Continuously rising medicines cost-- Why ?

[alekhkhanna]

Vymada

There should be other companies launching variants in Jan 2023 AFAIK. If going off patent soon in India.
JB is already selling a generic, though just 7-8% cheaper.

Buy Vymada 100 which costs only Rs. 81 more and take only half pill. You save almost 50%. Order online, save another 20%.

Please don't do this unless it's a score tablet aka it has a line providing easy split. Non score tablets many not spread API evenly across the tablet, and you'll end up with uneven dose.

 

[gopal_agrawal]

Any reviews on Zeno health medical store?
prices are 3-5x lower than branded medicines

I am buying medicine from Zeno health. They have generic and branded as well with good discount on branded medicine. Only issue is they don't have all the medicine available and also their software seems to be buggy as they are unable to find alternatives for most medicine.

 

[gourav]

I'll suggest to stay away from generics if one doesn't understand them or have no time to study them. Regulations and laws are lax in India as they are politicised. And Indian med industry has a proven history of cheating the regulations.

Exactly why I don't buy generics despite having known about them for over 10 years. When I buy branded, I at least have some way of trusting the meds - either the name of the company or my doctor's recommendation. If I buy generic, how do I even know that the paracetamol tablet actually contains paracetamol?

Checking and enforcement of manufacturing standards are nowhere near strong enough in India for me to blindly trust whatever tablet I'm getting.

 

[TEUser2K1]

@nRiTeCh vaguely remember reading somewhere UK (or was it USA) business-politico interests wanting Indian govt. to increase medicine costs in India. So...

edit: got it: https://finshots.in/archive/the-secret-practice-of-evergreening/

A very interesting short article on how these companies eke out monies mercilessly, econo-political influence, etc.

 

[lockhrt999]

Please don't do this unless it's a score tablet aka it has a line providing easy split. Non score tablets many not spread API evenly across the tablet, and you'll end up with uneven dose.

Use blade to split the tablets or there are tablet splitters available. Anyway, it's only viable if the tablets aren't coated. Coated tablet get digested way down into the digestion system or are slow release.

 

[alekhkhanna]

Exactly why I don't buy generics despite having known about them for over 10 years. When I buy branded, I at least have some way of trusting the meds - either the name of the company or my doctor's recommendation. If I buy generic, how do I even know that the paracetamol tablet actually contains paracetamol?

Checking and enforcement of manufacturing standards are nowhere near strong enough in India for me to blindly trust whatever tablet I'm getting.

Well, a few weeks ago it was found that certain batches of branded meds (big names like Cipla, Sun etc) had no API at all. Can't locate the news link now - I think this was checked by one of the NE States FDA.
Even included very common names like Pantop etc.

Use blade to split the tablets or there are tablet splitters available. Anyway, it's only viable if the tablets aren't coated. Coated tablet get digested way down into the digestion system or are slow release.

Doesn't matter if you use blades or Kratos' axe. If it's a non score tablet, you cannot be sure about API being distributed equally throughout the tablet.
Dosage will be uneven.

 

[gourav]

Well, a few weeks ago it was found that certain batches of branded meds (big names like Cipla, Sun etc) had no API at all. Can't locate the news link now - I think this was checked by one of the NE States FDA.

Is actually adding to my point. If this can happen with branded, then the situation is likely to be way worse with generics.

Which is why I said I "at least have some way of trusting". I don't have absolute faith in them, but I have some degree of certainty that being a big brand, they'll have some kind of checks and balances and that they won't deliberately sell harmful chemicals to me. Can't be sure of any of these in case generics.

 

[lockhrt999]

Well, a few weeks ago it was found that certain batches of branded meds (big names like Cipla, Sun etc) had no API at all. Can't locate the news link now - I think this was checked by one of the NE States FDA.
Even included very common names like Pantop etc.

That's bad if it's true. Like Gourav says another reason against generics.

Doesn't matter if you use blades or Kratos' axe. If it's a non score tablet, you cannot be sure about API being distributed equally throughout the tablet.
Dosage will be uneven.

