaching
and Referral Hospital of Ethiopia was 98.7%  (n = 2419)
and 96.6%  (n  =  2367), respectively.[32] Although, earlier
study findings were 75.2% and 87% in Jimma Hospital and
National baseline study of Ethiopia, respectively.[33,34] Generic
prescribing was found to be 49.3% in Nigerian army hospitals.[35]
In another Nigerian study in a tertiary care teaching hospital,
generic prescribing was found similarly low at 42.7%.[36] The
drugs prescribed by generic name was 64.12%, and from the
National Essential Drug List was 67.70% in village health
clinics across ten provinces of western China.[37] Prescribing
generic names in three public hospitals, namely, Pakistan
Advances in Human Biology  ¦  Volume 7  ¦  Issue 3  ¦  September‑December 2017
Institute of Medical Sciences Islamabad, Rawalpindi General
Hospital and Military Hospital of Rawalpindi, found quite
low (23.6%) but 80% of medicines prescribed were from the
National EDL Drug List of Pakistan.[38] Although there were
improvement regarding generic prescribing and utilization of
EDL but the country need lot more to do to improve rational
prescribing and to ensure better health care.
Physician Perception Regarding Generic
Medicines
Largely, the mainstream of physicians is comfortable with
the efficacy of generic medications and is satisfied in using
generics. Nonetheless, there are significant fractions of
physicians’ expresses their apprehensions about the efficacy and
quality generics, and especially senior physicians have definite
trepidations.[39] A systematic review analyzing 52 articles revealed
that a noteworthy number of doctors were concerned about the
efficacy, safety, and quality of generic medicines. Moreover,
doctors believe that generic medicine causes more adverse
effects. The negative perceptions of specially among doctors and
pharmacists are the principal obstacles for wider acceptance of
generic medicines both in individual and community level.[40]
One recent Greek study reported that the national initiative for
generic prescribing has been poorly endorsed by the physicians
of the country.[41] Nevertheless, Jordanian physicians have a
positive attitude in the direction of generic medications and highly
motivated to prescribe generic medicines.[42]
Medical Students’ Perception Regarding Generic
Medicines
Although other aspects of generic medicines knowledge
level were found good, there was a significant knowledge
gap about the regulatory bioequivalence limits for generic
medicines.[43] Medical and pharmacy students of Bangladesh
possess a moderate knowledge level of generic medicines.
Moreover, it has been found that pharmacy students were
more inclined about generic medicines than that of medical
students. The study finally recommended that Bangladeshi
medical educational authorities should take abrupt action to
transform curricula to safeguard better understanding of future
medical practitioners about the use of generic medicine.[44]
Another Afghan study reported that medical students need
more accentuates to improve awareness and knowledge
about generic medicines. There is an urgent need to progress
regarding the knowledge level of the quality, prices, and
safety of generic medicines including cost‑efficacy.[45] Another
study from Iraq clearly shows that medical students in Iraq
are deficient related to generic medicine use. The study
thereafter suggested that incorporation of generic medicine
use in curriculum may improve and promote the use of generic
medicines and prescribing.[46] The principal result of one study
from the USA was that only 24% of study participants possess
proper knowledge of generic medicines. Therefore, promoting
the use of generic medicines and prescribing is imperative to
103
 Haque: Generic medicine
minimize healthcare costs.[47] The overall perception of medical
students regarding generic medicines is not up to the mark to
promote generic prescribing. Therefore, there is an urgent need
to enhance medical students’ knowledge and attitude in their
teaching–learning sessions of clinical pharmacology regarding
generic medicines and promoting generic prescribing. Hence,
community or country can minimize healthcare costs and also
ensure rational prescribing.
