India is known as the ‘Pharmacy of the World’ for being the largest global supplier of generic medicines and affordable drugs. Yet, policy gaps compel India’s poor to struggle to source medicines, sometimes at exorbitant rates.

Anywhere between one in three and half of Indian households grapple with health expenses, and millions are pushed into poverty, or deeper into poverty because of insufficient state support. And medicines account for 70% of all out-of-pocket healthcare expenses.

This is the first of a two-part investigation into India's medicine affordability crisis, examining why the generic medicine system fails despite extensive infrastructure. The second part focuses on medicines for rare and specialised diseases.

The prescribing problem

The Jan Aushadhi scheme introduced in 2008, and rebranded Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in 2015, aimed at facilitating the sale of centrally procured reasonably-priced generic medicines.

The problem is, doctors aren’t prescribing medicine by their generic names.

On August 2, 2023, the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulation 2023 aimed to address this gap. Its Clause 8 reads: “Every RMP should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets.”

But the government withdrew the legislation barely three weeks later, on August 23.

Explaining possibly why, Abhay Shukla, national convenor, Jan Swasthya Abhiyan (People’s Health Movement-India) said, “A single decision in isolation doesn’t work; every element of the medicine prescribing and purchasing system must be addressed—the prescribing doctor, the fulfilling chemist and the patient.”

Instead of passing a solo order, Shukla suggested that the availability of affordable generic medicines in medical stores should have been ensured. A generic medicine contains the same active ingredient as a branded medicine but is much cheaper. Dolo 650 is a popular tablet taken for fever, but its active ingredient, paracetamol, in the same strength, could also be available generically.

Additionally, “mandating........

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