Why India cannot have a clear Drug pricing policy after 57 years of Independence?

( A Note being circulated for discussion as part of the Campaign for Affordable Medicines)

Our  country   was  regarded  as  the  best among  the  developing  countries  in the  world  for  evolving  a  well defined  Drug  Pricing  Policy    for  reaching   the   essential  and  life  saving  drugs  and other   medicines  to the common man  with affordability and  availability of the  right  drug  prescribed  by the Medical Profession.     The  Drugs  Price Control Order  ( 1987 ) clearly spelt out   the necessity  of  having  a  clear  Drug Policy  to ensure  abundant  availability of  good  Quality Drugs  at reasonable  prices .  Explaining  the  above objectives  of the order  Mr.R.K.Jayachandra Singh ,the  then   Union Minister of  State  for  Chemicals  and Petro-chemicals   felt that  the new DPCO will evolve a   good  system of  Price Control  which  would  encourage  production  by allowing  a  reasonable  return   to  the  producers of  essential drugs.     The  minister  also  said  that  almost 75% of the  total production   of  multi national  drug  companies  would  fall  under the purview of  Drug Price Control Order   and  entrusted   a  high powered  committee  headed  by  Dr.Vijay Kelkar, the  then Chairman  of the  Bureau  of  Industrial  Costs  & Prices   which identified  two category of  drugs  viz…category I and category II.  The  said  DPCO  1987  provided Maximum Allowable Post  Manufacturing  Expenses  (MAPE)   of  75%  in the  case of   Category I   Formulations  and  100% in the  case  of  Category II Formulations.    Category I  Bulk Drugs  were  those which are required for   Formulations  which were   expected to be meant for  the  National  Health Programme   for  control of  Tuberculosis, Leprosy, Malaria, Trachoma  and prevention of  dehydration  in certain disease  conditions. Category  I  Formulations  are  those  Formulations  based on the  Bulk Drugs specified   in Category I   .    In Category II all Bulk Drugs  other  than   those  required  for  formulations in Category  I  were included   and the Formulations  based  on the Bulk Drugs in Category  II were  included  as  Category II Formulations.   

 

This  Broad Banding of Drugs   was   the  main basis   by  which the  margins  were  permitted   to the  Manufacturer and  the Trade .   In Category I  Formulations   the  post-manufacturing  expenses  were  75 %  and  in Category II Formulations   the  same  was   fixed  as  100%. The  Trade margin was  also  fixed  by the  said  Price Control Order.  In Category I  Formulation  the  Retailer  Margin was   12  %  and  16%  in  Category II Formulations   .    The  Price  Control  Order also specified   the  term  “post-manufacturing  expenses “ as  all costs   incurred  by a  Manufacturer  from the  stage of  ex-factory cost to retailing  and includes  Trade  Margin.   

 

