Pill-popping public ‘victims of unregulated market’
Hera Diani, Jakarta – If you are a health consumer in Indonesia some of these situations may be familiar to you.
You go to a doctor instead of self-medicating for your cold and fever and end up with three different types of medicines, plus vitamins, which cost you a cool Rp 400,000 (US$43.50).
You are stuck in an emergency room of a hospital with a bad case of food poisoning, when you get another reason to vomit – the price of your bill for the medicines is Rp 700,000. Then the doctor gives you a shot and you feel fine, but annoyed.
You take your toddlers to the pediatrician almost every month, forking out good money for many packets of medicines to treat the same reoccurring cold and flu symptoms. Your pocket hurts and you worry about the effect the many pills are having on your children’s development.
Unable to afford your medical bills, you pay half – and get only half – of the prescribed drugs. Or you risk all and go to the Pramuka black market in East Jakarta for cheaper medicine.
Health is wealth, as the saying goes, which in this country could translate to mean “getting sick can rob you blind”.
Experts say doctors here often overprescribe drugs to unwary patients, who are also paying too much for medicines – a situation they say is caused by a lack of regulations and monitoring.
University of Indonesia medical school professor and pharmacologist Dr. Iwan Darmansjah said an absence of regulations governing the retail prices of prescription drugs here had caused some doctors and companies to inflate prices to ridiculous, rip- off levels.
“The amoxycillin antibiotic, which in other countries only costs between Rp 400 and Rp 500 (about 4 US cents) a tablet, is being sold here by several companies for as much as Rp 2,800 a pill. That’s deceiving, unfair business,” Iwan said.
Health Ministry rational drug use department director Husniah Rubiana Th-Akib said manufacturers were also taking advantage of the erroneous public perception that generic drugs were less effective than their patented counterparts.
Husniah said all drugs were categorized as either generic or patented. Patented drugs were generally the latest generation of a drug, and were usually more expensive. But generic drugs – often made specifically for low-income consumers – should be no less effective and prices should be considerably cheaper in most cases, she said.
Patented drugs have only a 2 to 3 percent market share but make up 15 percent of national drug revenue. “What manufacturers do, however, is take a generic drug, make it more appealing with packaging and everything, and then slap a ‘brand’ and a high price on it. We can call this type of drug a ‘branded’ generic drug,” Husniah said. “For amoxycillin, for example, there are over 100 brands on the market, with (wildly) fluctuating prices, while the content (in the tablets) is the same.”
Often cheaper generic drugs are sold at the same price as patented drugs – or worse, were packaged as such, she said. Marius Widjajarta of the Indonesian Health Consumer Empowerment Foundation said drug prices should not fluctuate much. “(Prices) tend to decline because newer, more sophisticated drugs enter the market.”
However, international Pharmaceutical Manufacturers Group director Parulian Simanjuntak said drug prices here were based on the simple market mechanisms of supply and demand.
Because health insurance is not common in Indonesia, about 80 percent of drugs are being bought by individuals or companies, Parulian said. Large insurers, as big buyers of drugs, could help set market limits on prices, he said.
With a total market value of about $2 billion a year, many companies here are involved in drug manufacturing – 34 multinational companies and another 170 local ones, according to data from the group.
In such a competitive market, companies often pay doctors commissions to prescribe drugs, meaning patients often get medicines they do not need.
Indonesian Doctors Association chairman Farid Anfasa Moeloek said the government should subsidize drugs for low-income groups, who were supposed to get free medical treatment. Farid said the unregulated system, not doctors, was to blame for the high prices.
Husniah, meanwhile, said the Health Ministry planned to regulate the packaging of drugs to ensure consumers could easily tell the difference between generic and patented medicines. Branding on generic packaging would be 20 percent smaller and retail prices and ingredients would also be listed, she said.
“It’s important for consumers to know what is in the tablets they buy,” she said. If they had a choice between three chemically identical drugs, they could then choose the cheapest one, she said.
Manufacturers are opposed to the new labeling rules, which they say are against trade laws and will only increase their costs. Parulian said international manufacturers already labeled their drugs clearly and included tablet ingredients.
“The plan would change the layout of the whole packaging. Besides, (the idea) goes against the regulation for Trade-Related Intellectual Property Rights on brands.” “We need brands, we invest in them. By including a drug’s generic name, it will weaken our brands. We are going to protest this plan,” Parulian said.
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