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Combo drugs bite into patients' pockets

Chemists stock up more combination drugs to meet demand

CHENNAI: From aggressively pushing new drug combinations to reducing supply, pharma bigwigs are coming up with various ways to circumvent the government’s new pricing policy, even as the Centre has brought 52 more drugs under its price control mechanism.Chemists say while supply of many essential drugs on the price control list — ranging from painkillers and antibiotics to those treating cancer — has reduced since the policy came into effect in 2013, newer and more expensive combinations are finding their way to doctors’ prescriptions.Medical representatives say companies have instructed them to “aggressively” market combination drugs. When TOI called pharmacies asking for amoxicillin, an antibiotic used to treat tonsillitis, bronchitis and pneumonia, many said it was unavailable. However, a combined version with antibiotic cloxacillin was available. While one strip (10 pills) of amoxicillin costs 68, six pills of the combined version cost 150.The medical representatives said companies were also playing the trick of changing dosage.Manufacturers are changing the dosage of the drug to evade DPCO. For example, 500mg of pain reliever paracetamol is in the price control list, so companies have increased the dosage to 650mg and are selling it as a higher price," said G Gopinath, working committee member of Federation of Medical Representatives Association of India (FMRAI).And there is further tweaking of drugs. "In the list, a cap has been placed on 500mg of anti-diabetes drug metaformin. Now companies are pushing for metaformin sr (sustained relief), which, again, doesn't feature on the list," said H Sriram, who is also an FMRAI committee member.More than 450 drug formulation packs are now under the price control mechanism of the National Pharmaceutical Pricing Authority. To meet the demand, chemists are stocking up more combination drugs. "While supply of essential drugs under the price control list has decreased, I wouldn't say there's a shortage. We do have most of these drugs, but demand for these combination drugs is more as doctors are increasingly prescribing them," said S Elangovan of Tamil Nadu Chemists and Druggists Association. When contacted by TOI, pharma majors Novartis and GlaxoSmithKline denied they were aggressively marketing combination drugs. While a Novartis spokesman denied the company's drugs that feature in drug price control order (DPCO) are in short supply, GlaxoSmithKline said the company had some issues in its manufacturing network, which would be rectified soon."We have been selling combination drugs for years and they are supplied based on the evolving demands. Besides, they are convenient for the patients as they can have one tablet instead of two," said a Glaxo SmithKline spokesman.Experts say pharma companies are creating an artificial sense of shortage of essential medicines to push the more expensive version. "Their argument is that they are facing losses. We have done studies to show that only 17% of the market has been affected after the new drug pricing policy. And by 'affected', it just means reduction in profitability and not losses," said Sakthivel Selvaraj, a senior health economist with Public Health Foundation of India. He said 47% of the one lakh brands of drugs in the market are combination drugs. "The efficacy of these combination drugs is still ambiguous," he added.