Parallel Imports of medicines from India

[Guest guest]

Dear forum members,

You may be interested to read the following article about Philippines

experience of " parallel import " of medicines (some are used to treat

HIV/AIDS related infections) from India. Moderator.

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About those medicines

By L. Tan

There were quite a few letters from readers in response to the two

articles I did two weeks ago about medicines so I thought I should do

a follow-up.

One article was about the Department of Health's quiet revolution with

parallel imports, which involves bringing in the same brand-name

products from other subsidiaries of multinationals, in this case from

India. The result was the DOH being able to offer the same products at

much lower costs. For example, the DOH is offering Bactrim

(cotrimoxazole, 800mg/160mg) from India at P4.73 each, compared to

Bactrim from the Philippine subsidiary, which is sold at P24.10.

The multinationals aren't happy and have brought the DOH to court,

hoping to stop the imports. So far, the Makati Regional Trial Court,

where the case is lodged, has turned down the companies' appeal for a

temporary restraining order so the DOH is able to sell several

products:

Ventolin (salbutamol) inhaler, Bactrim (cotrimoxazole), Augmentin

(co-amoxiclav), Daonil (glibenclamide) and Adalat (nifedipine).

(snip...)

The DOH warns that they will impose restrictions on the amount that

can be purchased to make sure these are not for commercial purposes.

You also have to present a prescription for all these medicines.

Readers' reactions were mostly in favor of parallel imports. However,

several readers asked why the parallel imports did not involve the

more commonly used medicines. I am not in the position to answer for

the DOH about the medicines selected for parallel importations, but I

would venture that the whole exercise constituted an " experiment " to

show that multinationals are making a lot of money on these branded

preparations, considering that their own subsidiaries are selling the

medicines at much lower cost in India.

One drug store owner wrote to complain that there is a lack of

attention given to their plight. The requirement for discounts to

senior citizens, the reader writes, was an added burden for them.

Some readers, including physicians and former drug salesman (and one

saleswoman), wrote in to say that the medicines are expensive

because of marketing expenses, including advertisements and perks

for physicians.

Dr. Sarabia, an ophthalmologist based in Bacolod, agreed with

my observation that multinationals get away with high prices because

we have not developed our own local capabilities.. He notes that India

produces its own intraocular lenses (IOLs) for cataract patients,

which they can sell 20 times cheaper than the American-made lenses.

Sarabia just returned from a study course in India and says the

lenses are of good quality, the manufacturer having ISO 2000

certification. Sarabia says he has used over 2,000 of these Indian-

made lenses and they are " excellent and safe to use. "

In closing, Sarabia asks, " When will we Filipinos learn that we have

to fight for our place in the sun? This is a dog-eat-dog world, and

so far we have always allowed ourselves to be eaten alive. Enough is

enough!!! "

The same week I did the column on parallel imports, I also featured

the controversy over phenylpropanolamine (PPA), a drug found in many

cough and cold preparations. Following a study in the United States

that linked the drug to hemorrhagic stroke (bleeding in the brain) in

young women, manufacturers decided to withdraw their preparations

with PPA.

Our Bureau of Food and Drugs (BFAD) has since reviewed the case and

Health Secretary Alberto Romualdez, Jr. has issued an administrative

order with new regulations for PPA. The order points out that there

were " methodological flaws " in the study and that the risks were

probably associated with PPA in appetite suppressants, where the

doses are as high as 75 to 150 mg, none of which are approved for

sale in the Philippines. What we have are cough and cold preparations

where the PPA content is only 12.5 to 25 mg per tablet or per

teaspoon of syrup.

Nevertheless, as a " precautionary measure, " the BFAD has banned " the

manufacture, distribution and sale of any drug product containing PPA

at doses exceeding 50 mg. " The BFAD has also reclassified all drug

products containing PPA with doses of 25 mg to 50 mg as prescription

drugs. These can no longer be sold over the counter and must have a

warning that PPA at these doses should not be used in patients with

severe heart disorders, tachycardia (fast heart beat), hypertension

(high blood pressure), diabetes mellitus and hyperthyroidism.

Some readers have asked for a list of the medicines but there are so

many of them it would take up too much space. Let me repeat my advice

from the earlier column I did about PPA: read the product label. There

should be a large box where the generic names of the ingredients are

printed. Check the smaller print elsewhere on the label to find out

how much PPA there is in the product. Even if the product

contains " only " 25 mg of PPA per tablet, you might want to limit

your dose, especially if you have heart problems. Just taking two

tablets twice a day gives you a total of 100 mg of PPA for the day,

which is the maximum recommended daily dose in Britain.