There are good moments too, he says, when people thank you after someone in the family gets better after taking your medicine. But Mr Iyer’s task as OPPI chief has become more complex as India implements product patent protection and the Centre threatens to widen price control to make them more accessible.

Pricing and accessibility are different issues, he says, cutting to the chase. “In this country, we give vaccines free. Even then, compliance is as low as 50-60 per cent. We have the highest number of women with anaemia, and our anaemia drugs are the cheapest, at Rs 1 per day. So, clearly, there is no linkage between pricing and access. We need to separate the two,” he says.

In a post-lunch chat at his South Mumbai office, Mr Iyer stresses that difference. He denies allegations that MNCs have but a skin-deep interest in India and offers suggestions on how the Government should be more proactive in reaching medicines to people who cannot afford them.

At present, two major patent-related cases are underway in the country, both involving cancer drugs from two different Swiss-drug makers. Novartis’ patent application on blood cancer drug Glivec had been rejected by the Indian Patent Office, despite it having obtained marketing approval before the product patent regime came into effect in 2005.

The drug costs over a lakh rupees a month, though local companies make similar versions of the drug at Rs 10,000. The other case involves Roche’s lung-cancer drug Tarceva. Local companies make similar versions of the drug at a lower cost, despite Tarceva getting a patent in India. This is a sore point for the MNC, as a patent gives the innovator company 20 years of exclusive protection.

It is clear that pricing lies at the heart of these complex patent-related litigations. And medicine prices become an emotive part of the political agenda, especially when elections are round the corner.

Mr Iyer nods, but points out that pricing and accessibility are related to the extent that the Government can use the pricing aspects to improve access. The Government should procure medicines from industry at a much lower price and distribute it through agencies such as the Gates foundation or any NGO (non-governmental organisation).

Take GAVI (the Global Alliance for Vaccines and Immunisation). It negotiates with companies, buys at a particular price, and the product is distributed to several countries and the Governments at a rock-bottom price. Similar models can be worked out by the Government.

While negotiating with the Government, companies may not want to give branded products, because it could come back into the private market. They may offer a generic product, possibly in a different packing, like a bottle instead of a strip. But these are negotiable aspects, he adds.

India has the infrastructure for better distribution — like post-offices and public distribution “ration” shops, besides, of course, Government hospitals and primary health centres (PHC), he observes. But there is little attention to PHCs, with the Government buying largely for its hospitals that cater to only 35 per cent of the population. To improve access, you need a different model and there are enough available, he stresses.

So pricing should be left to competition? “In the 13 years since the Drug Price Control Order (1995), medicine prices have largely been stable because of competition”.

“Drug prices have not matched inflationary increases in the country, unlike other prices,” he insists, taking an overview of the estimated Rs 30,000-crore domestic pharma industry; he does not single out individual instances where prices may have spiked.

Even the Supreme Court judgement that put the focus on essential medicines, did not call for price control.

There is enough legal opinion on that judgement, he says. Illustrating the bitter side-effect of price-control, he says: “How many of the drugs that figure in the DPCO are still available and how many have gone out of the market?” he asks rhetorically.

Price control makes you inefficient and, ultimately, the patient suffers.

But do not existing prices put many drugs beyond the common man’s reach? In a market as disparate as India, where one person is worth $48 billion and another is worth less than Rs 48, MNCs toy with different models, like differential pricing. Citing Merck’s recently launched diabetes drug Januvia, or GlaxoSmithKline Pharma or Wyeth’s own oral contraceptives “that are sold in this country cheaper than overseas.”

So there is no one model. There are various models in operation today by different companies and it depends on the product mix the company has, the treatment or therapy, the segment it belongs to, and so on. “Our oral contraceptives are the cheapest in the whole world. We sell at $0.5 a cycle, whereas globally it is sold at $10,” he says.

What about anti-cancer drugs? “Don’t quote a cancer drug and say it is expensive. Cancer is a killer disease, there are other serious widespread ailments and infections, gastro problems; “Aren’t they being treated?” he asks. In the case of cancer, the Government will have to work out a similar model for that too.

He steps back a bit; who really benefits from price control? By controlling prices, does access really improve? “Let’s assume that the price is controlled for anti-cancer drugs. Let us take the example further, are you saying that it is accessible to people if treatment costs are brought down from Rs 2.5 lakh to Rs 1.5 lakh? “It still is expensive. You need to develop a model where you can provide the medicine almost free,” he reiterates.

Also, companies cannot always give drugs for free, as they are answerable to shareholders, since it is a commercial business. Government has to step in, work with companies and NGOs to make medicines accessible, he says.

In Kerala, the Government distributed free anti-filarial tablets to people, with the back-water region being a high breeding ground for mosquitoes, after discussing with companies and procuring them at a certain price. That’s how it needs to be done, he feels.

One pricing-related proposal suggests that the Government negotiate prices of new or patented medicines being brought by companies into the country. Mr Iyer is not enthused by that idea; that would mean discriminating between Indian companies and MNCs.

Will an Indian company with a patented drug emerging from its own research not be subjected to price control? What if the MNC does not launch its patented drug and instead gives it away to an Indian company as a licensee? Will it still be under price control?

Price negotiation will only benefit the affluent paying population, he counters. The private market should be allowed to operate as it is, and Government should merely monitor the prices, he says.

For people who cannot afford the product, government should negotiate and buy the drugs from companies at a low cost. These can then be distributed to those who need them at no cost or at a subsidised cost, he says.

We have offered to sell to the Government at 50 per cent of the price, he says, but the Government finds even that expensive, he adds. Price negotiation should be only for the public market.

The urban public who cannot afford medicines will be able to access them though public hospitals, he explains. If agriculture, fuel and kerosene can enjoy subsidies, surely medicines should, he concludes.

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