Generic Medicines and Neglected Diseases
A lot of diseases conquer because drugs are old and
ineffective, or merely do not exist. Every year, 1 billion
people globally are affected by neglected diseases, such as
malaria, tuberculosis (TB), leishmaniasis, and lymphatic
filariasis, which impose tremendous public health burdens.[48]
TB is a major killer in poor countries, but no new anti‑TB
drug has been developed since the 1960s.[49] There are rare,
often life‑threatening diseases, defined in Europe as affecting
fewer than one in 2000 people, for which more ‘orphan drugs’
need to be developed.[50,51] There are diseases that are highly
prevalent, such as HIV/AIDS in South Africa, but while
new, effective medicines exist, millions of people and their
governments cannot afford them or they are not available at
all.[52,53] Neglected tropical diseases, such as malaria, affect
millions of people, but most are too poor to constitute a market
that is profitable enough in the private market to develop
new treatments.[54,55] Since the 1970s, some pharmaceutical
industries in developing countries have been unfolding new
production procedures through reverse engineering technology
to produce medicines which are still under patent elsewhere in
the world.[56] This generic production has contributed to both
industrial development and greater access to medicines through
lower prices.[56] These countries may not be able to continue
to produce generic medicine as because of the introduction of
new stronger and stringent patent protection law.[57] Currently,
the principal approach for safeguarding access to medicines
for neglected diseases is drug donation from Western drug
industries.[58] Nevertheless, this reliance upon profit‑driven
organisations is dangerous. Undoubtedly, a more defensible
approach is required.[58] Public, private, and benevolent societies
and groups internationally have started to work together to find
and produce new medicines to treat neglected diseases.[59‑61]
Generic Medicines and Essential Drugs
‘Essential medicines are those that satisfy the priority healthcare
needs of the population. Essential medicines are selected with
due regard to disease prevalence and public health relevance,
evidence of clinical efficacy and safety, and comparative costs
and cost‑effectiveness. Essential medicines are intended to
be available within the context of functioning health systems
at all times in adequate amounts, in the appropriate dosage
forms, with assured quality, and at a price the individual and
the community can afford. The model list is a guide for the
development of national and institutional essential medicine
lists. It was not designed as a global standard. However, for the
104 Advances in Human Biology  ¦  Volume 7  ¦  Issue 3  ¦  September‑December 2017
past 30 years, the model list has led to a global acceptance of the
concept of essential medicines as a powerful means to promote
health equity. Most countries have national lists and some
have provincial or state lists as well. National lists of essential
medicines usually relate closely to national guidelines for
clinical healthcare practice which are used for the training and
supervision of health workers’.[62] ‘The WHO Model Lists of
Essential Medicines has been updated every 2 years since 1977.
The current versions are the 19th WHO Essential Medicines List
and the 5th WHO Essential Medicines List for Children updated
in April 2015’.[63] ‘In 1977, nearly a dozen countries had what
would now be considered an essential medicines list or an
essential drugs program. Today, four out of five countries – at
least 156 countries in total – have adopted national essential
medicine lists. Thirty years ago, the concept of a national
drug policy was unknown to most countries. Today, over 100
countries have such policies in place or under development. In
1977, objective information on the rational use of medicines was
extremely limited, especially in developing countries. Today,
at least 135 countries have their own therapeutic manuals and
formularies, which provide health professionals with up‑to‑date,
accurate, and unbiased advice on the rational use of drugs.
When the first Essential Medicines List appeared, the WHO
Programme for International Drug Monitoring was just being
formally established. Today, a network of 83 countries provide
global monitoring for adverse drug reactions and regularly
pick up signals on potential safety problems. Thirty years ago,
there was virtually no publicly available price information and
few countries actively encouraged generic substitution. Today,
at least 33 countries have carried out availability and pricing
surveys and provide that information publicly. In addition,
the wider use of quality‑assured generic medicines since the
1990s has brought down prices through increased demand and
competition’.[64]
The high price of medicines, predominantly in the private sector,
is additional strategic hurdle to access to inexpensive essential
medicines in developing countries.[65] Several countries have
made considerable improvement towards increasing access
to essential medicines and treatments to combat HIV/AIDS,
malaria, and TB, but access to essential medicines in developing
countries is not sufficient. In countries for which there is
information, the availability of medicines in the public sector
is only one third, while private sector availability is about
two thirds, and the prices people pay for low‑priced generic
medicines vary from 2.5 times to 6.5 times international
reference prices in these two sectors, respectively.[65] ‘Access
is defined as having medicines continuously available and
affordable at public or private health facilities or medicine
outlets that are within one hour’s walk from the homes of the
population’.[66] In the mainstream of circumstances, generically
equivalent medicines are priced substantively lower than the
originator brand.[67] Increasing the use of quality‑assured
generic medicines is, therefore, a key strategy for improving the
affordability of medicine. A range of policy options is available
to promote the use of generics, including allowing pharmacists
 Haque: Generic medicine
to dispense a generically equivalent product in place of the
originator brand listed on the prescription. Such generic
substitution by pharmacists is allowed in many countries,
sometimes with a requirement to inform the patient. [68]
Lawful provisions to permit will inspire much more generic
changeover of medicine from costly branded proprietaries
in the private sector which occurs in 86% and 100% of the
developed and transition economies, respectively.[69‑71] The
WHO suggested that to accelerate the progress of essential
medicines many policy changes needed both at national
and global level needed. Those are ‘At the national level: (i)
eliminate taxes and duties on essential medicines; (ii) update
national policy on medicines; (iii) update the national list of
essential medicines; (iv) adopt generic substitution policies
for essential medicines; (v) seek ways to reduce trade and
distribution markups on prices of essential medicines; (vi)
ensure adequate availability of essential medicines in public
healthcare facilities; (vii) regularly monitor medicine prices and
availability. At the global level: (i) encourage pharmaceutical
companies to apply differential pricing practices to reduce
prices of essential medicines in developing countries where
generic equivalents are not available; (ii) enhance the promotion
of the production of generic medicines and remove barriers to
uptake; (iii) increase funding for research and development in
areas of medicines relevant to developing countries, including
children’s dosage forms and most neglected diseases’.[65]
Generic Medicines’ Situation in Malaysia
One study conducted in Malaysia reported that practically half
of the respondents had negative belief in generic medicines.
