This week we look at prices of medication on shelves at pharmacies around the country and what makes these prices? Importantly what shoppers should look out for. Medication either for fever or back pain does come in handy don’t you think? For some, any slight sign of absurd fatigue deserves a visit to the doctors and “regular checks” is a golden rule that only the minority follow. In other words “we only visit the doctor when we get sick”.
We can say such about the laxity for modern medication such as pills and its side effects but without an equal alternative healer that provides the resource, supply and instant results — we just can’t leave without modern medication.
Nothing beats a torturing toothache that gets even disbelievers of modern medicine, jetting to the pharmacy in disconsolateness just for a quip of Ibuprofin pain killers for instant relief.
However pricing of medication has been an issue for customers according to the Consumer Council of Fiji.
CCF said there were two types of medications sold in pharmacies in Fiji — generic and branded drugs. Branded drugs are more expensive because of costly clinical trials, advertising, marketing, and promotions.
CCF says most consumers in Fiji are unaware of the difference between branded and generic medications because of limited knowledge of medication, majority of consumers in Fiji place complete trust in pharmacists for their health care.
However results from their survey show that this trust is often violated by the pharmacists by not informing consumers of the choice over the generic and originator brand medication.
In its reply to questions sent CCF said “Often consumers are handed expensive branded medicines without giving the cheaper option i.e. the generic medications.
Generic drugs are similar to 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.
Their pharmacological effects are exactly the same as those of their brand-name counterparts.
Generic drugs are as good as branded ones provided it conforms to British Pharmacopoeia (BP) or United States Pharmacopeia (USP) standards.
At the Council we have received a number of complaints on the price variance on pharmaceutical medication. There are many factors that determines the price of the drug.
Issue of high mark-ups
When the council receives complaints regarding high mark-ups on price controlled drugs or generally high price of any drug it conducts a price survey and findings reported to the Fijian Competition and Consumer Commission (FCCC).
The pharmacies are then required to justify the price of the medication.
Where does the council raise these
concerns ?
In Fiji, the Fijian Competition and Consumer Commission has placed essential medications under price control. The council refers cases to FCCC for further action.
In addition, the council sits in the Fiji Pharmaceuticals and Biomedical Services Board, where it puts forward issues received against pharmacies for consideration.
We also hold meetings with Fiji Pharmaceutical Society to discuss pharmacy related matters.
Other nature of complaints lodged at the council in relation to pharmacy practices are essential medication needed for survival are out of stock, wrong medication given despite a prescription, expired and damaged medications given, non-disclosure of information.
In response to the comments Fiji Pharmaceutical Society’s president Reshnika Sen said that prescribers (doctors & dentists) often prescribed branded medication with a leeway that should that brand not be available, another brand or generic can be given in its place.
“Now, naturally if a branded medication is prescribed, pharmacists give that one first. However, if the patient cannot afford it and there is a generic available then pharmacist definitely change the medication with the consent of the patient.
“Also, for some medicines such as anticoagulants and anti-convulsants, we do not do brand substitution at all as for these drugs their different brands show different bio-equivalence. Hence, changing the brands would mean a drastic change in treatment.
“At this, we would like to say that pharmacists have employed the procedure of asking the patient if they would like the price first. This has helped a number of patients as medicines (branded or generics) are dispensed as to what the patient can afford,” she said.
Ms Sen said there were times when only the branded medications were available in the country especially for medicines of rare conditions or medicines which are rarely prescribed.
“Pharmacists have a very unique role in the health care system of being a safety net for prescribers and being the link between patients and their medicines. It is always our goal to understand the reasoning behind the doctors prescription and ensure that patient gets the full potential of the medicines prescribed. Hence, we have to keep in mind the rights of the patients and the prescriber while keeping hold of our own integrity and our rights.
We are not violating anyone’s trust but practising as per the guidelines and procedures that we were taught in our Four years of pharmacy school.
When asked whether generic and branded drugs had the same results and risk factors, Ms Sen said generic medications and branded medications had the same results and their formulations and strengths were the same.
“There is however, one difference between different brands of medications which pharmacists also look at is bio-equivalence — what the medication actually does in the body. There are certain medicines as mentioned before anticoagulants and anti-convulsants for which we do not do brand substitution. The reason being, the doses and formulation of the medicine between brands is the same however, the two brands exert different effects on the human body.
Therefore, changing brands mean the treatment will be affected,” she said.
Adding until to date the society has not been informed by the FCCC regarding any pharmacies brought to their attention.
“Normally, as CCF had highlighted, the patients fail to understand that the difference in pricing between pharmacies is due to different brands.
There are times as well when the same brand of medication has different pharmacies and this is attributed to the two factors of increasing competition between pharmacies and different suppliers of medications.
As a general statement, patients shouldn’t expect the same price (of the same brand of medicine) in all pharmacies as each pharmacy has a different set up, clientele and structure. Just like how each supermarket has a different price for the same number of a popular brand of frozen chicken. The pharmacy sector is a heavily regulated industry in the country with avenues such as price control and the Free Medicine Initiative to help the financially burdened in the country. All 65 pharmacies are practising within these guidelines and assist their patients wherever they can.
Pharmacists are regarded as one of the most trusted professions in the world and Fiji is no different.