The  1987  Drug Policy   gave  a disciplined  approach  in Drug Prices  Control and consequent  implementation of the  essentialities   of the  National  Health  Programme  as  almost 165 drugs   were  under  Price  Control  then  .      The  disciplined  Price  Policy  continued   till the  announcement of the  Drug  Price Control Order  1995 .   By this  order  the  Government  has the power   to   fix   the price   of Bulk Drugs    and  also   to  fix  the  ceiling price  of  scheduled  formulations   from time to time     by  Notification  in the  official  gazette   keeping  in view of the  cost or  efficiency   or  both  of  major  manufacturers  of  such formulations   and  such price  shall operate  as  the  ceiling  sale price  for  all such packs   including  those sold  under  generic name   for  every manufacturer  of  such  formulations.   By this order   the  number of  Bulk Drugs  retained  under  Price  Control was  restricted to  76  from the  previous  165  items  in as  specified  1987 order.   The  subsequent  years    witnessed  the  decontrol of  various  bulk drugs  from the  Controlled  Category  and  accordingly  the  formulations  also came out of the  Price Control Order    with  FREE  PRICING  POLICY  for  the manufacturer  and  fixing  enormous  Trade margins  disproportionate to what has been   generally prescribed   for the  decontrolled   Category of  Drugs.     The  1997  Drug  Policy  clearly  fixed the power   on the  National Pharmaceutical Pricing  Authority   to fix  the price of   scheduled  formulations  including  those  sold  under  generic name  but  unfortunately  the Industry   took  the policy into their  advantage    by   fixing   the  MAXIMUM RETAIL  PRICE  to their  advantage   and also  to attract  the  Trade    to   push their products  into the market  with high  Trade  margins  to the  extent of  even  200 %.    Added to this  in 1998    the   Excise Duty on  Formulations  was  also revised  as  16%   for  branded  items  and also for  generics.   Until such time  the  generics  attracted only   8%  Excise  Duty .  In the  angle of the Government  and the Policy Makers    it  was  felt  that   this change will increase  the Excise Revenue  but  it  happened  contra-revise   as  the  Pharmaceutical Manufacturers  introduced  a  range of products  under the  term   “ BRANDED  GENERICS”  . All the major  companies  have both “PROMOTED “ items   and “BRANDED  GENERICS “ Items    marketed  regularly  with the  same  “MAXIMUM  RETAIL PRICE” .   This  is more so  in  decontrolled  items although  such   practice  cannot be   carried out  by  any manufacturer   having  controlled price fixed  products.   This practice of  offering   “HIGH TRADE MARGIN”  has become  a practice  since  1998  onwards  by  major  companies  like  Ranbaxy, Cipla, Cadila, Aurobindo, Dr.Reddy’s, Nicholas, Lupin,Glenmark,Wokhadt,Alembic,Alkem,Merind,Ind-Swift, Intas, Micro,  and  many  like them  followed  the  suit competing  each other  in offering   HIGH TRADE MARGINS along  with    fabulous  gifts   and   foreign travel   etc..  to the Trading partners.    Ironically the MRP  remained the  same   and  the products are  offered   at   200 % margin   to the  Retailers.  The Retailers  thereby  become  interested to  push  only these products into the market    as  they  get  VERY HIGH  TRADE MARGIN   as  against 16 or  20%  as  fixed  by the Drug Price Control Order   on  Controlled  and Decontrolled Drugs.   In  other words  the   decontrol  of the  Bulk Drugs  and  the  Formulations  resulted   in  advent  of  a  new class of  products  called   BRANDED  GENERICS  with the same  MRP  as the  promoted item  for the same  product  with  HIGH TRADE MARGIN   and  the MRP  remains  the  same  to the   ultimate  consumer.    Medical Profession  feels  that  the patients   are  not  getting  the  prescribed  product  as  the  Chemists  substitute  the  prescriptions  with  HIGH TRADE MARGIN  PRODUCTS    with or  without  proven  quality.   All these are consequences  of the decategorisation  of  Bulk Drugs  from  controlled Category  every  year  by the   respective  announcements   by the  Ministry of  Chemicals  and Petro-chemicals   which  have    resulted  in sub-standard  drugs  all over the  country   WITH HIGH PRICE    to the consuming  public.    It  is  the  equalization  of   the   Excise  Duty  to  16%    for   both PROMOTED  ITEMS  AND GENERIC  ITEMS   which prompted   the  Manufacturers  to   introduce  the  branded  generics   using  the   decontrolled  bulk  drugs  and   make  variety  of  formulations    and  dump into the  market   and  play  illegal   and  unethical   games in the market  ultimately killing  the   poor  consumer  WITH HIGH DRUG PRICE. Important and widely used drugs like Amoxylicillin 250 (MRP Rs 34.00/10capsules) and Paracetamol 500 mg Tabs (MRP Rs 7.50/10 Tabs)  are  sold to  retailers at unimaginable Price of Rs 85.00 for 10 caps and Rs 1.25 for 10 Tabs by the very large Indian and multinational companies  under the garb of BRANDED GENERICS and more than 500  such products are sold by leading Companies like Ranbaxy & Cipla and many follow their way competing each other   at the  cost of the  consumer. The margins offered by these Companies offering such huge Trade margins at the cost of the poor and helpless consumer in this  manner is illegal and violative of the existing rules and regulations and  should be  considered  as  criminal  offence in the  existence of  a  Drugs  Price Control Order   in India.   

COSTING:

The  following  table  will also give  an idea    about the cost of  various materials  and also the MRP  in relation  with the  raw material cost prevalent in  2002   for  certain vital  and  essential products in comparison with what is prevailing now.

