Lead Author: Felix Lobo
Organization: Universidad Carlos III de Madrid
PROPOSAL FOR EXPANDING THE GENERIC MEDICINAL PRODUCT MARKETS, AFFORDABLE PRICES AND ACCESS TO THE MEDICINAL PRODUCTS FOR THE DISADVANTAGED, THROUGH APPROPRIATE NATIONAL AND INTERNATIONAL REGULATION, ADDED TO THE OTHER TWO PROPOSALS MADE BY F LOBO:
PROPOSAL 3. JOINT USE OF THE INTERNATIONAL NONPROPRIETARY NAMES (INN) AND TRADEMARKS BY PHYSICIANS WRITING PRESCRIPTIONS
Despite the fact that the international nonproprietary names appear on the label, physicians can continue to prescribe by brand name. but the physicians should use the nonproprietary names to achieve all of its social benefits. It would also be a good idea for them to be used by pharmacists, including beyond the procedures for substitution of a brand name by a generic product. It would also be good for the patients to have some familiarity with the nonproprietary names, especially with chronic illnesses.
Errors are still being made in prescriptions and doses due to confusion between a brand name written or pronounced similarly. The transparency of the market for generic products and the price competition depend to a great extent on the knowledge the physicians and patients have about the equivalence between competing medications, coming from various suppliers. The obligatory substitution of brand names with generics could overcome the lack of knowledge about the equivalence of the generics or the lack of the desire to prescribe them instead of more expensive brand names, but it is not always possible to develop this and it is not legal in every country.
To expand the use of nonproprietary names, the solution we propose is to have all prescriptions be written using them, even when there is not a possible substitution of a brand name by a generic. However, we do not recommend replacing all brand names by nonproprietary names. The brand names provide incentive for pharmaceutical companies to invest in research and development beyond the patents, since they are a mechanism that lets them internalize the profits earned from the sale of their products. They also give consumers, understood as the physicians, pharmacists and patients, the chance to choose their preferred medicines and manufacturers.
It is true that the function of brand names as a consistent guarantee of quality is redundant to the extent that the regulatory agencies develop the appropriate quality controls. But the redundancy is certain only with individual products. Brand names are useful so that consumers can recognize and reward the overall reputation of a company, such as being a leader in research efforts. So this total prohibition of trademarks for medications would entail costs and could not be recommended.
The recommendation is therefore that the prescription contain a dual identification of the medication, using the nonproprietary name and the manufacture name or the brand name. This will decrease the number of errors and promote transparency and price competition. During the life of the patent writing the nonproprietary name would increase knowledge and awareness of the possible supplies coming from other companies when the patent expires.
The dual prescription is also a fair solution for pharmaceutical companies since it combines the property right incorporated in the trademarks with the public interest in reducing confusion and promoting competition.
It would be good to minimize the additional effort that a dual prescription requires of physicians. In any event, in a world where in many countries medicines are prescribed with the help of computers and this trend will increase in the future this extra effort would not be very much. It would be a matter of reprogramming the electronic prescription systems to include the nonproprietary name on each prescription.
The rollout of the INN system had been a success but needs to be completed. The dual use of nonproprietary names and trademarks, a fair solution, would facilitate the universal use of the INNs by health professionals. This solution would bring benefits to the patients and improve the efficiency of the health systems.
Bibliography and References
LOBO, F.: Políticas actuales de precios de medicamentos en Europa: panorama general. [Current medicinal product price policies in Europe: a general overview], Springer Healthcare, Madrid 2015. 181 p. ISBN 978-84-940-3469-5
LOBO, F.: La intervention de precios of the medicamentos en España. Panorama de la regulation y los estudios empíricos [Medicinal product price intervention in Spain: overview of regulation and empirical studies], Springer Healthcare, Madrid 2013. 159 p. ISBN 978-84-940-3468-8.
FELDMAN, R. y LOBO, F.: “Competition in prescription medicinal product markets: the roles of trademarks, advertising, and generic names”, The European Journal of Health Economics, 14(4): 667-675, August 2013. ISSN 1618-7598; e-ISSN 1618-7601. DOI 10.1007/s10198-012-0414-7.
LOBO, F. y FELDMAN, R.: ”Generic Medicinal product Names and Social Welfare”, Journal of Health Politics, Policy and Law, 38(3): 573-597, June 2013.
ISSN: 0361-6878; e-ISSN: 1527-1927. DOI 10.1215/03616878-2079505.