So you are saying some non-scored tablets don't have homogenous composition? I didn't know that. Never seen one.

 

[alekhkhanna]

So you are saying some non-scored tablets don't have homogenous composition? I didn't know that. Never seen one

Yes.

 

[Arjun]

There should be other companies launching variants in Jan 2023 AFAIK. If going off patent soon in India.
JB is already selling a generic, though just 7-8% cheaper.



Please don't do this unless it's a score tablet aka it has a line providing easy split. Non score tablets many not spread API evenly across the tablet, and you'll end up with uneven dose.

Now vymada has gone off patent and score tablet is available. Is there any markings on the packaging to identify if tablet is score. I was told valentas is score tablet by the cardiologist.

 

[alekhkhanna]

Now vymada has gone off patent and score tablet is available. Is there any markings on the packaging to identify if tablet is score. I was told valentas is score tablet by the cardiologist.

If it has a marking to break in multiple parts, it's a score tablet.

 

[Arjun]

BUt to find this i have to buy every brand and open it. THere are no marks on the packaging?

 

[chetansha]

Pls check these shops generic aadhaar.

 

[salian]

Wanted to chip in with an anecdote regarding generics.

I support generics and recommend them wherever possible. However I recently faced one instance where the generic versus the branded drug had a marked difference in effectiveness for me.

The prescribed brand was manufactured by Strides and marketed by Biocon while the generic was manufactured and sold by RPG. After using the generic for six months I noticed it had hardly any effect whereas the Biocon-marketed one was much more effective.

I don't know if there were other mediating factors, maybe the coating, or maybe just the disease progress, but after this observation I definitely treat generics as a cost-saving experiment to be done when the illness is not severe or critical. And I will periodically evaluate if its working for me rather than just assuming both are equivalent because the salt is labelled the same.

 

[lockhrt999]

The prescribed brand was manufactured by Strides and marketed by Biocon while the generic was manufactured and sold by RPG. After using the generic for six months I noticed it had hardly any effect whereas the Biocon-marketed one was much more effective.

I have had same experience with generic maker with franchise model by name 'Dava India'. Simple Paracetamol didn't work.

Now, I recommend not buying generic-generic but buying big branded-genericly priced.

 

[alekhkhanna]

When I was working with MSF - they used to send their QA guys (from Netherlands) quite often to the Indian drug factories from where they were procuring stuff. More often than not, these factories tend to have 3 different lines - cheap generics (abysmal QA), branded generics (substandard QA) and export (standard QA).
The ranbaxy saga has already told us how drug manufacturing works in India - please don't think that things have changed drastically. You can still see the poor Ranbaxy whistleblower trying to make a difference since regulatory bodies on drug manufacturing are mere puppets.
USFDA deals with export generics, and still several USFDA officers have talked about the extremely poor QA from India.
I've to check now, but a couple of years ago USFDA had to allow a substandard BP med in US simply because no other alternative was available at that time (would have lead to drug shortages in US).
The Indian drug lobby is EXTREMELY powerful, more than you can imagine.
I, for one, cannot trust unbranded generics at all. Even for branded ones, I generally like to look at the manufacturing sites and see if there have been export bans on such sites anytime in the past. It is difficult to get the info since most of it is either not reported or exists on obscure sites.
How many of you know about the LACK OF ACTIVE API seen in almost 75% of Pantoprazole samples checked by one of the North east state FDAs ? Literally hundreds of brands were affected, including big names like Sun. Story got little to no traction. Such is the power of pharma lobby.

 

[t3chg33k]

Wanted to chip in with an anecdote regarding generics.

I support generics and recommend them wherever possible. However I recently faced one instance where the generic versus the branded drug had a marked difference in effectiveness for me.

The prescribed brand was manufactured by Strides and marketed by Biocon while the generic was manufactured and sold by RPG. After using the generic for six months I noticed it had hardly any effect whereas the Biocon-marketed one was much more effective.