Correspondingly, many patients were not conscious of the
relationships and variances between generic and original
brand medicines. Consequently, there is a need to provide
patients with adequate information about generic medicines.[72]
Although the Government of Malaysia has definite policy
regarding generic medicines to foster healthy competition
in medicines pricing, the generic shall be ‘used to guide the
use and procurement of medicines as follows: (1) prescribing
in generic International Non‑proprietary Name (INN)
shall be practiced at all channels; (2) procurement of all
medicines by generic INN shall be promoted; (3) in selection
for procurement, priority shall be given to domestically
manufactured medicines; (4) all dispensed medicines shall
be labeled prominently with the generic INN of the medicine
with or without the brand‑name; (5) a list of interchangeable
and noninterchangeable medicines shall be made available;
(6) generic substitution shall be permitted and legislated for
all interchangeable medicines; (7) appropriate incentives to
promote the use of generic medicines and their production in
the country shall be introduced’.[73] Nevertheless, another study
revealed the lack of awareness about the regulatory approval
system of generic medicines. Furthermore, negative insights
about safety, quality, and efficacy of generic medicines persist
among different healthcare different stakeholders in Malaysia.
In addition, there was a gap between policy construction and
Advances in Human Biology  ¦  Volume 7  ¦  Issue 3  ¦  September‑December 2017
its execution in Malaysia.[74] Malaysia’s well‑established public
healthcare system is encountering new threat from increasing
medicine costs. The free market by definition does not control
prices of any product including medicine, demanding price
monitoring, and control mechanisms. Markups for generic
products are greater than for innovator brands. Reducing the
base price without controlling markups maximizes profits
for retailers and dispensing doctors without plummeting the
price paid by patients. Promotion of generic medicines, and
improved accessibility of medicines in the public sector are
required to increase access and affordability of most essential
medicines for the common people of Malaysia.[75] Thereafter,
the aims of National Medicine Policy of Malaysia[73] which
describe access to affordable and lower priced medicines for
common people of Malaysia are not being achieved.[75]
Struggle of Bangladesh for Generic Medicines
The Bangladesh court ordered that ‘doctors must use generic
drug names rather than specifying particular brands’.[76]
Bangladesh has built a durable baseline and self‑sufficient
medicine production line after the promulgation of Drug Control
Ordinance – 1982. Such development of pharmaceutical sector
has contributed substantially to its economy and developed
from an import‑dependent country to self‑reliant and exporting
globally. Bangladeshi pharmaceutical industries have started to
produce vaccine, insulin, anticancer drugs, etc. Pharmaceutical
industries are quite successful in domestic market. Hence, the
pharmaceutical sector has already been acknowledged as the
thrust sector by the Government of the People’s Republic of
Bangladesh.[77‑79] In South Asia, India is the principal producer
of generic drugs followed by Bangladesh and Sri Lanka.[80]
The Bangladesh pharmaceutical industry produces about
8000 generic drugs under 26,813 registered brands in different
dosages and strengths. The Government of Bangladesh controls
the price of 209 generic drugs in specified dosage forms,
along with 41 active pharmaceutical ingredients produced in
the country and medicine imports. Bangladesh exports about
500 pharmaceutical items, including active pharmaceutical
ingredients as well as a wide range of pharmaceutical products
covering all major therapeutic classes and dosage forms, to
about 100 countries.[81] Bangladesh is targeting to progress
thirty world‑class pharmaceutical industries in the next decade
to establish a strong position in the international medicine
markets. Bangladesh country is exempted from obligations
to implement patents and data protection for pharmaceutical
products until 2033 as a least developed country.[81] Thereafter,
Bangladesh is allowable to manufacture any patented
medicines without taking prior consent from innovator.[79]
Finally, it has been reported that ‘medicine price in Bangladesh
is currently among the lowest in the world’.[79]
Conclusion
The WHO says ‘medicine availability and prices in both public
and private sectors are key indicators of access to treatment.
Public sector accessibility of generic medicines is  <60%
105
 Haque: Generic medicine
across the WHO regions. Again, due to the low availability
of medicines in the public sector, patients are often forced to
purchase medicines in the private sector’.[82] Although there are
some improvement in generic medicine prescribing, it has been
advised by the WHO that ‘countries should intensify efforts to
measure and regularly monitor medicine prices and availability
and adopt policy measures to address the issues identified’.[82]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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