Muddling the cheaper medicines debate
When a good, if not vital and life saving proposal or idea is brought up, logic dictates that this has to be acted upon pronto, especially if it involves the lives of millions. Sadly in this country, more so if politics and self-interest get in the way, expect the best of muddling tactics.
This is exactly the sad fate of the much delayed Cheaper Medicines Bill. After years of debates and discussions, the proposed bill was approved by the Senate, and followed by the House of Representatives last year. But another long wait seems to be in order.
Now in the bicameral conference committee, an ugly row is shaping up once more, due largely to questionable, if not suspicious provisions in the House version which even loyal, professional physicians find oppressive.
Two of the more questionable, if not obstructive, provisions of the House version of the much sought-after bill are the establishment of a price control board and the more controversial rule mandating physicians both in private and public sector to prescribe only generic names of drugs and penalizing those who prescribed branded ones.
Physicians and other health care practitioners including the Philippine Medical Association and Philippine Hospitals Association immediately raised a howl over the generics-only provision even as the Health Department curiously opted to take a hands-off policy.
Patient’s right to choose
Our lawmakers are saying that the Generic Drug Act, or Republic Act 6675, which, among others, stipulates that physicians must prescribe drugs to patients in both the generic and brand name is not been implemented.
The law states that the generic name of the prescribed drug should be written more prominently than its branded counterpart, as against the previous practice of merely jotting down the more expensive brand name.
As many physicians have pointed out, several branded drugs under the same generic category have varying effects, side effects and effectiveness on different patients. A patient may respond differently to two branded drugs which are under one generic name.
This flexibility in the Generics Act allows for doctors to give their patients the best care. It is therefore surprising why the physician co-authors of the bill insist on a generics-only provision in the House bill. Is this just a way of putting up another obstacle to the immediate passage of the bill?
The problem with the Generics Act is not intention, but rather its enforcement. Patients are not given the right to choose between the cheaper, unbranded prescription and the branded but more expensive drug.
Simply, the generics law should guard against those doctors who push branded (and more expensive) medications because they receive or expect something in return from the sponsoring pharmaceutical firms.
An unnecessary board
The other controversial provision in the House version is the establishment of a Drug Prices Regulatory Board. To be headed by the Health Secretary, house proponents are saying that the board would be tasked with setting a maximum price ceiling for all essential drugs.
To hasten the passage of the bill into law, Sen. Mar Roxas had partly agreed to insert this provision in his Senate version, thereby allowing the President of the Republic to monitor and impose price ceilings on drugs to address artificial price increases, particularly during emergency or crisis situations.
On this point, I think the real issue has once again been side-stepped. True, we are against the high cost of medicines when we know there are cheaper alternatives. But what we need is to let lower-priced medicines easier access into the country, something that the current pharmaceutical firms are moving heaven and hell to prevent.
Now, if there is a concern about exorbitant price increases of medicines, there is already the Office of the President and the Trade and Industry Department, plus local law enforcement agencies and price advocacy groups looking after price hikes. So why do we need another price board for this?
Besides, whoever heard of anyone complaining that medicines costs are going up, in the same fashion that we complain of rice or milk prices artificially rising, most often because of stockpiling?
Latest whammy
The uproar over the generics-only provision and the creation of another price board in the House version of the Cheaper Medicines bill is the latest whammy delivered by Congress to the already critical health care delivery system in the country.
Late last year, physicians and hospital owners also threatened to stage a hospital holiday in protest over the outrageous Republic Act 9439 or the Hospital Detention Law filed by among others, presidential aspirant Sen. Manny Villar.
Under RA 9439, private hospital administrators and owners face penalties for detaining patients (except those treated in private rooms) who cannot pay their bills upon discharge. The only protection offered by the proposed law to hospitals is that such patients are required to submit a promissory note.
Basically, RA9439 is sending out the message to private hospital patients that, if you cannot pay the bills, just walk out of the hospital and leave a promissory note.
Maybe Villar’s research staff overlooked or opted not to inform the boss that based on experience of hospital administrators and owners, a mere 10 percent of patients who presented promissory notes returned to settle their hospital bills.
Many were left asking that if Villar truly believed in the soundness and fairness of this law, perhaps clients of his vast real estate empire, when encountering financial difficulties with their mortgage obligations, could merely present promissory notes, thereby not be harassed by threats of foreclosure.
Legislators owe it to the citizenry to make good their promises to improve health care delivery; we don’t need lousy laws like RA 9439. Neither can our countrymen wait for politics and greed to get in the way of the passage of a truly pro-poor Cheaper Medicines bill.
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