A visit to the doctor sets one back by Rs.200 for a small town/village or Rs.500 or more for a Tier I city on average. This may not include medicines, which could set you back by another Rs.500 or so, depending on the ailment and the medication the doctor suggested. Sometimes, the medicines are given by the compounder and the final cost is added, or the doctor will suggest buying an ointment or medication from a nearby pharmacy.
Overall, most primary care diagnoses cost up to Rs.2000 per visit, assuming the ailment may be easily curable. Even with high levels of inflation, most patients, rich or poor, don’t worry much about medicine costs as their main focus is the cost of diagnosis and tests.
Most people know that the medicines don’t cost that much, even requesting the doctor to prescribe cheaper medicines. We may not have realised this, but high-quality and affordable unbranded ‘generic’ medicines have been the biggest reason for improved healthcare access worldwide. Initially, most healthcare providers doubted the effectiveness of generic medicines, just like the way we avoid buying cheap clothes from the roadside, only opting for them if we really need to. However, generic medicines present a dilemma for doctors, one that isn’t easily visible.
“The biggest problem of using generic medicine is the confidence that clinicians need to have in the generic medicine. By and large, you can say that the branded medicines have by marketing and quality control, been able to place a kind of a confidence in the healthcare providers, the doctors, and that gets passed on to the patient,”
Dr Vijay Agarwal, the President of the Consortium of Accredited Healthcare Organisations (CAHO), a body representing healthcare organisations in India, explains.
Despite the high compliance requirements, especially for quality control, the pharma industry has been a vital cog in delivering affordable treatments to the masses. Doctors and healthcare providers have had to depend on cheaper, affordable generic medicines to keep costs low, without knowing how well the medicines will work.
“When I am not getting the desired outcome in a patient, then everybody tries to find what could have gone wrong. Unfortunately, there are no simple ways to do this. Therefore, you can say ineffective medicines are also one of the reasons. And at times, it has happened that when a particular brand was changed, you got the desired result. But it’s very difficult to pinpoint fingers,” Dr. Vijay adds.
At the supermarket, we generally choose the brands we are familiar with, as this gives us the confidence of quality, which we may have or may not have used earlier. The same rule applies to generics. Painkillers like Crocin or Dolo are well known, but they essentially sell the standard medicine Paracetamol. The brand makes a difference here, and the pharma companies have had to go to great lengths to convince doctors to trust their brand. Yet, at times, the pharma companies know the doctors may need to buy from them- especially during emergencies, offering them an opportunity to grow the brand (and reputation for effectiveness), banking on the trust of the doctors prescribing them.
Affordable medications: The strongest pillar of the world’s healthcare system
These affordable medications have been crucial to deliver the ideal treatments to millions of people across the developing world, including India. These medicines have helped save lives, mainly because they are offered at an extremely low price, as against branded medicines that are out of reach for most people.
Let’s understand this with an example. Suppose you’re looking to buy some detergent powder. In the detergent aisle, you’ll find Tide, a detergent brand you always use, with the cost for 1kg powder at Rs.80. Ahead in the aisle, you’ll also find the same detergent powder priced at Rs. 25 by a relatively unknown brand. Those who expect quality will go for Tide, while those who seek cost effectiveness go for the unknown brand, while the main intent is to keep the clothes clean. If you wash your clothes using any one of the brands, the clothes remain clean without any difference in the results, despite the Rs.55 difference between both the products.
The same is true for generics. Many doctors in the West initially didn’t trust generics, doubting its quality, even though they are identical to the branded ones, both in terms of ingredients and manufacturing practices. Over time, they have proven its effectiveness and slowly won the trust of doctors. Over time, almost 90% of all prescriptions in the US have used generic brands, encouraged by government policies and cost effectiveness. In many developing countries, almost all of the drugs prescribed are generics, except for those treatments that require branded drugs.
Flood of pharma companies- and its consequences
In India, the generics market has exploded, with over 3000 companies manufacturing a wide variety of drugs at similar price points- some have become brands in their own right.
That’s where the challenge lies. Your neighbourhood doctor may have his intentions clear when he writes you a prescription, but not always. Some desperate pharma companies are known to bribe doctors in various ways to get them to prescribe their brands. The National Medical Commission has put forth its Uniform Code for Pharmaceutical Marketing Practices (UCPMP) barring pharmaceutical companies from sending doctors on foreign junkets, or giving them gifts in kind, but these rules are poorly enforced. In March 2024, thirty doctors sent on a foreign junket by pharma company AbbVie didn’t face any action as the Department of Pharmaceuticals (DoP) refused to name the doctors accused. A committee constituted by the DoP found the company guilty of sponsoring the trip, but its own team refused to take the matter ahead, forcing the committee to reprimand the company instead.
Such cases are reported intermittently in the media, and many others are involved, though most are under the table. The naive patient trusts such unethical doctors, and even if the diagnosis fails to deliver, the doctor can always find another way to shift the blame.
A bigger threat to human lives
Yet, this isn’t the only challenge facing the pharma industry. There is a bigger, more sinister plot that can jeopardise the entire pharma manufacturing industry in India, and the regulators aren’t completely equipped to deal with it- fake drugs.
After COVID, the Central Drugs Standard Control Organization (CDSCO) tested multiple batches of 63 common drugs manufactured by leading companies, and many failed the required quality tests.
Taking advantage of the surge in ailments, many scamsters have started flooding the markets with counterfeit drugs, and the regulators and pharmacy organisations are having a tough time dealing with the surge in complaints.
Fake medicines with questionable ingredients are being manufactured in run-down sweatshops and sold with fake packaging, sometimes valued upwards of Rs.1 crore. In 2024, CDSCO flagged quality issues with almost 50 widely used drugs, including popular antacids from well known brands. The manufacturers have claimed they haven’t produced these drugs, essentially labelling them ‘counterfeit’.
The problem has become even more worrying, even as developing countries depend on India for cheap generic medications, and instances of spurious drugs have damaged India’s reputation as the world’s third-largest drug manufacturer.
In February 2025, the BBC conducted a sting operation in Mumbai where a company named Aveo Pharmaceuticals was manufacturing and selling powerful painkillers and muscle relaxants named Tafrodol and carisoprodol to West African countries like Ghana, Nigeria and Ivory Coast where it was found to be misused by addicts. The company has since been blacklisted by Indian regulators.
In 2022, the World Health Organisation (WHO) linked 66 child deaths in Africa to a cough syrup produced by Haryana-based Maiden Pharmaceuticals. The WHO’s research labs found that the syrups had unacceptable amounts of diethylene glycol and ethylene glycol, chemicals used for industrial use. The Indian authorities promptly shut down the company soon after.
Addressing these challenges
The CDSCO has had to take a series of measures to address the issue, including fast tracked prosecutions, stricter penalties and increased surveillance.Yet, some criminals do manage to cheat the system, casting lingering doubts regarding the efficacy of these affordable generic drugs.
For its part, the CDSCO is doing all it can to strengthen compliance, even considering advanced technological solutions like holograms and RFID tags to keep a close watch on the medical supply chain to identify counterfeits, a process similar to that used by the banking industry for identifying counterfeit notes.
Though it is hard to put a number on the number of counterfeit drugs seized in the market, surveys conducted by leading organizations have estimated upto 25% of all medicines sold could be counterfeit. As in the case of the doctor’s sponsored junket, the authorities are known to underreport facts for fear of repercussions. Though steps have been taken in the right direction, the CDSCO and other law enforcement agencies have catch up with the evolving criminal modus operendi, to spare lives that criminals exploit for profits.
