The Electric New Paper, 27 May 2008
By Ng Wan Ching
 
Drugs look the same? But for diabetes man... Switching to generic drugs
SAVES PATIENT $500 A MONTH

AFTER suffering diabetes for years, Mr Lee Bee Han, 69, was told his blood pressure needed to be controlled. 
 
The problem was the landscape engineer could not afford the medicine prescribed by a doctor at Gleneagles Medical Centre, which cost $3.50 per capsule.

'I told the doctor I have no money,' he said. 'The doctor gave me a prescription and asked me to try and buy it elsewhere at a cheaper price.'

Mr Lee went to Alexandra Hospital, where he met a helpful pharmacist.

'She said she would help me by getting a generic drug which would do the same thing as the branded drug,' said Mr Lee.

The cost: 63 cents per capsule.

Like many others, Mr Lee is saving thousands of dollars a year using generic drugs instead of branded ones, as inflation and healthcare costs rise.

'My blood pressure is now well controlled and I pay a fraction of the price,' he said.

And then there were some eye drops he needed.

'Before the patent on them ran out, I paid $26.50 per bottle and you can't use the drugs a month after opening it,' he said.

MUCH CHEAPER

After the patent expired, he paid $1.50 per bottle.

He estimates that he saves between $400 and $500 a month with generics.

'Now I spend $300 to $400 a month on all my medicine, which is much more affordable than $800 to $1,000 a month if I were using branded drugs.

'With the savings, I can afford to pay for it myself. My children have their own obligations,' he said.

Getting the best price for an approved generic drug is something that Ms M K Fatimah, president of the Pharmaceutical Society of Singapore is constantly on the look out for.

Generic drugs are sold in Singapore only after the patents have expired.

'Patent periods generally last 16 to 20 years, to allow the drug companies time to recoup their investment in developing new drugs.

'The moment the patent period is over, we will make an attempt to switch to generic drugs,' said Ms Fatimah, who is also chief pharmacist at Alexandra Hospital.

When a patent expires, the various restructured hospitals here may band together to call for a tender for a generic equivalent.

'Of course, the generic drug makers must have gone through the Health Sciences Authority and got their product licence. They are eligible to participate in our tender only when they have a valid licence,' she said. (See report on facing page.)

There are several ways to get the best prices from the generic drug makers. One is to group together.

'Each hospital has a pharmacy and therapeutic committee to evaluate all the drugs it needs. There are representatives from all the clinical disciplines to help make the decision,' said Ms Fatimah.

Once each hospital has decided which drugs it wants, all the hospitals get together to call for a tender.

'As a bigger group, we have more leverage to negotiate for better prices,' said Ms Fatimah.

Another way is to streamline the drugs that are bought.

'For instance, instead of buying six or seven types of generic drugs from the same group of medicines to treat one condition, we can streamline and buy three types. This way, the volume we order goes up and the price can be negotiated down,' she said.

Each year, one or two drugs come off their patents.

MONITORING PATENTS

'We keep a close watch on which drugs' patents are running out. Late last year, it was Amlodipine. Two years ago, it was Nifedipine. Both drugs are used to control blood pressure,' she said.

She stressed that patient care and safety are never compromised.

'Even if the hospital buys only three types of a generic drug, we will make sure that there are enough medicines to treat all the conditions we need to treat,' she said.

Not all branded drugs can be switched with generic ones.

'There are times when we do not make an attempt to switch. As pharmacists and doctors, we are very careful about which drugs we can go generic with and which drugs we won't,' said Ms Fatimah.

The drugs that they do not go generic with are generally those with a 'narrow therapeutic index'.

This means that the slightest variation in the drug may cause an over- or under- effect for the patient.

For instance, Warfarin, an anti-coagulant used to thin the blood.

Said Dr M Wong, a general practitioner: 'Too much and there is a possible risk of bleeding. Too little and there is risk of clot formation leading to strokes or heart attacks.'

When a patient is already stabilised on Warfarin, most doctors would prefer for him or her to remain on it.

'If we switch to a generic drug, there will be a slight variation in the drug. Then we would have to do a fantastic job of monitoring the patient to ensure that it is not too much or too little. In the end, that may not be worth the savings,' he said.

Other examples are: Digoxin, for the management of heart failure, and Theophylline, for severe asthma.

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