In pursuit of medicines that drug companies no longer produce

“Sun has let patients like me down.” The message could not be more telling, coming from someone trying to buy Sun’s generic version of anti-viral drug adefovir for about four months now.

Another generic drugmaker that makes similar versions of this medicine is Cipla. But it too has discontinued making the medicine here. Faced with a dwindling supply of medicine critical to his treatment, the patient was left with no option but to import from a Canadian retailer the drug made by Sun Pharma, but at a higher price (over 10 times more expensive) than he would have got in India.

The pursuit of medicine does not end there. For future regular supplies of the drug, he then had to get in touch with the original maker of the medicine, Gilead, based in the US.

This is not the first we know of medicine shortages in a country feted as being “pharmacy to the world”. The disturbing truth is that patients suffer when drug companies discontinue making a certain medicine for reasons of market competition, viability or regulatory action. Which is why they need to show greater responsibility to the patient who has been buying and is dependant on their drug.

For the ₹1 lakh crore-plus pharmaceutical industry, it’s clear that drug companies need to move beyond the mere business of making and selling medicines. A greater show of empathy in situations like this; a manned helpline, perhaps, to guide patients on where the medicine can be sourced from or a list of alternative drugs available, is necessary.

In the case of adefovir, responses from Sun and Cipla, after repeated follow up, was that the drug had been discontinued and the patient can use other alternatives or newer generation drugs.

But the catch is there are no generic alternatives. The company making the original drug does not sell it in India. And, the next generation medicines were not suitable or “well tolerated” (in medical parlance) by this individual. Informal probing with pharmaceutical industry representatives reveal multiple theories. May be the plant making the drug had received a regulatory rap from the United States Food and Drug Administration. And the product may have been discontinued as the plant was undergoing remediation efforts. Another version points to the shortage of the Active Pharmaceutical Ingredient (API) that goes into making the drug. This happens because APIs are largely imported from China and are impacted by price fluctuations.

Whatever the reason, the patient points to the irony of having to buy the same drug, from the same Indian company, shipped via a Mauritius centre and Canadian retailer at a higher cost.

Last year, a chain-mail petitioned the Health Ministry to step in and ensure supplies of Novartis’ thalassemia drug Desferal. Here too, it came down to few companies making a medicine that had limited profit margins. Shortages are repeatedly witnessed in the country with haemophilia, tuberculosis and AIDS drugs too.

A case certainly for the Drug Controller-General of India and the NPPA to step in and direct companies to inform patients when they stop making a medicine, besides ensuring that steps are taken to address the short supply.

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