I don't know if there were other mediating factors, maybe the coating, or maybe just the disease progress, but after this observation I definitely treat generics as a cost-saving experiment to be done when the illness is not severe or critical. And I will periodically evaluate if its working for me rather than just assuming both are equivalent because the salt is labelled the same.

It is really difficult to judge the effectiveness of most generics without usage which is not how it should be if there was regulatory QA done on samples regularly. However, I have the same approach where if the same composition drug is cheaper from a known manufacturer (like Mankind Pharma) at half the cost (compared to Cipla), then would generally go with that.

 

[lockhrt999]

@alekhkhanna You work in the industry so you know better. Which brands do you think are still honest?

The more I learn about this industry more I want to forget. My story is different. I got curious about meds about a decade ago. I used to check which meds have what ingredients and then I would check up on research articles on those chemicals. It was before the term 'generics' was commonly known. It amused me that some companies sell same composition for fraction of the price. I started recommending these cheaper alternatives to people. I didn't doubt the efficacy of these thinking govt must be doing its job. I was content knowing these weren't sold under FSSAI licence (it has 0 regulation).

But then came the book 'Bottle of lies' and it shattered every perception I had about this industry. That scandal was very big but I didn't know about it until then because it was actively suppressed in Indian media. Then I kept seeking such news and lo and behold there hasn't been any shortage of them. There was a news of govt suspending licence of many pharma companies for failing to reach the standards. But Govt never disclosed the names. That's enough to tell us how shady the regulations are.

I wished I hadn't gotten curious about meds decade ago. I wish I was ignorant. I wish I was more blissful.

 

[alekhkhanna]

@alekhkhanna You work in the industry so you know better. Which brands do you think are still honest?

The more I learn about this industry more I want to forget. My story is different. I got curious about meds about a decade ago. I used to check which meds have what ingredients and then I would check up on research articles on those chemicals. It was before the term 'generics' was commonly known. It amused me that some companies sell same composition for fraction of the price. I started recommending these cheaper alternatives to people. I didn't doubt the efficacy of these thinking govt must be doing its job. I was content knowing these weren't sold under FSSAI licence (it has 0 regulation).

But then came the book 'Bottle of lies' and it shattered every perception I had about this industry. That scandal was very big but I didn't know about it until then because it was actively suppressed in Indian media. Then I kept seeking such news and lo and behold there hasn't been any shortage of them. There was a news of govt suspending licence of many pharma companies for failing to reach the standards. But Govt never disclosed the names. That's enough to tell us how shady the regulations are.

I wished I hadn't gotten curious about meds decade ago. I wish I was ignorant. I wish I was more blissful.

I know I'll get hounded for this, but I don't buy meds from any Indian pharma (even those present multinationally) unless there's no alternate. Most Ranbaxy execs have gone free, and many of them are at positions of power to influence all sorts of non quality manufacturing.
Big MNCs, specially those based out of US have financial incentive not to sell spurious or non quality stuff. While much of their production is still India based, they will try their best to exert as much QC as possible.
A simple example is where I work - we have a novel patented device which injects steroid in the eye for some diseases. It is manufactured outside India - and one single vial in one batch showed a contamination with particle size 1/100th of human hair. We immediately recalled all drugs from that batch and the batch before that all across the globe, including India. We proactively informed a reg agencies across the globe on the recall etc and suffered stock out for about 3 months, millions of dollars lost in sales (and of course patients affected due to stock out). But it was just the right thing to do.
Generally companies HQed in US or EU should be OK. They can get pretty high financial fines if any wrong doing is found. Stick to them.

 

[lockhrt999]

Generally companies HQed in US or EU should be OK. They can get pretty high financial fines if any wrong doing is found. Stick to them.

Alright. So western companies like Abbott, Meyer etc who manufacture stuff in India are okay. In my experience, common compounds from these companies are fairly priced already.

I know I'll get hounded for this,

Yeah no worries here.