PRODUCT

RM

COST/KG          (Rs)

NO OF UNITS/KG

TOTAL MAT . COST  (Rs)

MRP

STOCKIST

RATE

Ampicillin Caps 250

Ampicillin Trihydrate

1450.00 ( 2004)

2300.00 (2002)

3300 Capsules         

0.55  (2004)                     0.90    (2002)                          

3.40                  3.40

0.65             1.10

Amoxycillin Caps 250

Amoxycillin Trihydrate

1450.00 ( 2004)

2300.00 (2002

3300 Capsules         

0.55 (2004)                0.90    (2002)                                

3.50                  3.50

0.65             1.20

Paracetamol  Tabs  500 mg

Paraceamol

150.00(2004)     

150.00 ( 2002)

2000 Tabs         

0.10  (2004)         0.10    (2002)

6.50     

4.50

1.20             1.50

Cough Syrup

 

 

 

5.00  (2004)

30.00

8.00

Ampicillin Injection 500 mg

 

 

 

3.25 (2004)

20.00

3.75

Antacid

 

 

 

6.00 (2004)

34.00

10.00

Paracetamol

Syrup

 

 

 

3.50 (2004)

16.00

5.00

Ampicillin DrySyrup30ml

 

 

 

4.00 (2004)

20.00  

4.50

Ampicloxa Caps 500mg

 

 

 

2.20 *(2004)

2.95

2.27

Amoxycloxa Caps 500mg*

 

 

 

 

2.25 (2004)

3.00

2.30

 

 NOTE:  ALL THE ABOVE  RAW  MATERIALS ARE  DECONTROLLED  BY  GOVERNMENT  AND  CONSEQUENT  FORMULATIONS ALSO   ARE  FREE  FROM PRICE  CONTROL.

 *Amoxycillin & Cloxacillin  Caps  500mg  is  under price  control   with  an MRP   of  Rs.3.00  with  no margin for the manufacturer  as  the  price  was  wrongly  fixed by  DPCO  and  Cipla  still continues  selling  the same   at higher MRP ( Rs.4.87) as  against  Rs.3.00   taking  a  stay  from Mumbai  High Court.     

 The above  table  clearly  shows    that for  all the  essential  products    which  have been  decontrolled   by Government  from   1998  onwards  the  MRP  remains  the same  with  heavy  Trade  margin  affecting  the consumer  violating  the  Drug Price  Control Order    by the manufacturers    and  Trade   together with  ulterior    motive   for  maximization of  illegal profit.   Whereas  on the control  price items   the  Manufacturers   have  taken stay  against the   National Pharmaceutical  Pricing  Authority  ( NPPA)   and  enjoy  higher  margin  fixed  by the Government.   

 SUMMARY:

It  clearly shows  that   on the   decontrolled  items    the manufacturers    have  fixed  their own  margins  to the  Trade  to the tune of   200 %   from the  MRP.   The  Government  itself  is  the  responsible for this irregularity  which  the  manufacturers  are    utilizing  it  for their own  benefit  at the cost of  the consumer   violating    the   Drugs Price  Control Order.   

 IMPACT OF  HIGH TRADE MARGIN ON THE   REVENUE IN RESPECT OF LOSS OF  EXCISE  DUTY AND  SALES  TAX  TO THE  EX-CHEQUER.

 The  following  table  will illustrate  the  loss of Central Excise  Duty  on each   Unit  which the  Government has been losing   since  1998 due to  the illegal activities of the   Pharmaceutical  Companies  in India.   

