Here's What I Think About Cutting Pill Costs

There are two types of medicines available: original or generic medication. Do you know this? If you do, then how you choose between them? If you want generic medication, how do you choose the right one? And if you choose original medicines, don't you know that you can get similar drugs for less?

Let us explore this subject some more ...

I just finished reading my favorite money magazine, Personal Money, issue #70, June 2007. One article stands out like sore thumb with the title:

"Cutting pill costs."

It's under the Smart Spending section, page 70.

Generally, the article points out ways to cut medicine costs for the average Malaysian. They suggested things like:

• buying generics
• shop around for the best bargain
• buy in loose form
• split the pills

It might sound ridiculous at first glance, but as Pharmaceutical Sales Professionals, you need to consider this issue seriously. Why? Because it is SERIOUS!

I'm talking from two perspectives here - without bias, of course - from the perspective of sellers and buyers. Simply, sellers need to make a living so they will promote all out for the sales. Buyers, on the other hand, want to cut costs and get the best medicine possible (hey! I'm also a buyer). Both parties work hard to their desired aim. If this is a tug of war, you can see lots of sweat but no movement. It's going nowhere!

What else do we need to consider?

Let me spell out the perspectives (or possible perspectives, if they think about it) from various parties involved. They're more than just sellers and buyers. They also include:

1. Drug company. From their point of view, what does cutting cost mean? Lower revenue. What does lower-income mean? Underperformance. And from the company's perspective, underperformance always spells trouble. The 'payer' or shareholders and stakeholders wouldn't like it. The market will shy away from it. They're on the losing end. So what do companies do? It'll buck up sales to cover the losses or they simply cut operating cost. Take Pfizer Inc for example. Just because they're facing patent expiry for Norvasc and fierce generic competition for Lipitor, 10,000 people have to go. Meaning? 10,000 people are jobless almost overnight. You might know them. But their storyline is as simple as that.
2. Drug rep (sellers). Or a Pharmaceutical Sales Representative. Well, from an 'ethical' or original or patented drug rep point of view, this is terrible news. Where is he going to get the sales?... to meet the quota?... to hit budget? If doctors are switching to generics and patients are buying them, it's all over. They might need to reconsider their position, or they put up a fight! Depending on the company's strategy, some companies put up a good fight before throwing in the towel. Such cases happened to Roche (Malaysia) a few years back when their top antibiotic, Rocephin, had its patent expired. Seven local generics quickly entered the scene; the minute the news was out. Roche never loses hope. Believing that quality will triumph in the end, the last two years, Rochepin was relisted in the Government formulary. The company was happy. The rep was delighted. But the competitors weren't pleased.
3. Drug rep generics. This is good news. If you're selling generics, this is the kind of story you like to hear over and over again. When Ranbaxy finds out that, "Hey... Pfizer only patented its Atorvastatin (Lipitor) crystalline form, the 'amorphous' form is left wide open!" they produced massive stocks of Atorvastatin amorphous form at lightning speed (if you have no idea what I'm talking about, just bare for a second will ya?). They start hitting the main places where big Lipitor sales came from. The result? Worldwide, Pfizer has to lay off 10,000 people. You can tell who's winning, right? And the generics keep coming for other products as well. Good news for them. They didn't hesitate to take full advantage.
4. The Prescribers... these are the doctors, specialists, GP, etc. From their perspective, especially the GPs, profit margin counts. In fact, to a certain extent, it's a priority. But not all GPs behave like this. There are benevolent ones but many of them. It's understandable. It's survival. The more money they make, the longer they survive. Consultants or Specialists, especially in the Government sectors, are at the opposite end. Since cost is less essential for them to (some medicines are subsidized), they look at efficacy, tolerability, and other evidence base attributes. But they don't mind to try the generics though.
5. The Pharmacists. You can call them the dispensers. They have an essential role that sometimes goes unnoticed. Government-based Pharmacists, they just follow 'circular.' If it stated that they have to purchase generics, that's precisely what they'll do. For retail pharmacists... well they're more like the GPs. Profit margin. Demand. Simple economics. If customers were prescribed with original and they have it, they'll sell it. If not, "This drug is the same, only packaging and color are a 'bit' different" is what they invariably say.
6. The Government. The government will like to save a single dime they can from the budget. It looks good for the economy and to woe foreign investors because what they're sending the message, "We're prudent." The government also love generics for the fact that it's produced locally and this is controversial but look more profound for the controlling stakeholder for many generics company. It's no surprise to see some Very Important and familiar Person ;) But they are democratic. If they can't control the company, they control the distribution. Some control both. Always 'win-win,' they say...
7. The People. I'm a seller, and I'm the user as well. The people are the end-users. After so many layers of perspective I've outlined above, actually, this is the most critical layer. Why? Ultimately, all of us are users. We use medicine one way or the other. We fall sick. Our wife falls sick. Our child falls ill. So, we need to buy medicine which makes us a user. And we're always taken as a puppet. Those people, the puppet-masters pull their strings and make us dance to their tune. Dare we object? What choice do we have? A hypertensive granny went to the hospital, and the Consultant prescribed her with nitrates (generics) and beta-blockers. What does she know? Nothing. She went back, and the BP (blood pressure) was still shooting through the roof. But that's all the Hospital and Government can afford. Granny's sons and daughters were all living in the city. Even with them around, what could they possibly tell the Consultant. Can they say, "Man, you're so outdated!" Can they? That's the dilemma, and as a member of the public, I'll share any relevant info whenever I can get so that other member of the public can make informed a decision regarding medicine and drugs issues.

But you must always check me out. Better still, counter-check me out with other resources. Then make your decision.

This post has taken more extended space than my usual one, but it's necessary. It's essential for you to understand the facts before making the judgment. After all that has been said and done about all parties perspectives, the effects remain:

• patented and generics are not created equal.
• it's not about which is better but what is better in your context... generics is better than no medicine and in a life-saving situation, patented is always a smarter choice
• Reconsider what your prescribers tell you. They might learn it from the drug reps and the drug companies
• Common sense is a better judge than stacks of clinical papers of trial evidence. If it works for you, regardless of patented or generics, cheap or expensive, stick to the treatment regime. That matters the most.
• Every party has their agenda. Don't fall victim to any of it.

That's all for now. You do have a choice, so make the right one. Your life depends on it.