Jan Aushadhi: Not yet a generic choice

Earlier this year, Chemicals and Fertilizers Minister Ananth Kumar vowed to end the “medicine mafia” in the country by opening many more Jan Aushadhi kendras, stores that sell generic medicines at affordable prices. Kumar was echoing the mission outlined by Finance Minister Arun Jaitley in Budget 2016. And the initial mission was to get to 3,000 stores by March 2017.

Two months short of the year coming to an end, Mission Jan Aushadhi is still shy of that target, with 2,637 stores presently operational, according to official data from the Bureau of Pharma PSU of India (BPPI). Operating under the Department of Pharmaceuticals, the BPPI implements the “revamped” ‘Pradhan Mantri Jan Aushadhi Yojana’ (PMJAY), which was first launched under the UPA Government.

But irrespective of whether Mission 3,000 is completed by December, the Jan Aushadhi initiative indeed has ramped up. From November 2008, when the first shop was established in Amritsar, the campaign floundered at about 100 stores in 2014. This number increased to 1,253 in April 2017 to the present 2,500-plus stores.

And though political detractors wonder aloud whether BJP supporters have been given a not-so-overt diktat to participate in this initiative, the BPPI data shows traction in non-BJP ruled states like Kerala, Karnataka and West Bengal.

This may not yet mean that it’s all hunky dory for the initiative as there still remains much ground to be covered. But certainly, some things have worked on the ground.

So what worked? The Centre has taken greater ownership of this campaign since the new Government was elected in 2014, says a BPPI insider on conditions of anonymity. The project was made more viable, upping incentives to start a store to ₹2.5 lakh (from ₹1.5 lakh), and distributor and trade margins were increased.

The Government's decision to allow people to open Jan Aushadhi stores outside public hospitals may have also worked as a catalyst. The Centre encouraged non-government organisations, doctors, unemployed pharmacists and so on, to open Jan Aushadhi shops, supporting their medicine procurement and reimbursing some of their expenses, says the representative.

The processing of bills is easier and shop owners are reimbursed within a month of their expenses, he claims, countering an often made complaint in the past that Government payments were delayed. “The payments are made online and are more transparent now. Now there's maximum sale and maximum incentive,” he says, convinced of reaching the 3,000-store mark.

Come November, the Jan Aushadhi initiative completes nine years. But despite its recent achievements, there's more work to be done.

More transparency is required on how these shops are doing as that will ensure whether it is sustainable or not, says veteran health expert Amit Sengupta with the Jan Swasthya Abhiyan, a health advocacy organisation.

A country like India will require more shops to improve access. More shops also means more stocks. And though the product basket includes 600-plus medicines — including antibiotics, skin products, diabetes, heart related and medicines for other therapeutic areas — patients often complain that the shops are ill-stocked, and high-end or critical drugs like cancer products are not available.

The BPPI claims that medicines for Jan Aushadhi stores are sourced from public sector pharma units and about 125 private suppliers. But big guns of the pharmaceutical industry complain that participation becomes difficult because the of the Government's apparent tendency to source from suppliers who give the lowest price. "This could disregard quality," says an industry expert. The BPPI representative counters that the medicines come from licensed suppliers and with technical quality checks from Government-accredited labs.

In the past, the Jan Aushadhi initiative also suffered because doctors did not prescribe medicines using their generic names. (A generic drug has the same active ingredient of an original branded drug, but is less expensive as it does not include the cost of research and development.)

In fact, this year the move to prescribe generic drugs received a nudge from Prime Minister Narendra Modi who called for a law to get doctors to prescribe using the generic names of medicines. The other counter narrative to this programme is that states like Karnataka and Tamil Nadu run efficient healthcare programmes. So for Jan Aushadhi to make a mark, it will need to have a much bigger basket of medicines with low prices, say people familiar with the initiative.

It also needs to be much more visible so it pops up in peoples' minds as a popular option to buy medicines. The challenges are only going to increase as the pharma retail landscape changes. Online pharmacists and retail chemists are getting more tech-enabled, bundling in services and discounts to customers.

These challenges are a clear indicator that Jan Aushadhi too will need to get more nimble-footed if it wants to break the high-priced “medicine mafia” and become a generic choice for people.