A. Excise  Duty collectable  on  Brand  Items.                         (Rupees)

YEAR

RATE OF EXCISE DUTY

PRODUCT

MRP

SELLING RATE

ED

1987

12 %

PARACETAMOL TAB

500 MG –CROCIN

0.25

0.20

0.02

1997

16 %

PARACETAMOL TAB

500 MG- CROCIN

0.45

0.32

0.05

2004

16%

PARACETAMOL TAB

500 MG- CROCIN

0.75

0.54

0.08

 B.Excise Duty collectable on  Generics/ or Branded  Generics :-

YEAR

RATE OF EXCISE DUTY

PRODUCT

MRP

SELLING RATE

ED

1987

8%

PARACETAMOL TABS

500 MG –Generic only

0.25

0.15

0.01

1997

16 %

PARACETAMOL TAB

500 MG-Generic  only

0.45

0.25

0.04

2004

16%

PARACETAMOL TAB

500 MG – BRANDED GENERIC-PARACIP

0.75

0.12

0.02

 The  above  table   shows  that  Paracetamol Tablet  (MRP 0.75/Tablet)   with Brand  Name  Crocin  is  sold  to Stockists  at 0.54  with Excise Duty @ 16%  of Rs. 0.08 (8paise)  whereas  the  same   product in Branded  generic   as Paracip   is  retained  same  MRP  of  Rs.0.75 /Tab  with   the  selling  rate  as  0.12 with  an Excise Duty of  Rs. 0.02 (2 paise) .  The  difference  in the  Excise   Duty    collectable  by the  Government  per  Paracetamol Tablet  is  6 paise  and  one  can imagine   how  much the  Government is  losing   to the  National   Ex-chequer    by  way of  Excise  Duty   difference.     The  Government  has  been losing  since  1998   due to over play and  irresponsible  behaviour   of  the  Government  officials   who  are  otherwise   the   watch dog  of the  national  revenue  and  wealth.  The  Pharmaceutical companies  especially the large  Generic  companies   like  Ranbaxy, Cipla and  such others  have been playing  around  on this  loophole  at the cost of the  consumer .   The  Government is the loser and  it is  high time   the Minister of  Petroleum & Chemicals   should  look into it and initiate  corrective measures  and   stop  over play   of the  Generic pharmaceutical manufacturers  in  the  India in the interest of the  Government  and the  common man.

 It has  also been well documented  that  on decontrolled  items  the manufacturer is  expected to  give  20%  to the Retailer and   10%  to the   Whole Saler.   This  is the policy  rule  and  every  manufacturer    should  have  complied   to this  directive   whether  it is   a  formulation  in branded  items   or  branded  generic  or  generic.    The  Government  should  not have permitted  to clear  the goods  from the  factories  on a  much  lower price fixed  by the  manufacturer   to the  extent of  200 %  violating  the Trade margins   fixed   to   decontrolled  items  as  20  &  10 %.     If  6 paise   per  Paracetamol  Tablet   is  lost  out of  Excise  Duty  we  can  imagine  how  much   our  country has  lost  by way of  Excise Duty   combining  all Pharmaceutical  products  being marketed  as  Generics or  branded  Generics at such  High Trade margin.

 WAYS AND  REMEDIES:

A. Products  under  Price  Control.  This  should  be  continued  as practiced by  NPPA with periodic reviews  for  revision   due to escalation  in   price  of  various  inputs.

 B. Products   without  Price Control : 

We  appreciate  the  move  by the present  Minister  of  Petroleum  and  Chemicals   to   fix the   manufacturing  cost on each product    and  the MRP should not   be  more than  100%   of   the manufacturing  cost. In this  way  the  price of Drugs  can be  controlled  as  the  MRP  will come down drastically.   This may be  made applicable  to the  decontrolled  items   only  as  this is  the  area  where  maximum violation   is taking place  by the  Generic  Manufacturers.   The  manufacturer   still  is  at his  freedom to fix  the Trade margin  but  it is  expected  that  it  will not be more than   25 to 30 %  as   the margins  have  been thinned out as the M.R.P will come down.   The  Retailer  margin  also will come  down drastically  and  this  will reduce the incidence  of  substandard    materials   coming  into the  market.  As  NPPA   has  got   voluminous data   on the  cost of  production on each product by the large  companies  the  same  can be taken for   fixing  the  MRP   of the  products with  100%   post –manufacturing  margin  and  expenses.    However, whether   it is  branded  ,  branded  generics  or  generics   the ceiling  price   should be  fixed   and   the manufacturers  should  not be permitted  to give    Trade  margin   of more than  20%  to Retailer  and   10% to the  whole saler.      In this  way   the Governments  revenue is  collected  .   

 Why  we  should not  have a Price  Control  System   ?

 India  is  poor; Indians  are  still poorer. Why  we  should  not  have  an effective Price Control  Mechanism  like  what we  had  in early 1990 s  which   should  deliver  quality  products  at affordable price  at the   place of  requirement.    The basic  idea  of  removing  more and  more  Bulk Drugs and Formulation  out of  Price Control Regime    should  be condemned by  each and every   responsible Indian and  strict   Price Control  should be implemented  with  full power  to  State  Drug  Control Department to   initiate  steps  against  those  who  violate the same.    No  distinction   between  SSI , Large  Sector and  others    should  be made   in respect of   price  control   as it  would  generate   indiscipline   and  misuse  as  it  has  happened  now.   For  all single  ingredient products    the ceiling   price  should  be fixed  by NPPA    for  other  formulations   containing  more   ingredients ,  the manufacturing  company  should   comply with the  Government  regulation that   the  cost should be  properly worked out   and  not  more than 100 %   post-manufacturing  expenses   can be  added.  It  should  be done   on individual manufacturers  responsibility   and   if  variations  and  violations  are observed   action should  be  taken    against the  erring  companies    by  cancellation of their  Manufacturing  and  Central Excise Licences.  

