Proposal to Promote Use of Generic Drugs in Public Healthcare Institutions

6 Mr Leon Perera asked the Minister for Health (a) what measures are in place to promote the use of generic drugs in public healthcare institutions where they are assessed to be both cheaper and clinically equivalent to branded versions of the same drugs; (b) whether the Ministry tracks what proportion of the volume of all drugs prescribed are generics for those drugs where generic versions exist; and (c) if so what is that figure in each of the last five years.

The Senior Minister of State for Health (Dr Lam Pin Min) (for the Minister for Health): Mr Speaker, MOH works with doctors and pharmacists from public healthcare institutions to encourage the usage of suitable generic drugs. In 2017, to better guide institutions and doctors in use of generic drugs, we introduced a basket of clinically and cost-effective generic drugs which can replace the more expensive branded equivalents.

MOH and the Health Sciences Authority monitor new generic drugs that enter the local market and add them to the basket on a regular basis.

MOH and public healthcare institutions have also implemented other measures to drive use of generic drugs. These include automatic substitution at the point of drug ordering, requiring doctors to provide explanations on the usage of more expensive branded drugs where generics are available and monitor its usage.

The utilisation of the generic drugs in the basket has risen over the years. By volume, the usage of the generic drugs in the basket has increased from 87% in 2013 to 99% in 2017.

Mr Leon Perera (Non-Constituency Member): Thank you, Mr Speaker, Sir. I thank the Senior Minister of State for his reply. Just a few supplementary questions: firstly, are there plans from Government to monitor the extent to which, across the board, branded versus generic drugs are prescribed in healthcare institutions because, as I understand it, the cost differences can be really tremendous? For one active ingredient that I just checked at retail, the cost difference is actually a factor of seven times so it can make a huge impact on curbing a spiraling healthcare costs. That is the first question.

The second question is, at the retail level, of course, given the trend that many people are self-medicating, anecdotally, it has been observed that at our pharmacies, generic versions of drugs sometimes cannot be found so easily, they are not displayed so prominently or sometimes they are not available at all as compared to pharmacies in countries like the US, for example, where generic versions are prominently displayed with huge cost advantages. Is that something that the Government is looking into?

Thirdly, again, anecdotally, there are cases that one hears about where in the private healthcare space, generic versions of drugs are sometimes prescribed at the same price as the branded version without the patient really being aware of it. Is this also something that Government is looking to?

And lastly, is there a resource that patients can go to, to access typical retail prices of branded versus generic drugs for common cases? Is this something that is available, and if not, can that be looked into as well?

Dr Lam Pin Min: I would like to thank Mr Leon Perera for those supplementary questions. In the public healthcare institutions, we do have a committee called the National Pharmacy and Therapeutics Committee that looks into the various kinds of drugs that can be included into this basket of generic drugs. We review them very regularly and these drugs are included because they have high impact on the costs in terms of drug prescription. Basically, these drugs are usually assessed to have high spending and high utilisation in the public healthcare institutions.

With regards to the generic options at retail pharmacies, I think this will be up to the business model of the pharmacy in deciding whether it is better to bring in the generic options or the branded options. However, I have come across many private pharmacies that do carry generic options for patients' purchase.

For like-minded practitioners such as private GPs or even intermediate long-term care providers who are mindful of drug cost, we are also trying to encourage them to have some form of collaboration in terms of group purchasing or group procurement. This will, hopefully, help reduce the cost of drugs in the private sector.

The Member also mentioned about whether we could encourage private healthcare providers such as private hospitals or private clinics to use more generic options, and also amount of generic drugs versus branded drugs are being charged. This is a business decision by the private hospitals and practitioners. As they have different operational expenses and considerations, it is difficult for MOH to dictate exactly how much or what kind of drugs they prescribe to their patients.

Mr Leon Perera: I thank the Senior Minister of State for his very detailed answers. There was one question I asked: is there an online resource available for patients to check the price of generic versus clinically equivalent branded drugs, to educate patients so that they can perhaps demand for generic versions to lower the cost that they will need to bear? And if such online resources are not available, is this something the Government is looking into?

Dr Lam Pin Min: I thank the Member for the suggestion. I am not aware whether there is an online resource for that purpose but I can check and update the Member.