Doctors want more transparency in branded drugs prescription at public hospitals

Former Malaysian Medical Association president Dr Milton Lum says at no time should anyone with a chronic disease stop treatment without medical advice. ― Picture by Choo Choy May

KUALA LUMPUR, Aug 18 ― The Malaysian Medical Association (MMA) called today for a more efficient and transparent process for prescribing branded medicines to patients, amid the Ministry of Health’s (MOH) “generic first” policy.

MMA president Dr Ravindran R. Naidu said approval for giving patients at public clinics or hospitals drugs outside the ministry’s formulary should not rest solely with the Health director-general.

“It’s more important to have a transparent process, so everyone knows exactly what is needed for approval,” Dr Ravindran told Malay Mail Online.

“If a safe and effective generic is available in MOH formulary, every public sector patient should receive the same drug, except where the patient cannot tolerate the generic (for instance, due to allergy). In case of intolerance of generic, the government should supply original drugs ― it’s not the patient’s fault,” he said.

He added that MOH should bring in original drugs with good cost-to-benefit ratio should generics be unavailable, pointing out that “many” drugs do not have generic versions.

Malay Mail Online reported today that retired civil servants, numbering at 700,000, will no longer be reimbursed if they buy brand-name medications unavailable at public hospitals, as they will instead receive generic drugs like other patients.

According to a June 30 circular by MOH, approval from the Health director-general is required to get drugs outside the MOH formulary based on these guidelines: drugs in the formulary are ineffective in treating the patient, the patient suffered adverse effects from drugs in the formulary, and the application is not intended to continue medical treatment that had been started at a private hospital or a hospital from another ministry.

MMA past president Dr Milton Lum said generics sometimes do not work in cases of dialysis, high blood pressure, and arthritis. He also highlighted resistance to generic antibiotics and common drugs, pointing out too that there are no generics for many cancer drugs.

“The Blue Book is based on essential medicines,” Dr Lum told Malay Mail Online, referring to the MOH formulary. “They cover the majority of common illnesses, but it doesn't cover everything.”

He questioned how long patients and doctors must wait for approval of applications to use branded medicines.

“Is there a process to fast-track it, particularly when it's needed urgently? What happens if the DG is not in the country? Who approves it then?” said the past president of the Federation of Private Medical Practitioners Associations.

“It has to be an efficient process with certain timelines for decision to be made, for approval to be given. If you give approval, there is a time lag before you obtain the medicine. So there has to be efficiency in the process and timelines to be complied with.”