 SMALL SCALE  SECTOR  PHARMACEUTICALS – A TOOL FOR  MULTI-NATIONALS AND  LARGE  INDIAN COMPANIES.

It is  also seen in recent years    that  many  multi-national and large  companies in India   are  acting  as   marketing  companies   for  small scale manufacturers.   The  products are manufactured   by  a  SSI and  marketed by   Glaxo, Smithkline , Pfizer, Parke-Davis and  many  other  multinationals  operating in India.     It is  also  a  known fact that   many of these  multi-national  companies    have  closed their  factory   giving    compulsory  retirement  to their  workers  and  solely  resort  to  getting the products  manufactured  by   Indian Small Scale  Sector  Companies  with   their logo   on the manufactured products.     This is  highly  illegal  in respect of  Central Excise   Regulations  and   other  Drug  Control regulations   as the  marketing  company cannot put  their logo  in  any manner   on the primary or  secondary packing materials  thereby   creating  a false  image   for the  consumer   that    the product is  a  multi-national  companies product  and  we  Indians , out of  ignorance  and  helplessness   are cheated    by this  method.    The  multinationals  also    take  full advantage   of the  facilities   offered  to the  small scale  sector  in respect of  Central Excise    and other    Price Control obligations.  WHO GAVE  THE  PERMISSION FOR  MULTINATIONALS  TO ACT  AS MARKETING  AGENTS IN INDIA  ?    IS  IT  THE  DRUGS  CONTROLLER INDIA  OR  THE MINISTER OF  PETROLEUM CHEMICALS OR   THE MINISTRY OF  COMMERCE OR  MINISTRY OF  HEALTH   ?  This should be looked into by a special committee of Parliament on a war foot basis.  If  the present  system    is  permitted to be continued ,  India  will be  indirectly owned  by multi-national Pharmaceutical  companies  who have no interest   to  participate  with the  Government   in the National  Health Programme or   bringing  new molecules to  India  by    Research and  Development   with strong base in India which  they have  already demolished   like   Hoechst Research in Mumbai , Ciba Geigy in  Mumbai  or  Smithkline  Research Centre  in Bangalore.    Multinationals  are  thriving  in India  at the  expenses of  SSI   and  detriment  of  the   under   educated  poor   Indian  with no investment  in Plant  and  Machinery  ,  R & D and  such activities.    Government  should look into  very  deep   their  activity in India  and persons  who  have  given Licence   for  their  marketing  activities  without proper  permission or  authorization should be punished.   The  multinationals  also  are    strongly   recommending  and clamouring   for the  SSI limit  to be  increased  Rs.5 Crores   from the present  Rs.1 Crore.    While   the SSI s  should be  encouraged    to  invest  on their  Plant and Machinery to conform to Schedule M  Regulations  and c GMP ,  it  should not  happen   that  the  multinationals  are the beneficiary of   the Governmental decisions.    While  SSI   should be  the back bone  of    India’s Pharmaceutical Manufacture and Delivery Mechanism  only  such  SSI s who have produced and marketed  70%  of their  production for  own domestic  or  export  requirements for the past 3 years should be permitted to utilize the facility of investment of 5.00 crores.    In this  way the  SSI  s   will stand on their  own  making progress  steadily rather than  become  a mouth  piece for  multinational  companies or  large sector  companies  who utilise them for  all their needs  at unimaginable  low profit  which the  SSI  will not  be  able  to sustain   with such low margins.    Multinational  should   not  be  permitted to   get the products manufactured in India under marketing  arrangement.  They have to have  their  own manufacturing facility   with  strong  R & D base  rather than  producing  unwanted  stereotyped  products    which are of no relevance   to   India’s Health Care Programmes  and  the Welfare of  the Indian.

 India should have a clear and strong Drug policy that will go along with the Government’s desire of developing rural India which is the backbone of India’s future and development. The clear Drug policy should aim at bringing the price of all manufactured product under tight control and beneficial  to  the common man. The time has come to carve out a well defined policy that will bring quality Drugs at affordable prices has part of our National Healthcare Programme.