Doctors in Bihar are not averse to Prime Minister Narendra Modi's idea of making a law wherein doctors are required to prescribe only generic drugs.

But they said there are lots of issues that need to be addressed before any such law is made. The issues involved are accessibility and quality of these drugs. While inaugurating a multi-speciality hospital in Surat on Monday, Modi had said the government would put in place a legal framework to ensure doctors prescribe only low-cost generic medicines to patients. It means doctors can only prescribe the chemical composition of the drug and not the brand under which it is manufactured and marketed.

"It is a good move that will benefit patients, as they will get life-saving drugs at a cheaper rate," said Ajay Kumar, senior vice-president of the Indian Medical Association's Bihar chapter. "The problem, however, is that we should not just produce generic drugs but also quality ones, as it is a matter of people's lives. The government should ensure a mechanism to monitor quality of these drugs. The approved generic drugs must meet rigorous standards with respect to identity, strength, quality, purity and potency."

Quality control is an issue, as there are just 1,800 drug inspectors in the country. Also, Bihar has no drug-testing laboratories. "Drugs are sent to Kolkata, Shimla or Pune for testing. It is important that laws related to drug testing and quality assurance are strengthened before the prime minister's idea is implemented," Ajay said. "The issue is not of branded or generic drug. If the government really wants drugs to be available cheap, why can't it bring more drugs under the Drug Price Control order and National Pharmaceutical Pricing Authority. The prices of these drugs are fixed by the Union government."

Another point raised by Ajay was availability of these medicines and prices. "Some generic drugs are priced higher than branded drugs and 90% of generic drug business in Bihar is conducted without any receipt," Ajay said. "There are not enough outlets selling generic drugs and neither are they well-stocked. It is not as if we don't prescribe generic drugs. But accessibility and quality are issues."

"Generally, branded drugs cost more, as pharmaceutical firms spend a lot on their promotion," said Mukund Prasad, head of department of neuro-surgery at Paras HMRI Hospital. "Besides, even if a generic drug is prescribed, the pharmacist would decide which company's drug to supply and he might end up giving the patient the costliest brand of that generic drug."

Also, generic drug makers cannot be sued if their products trigger adverse reactions. "Only branded drug makers are responsible for design and safety warnings under The Pharmacy Act, 1948," Mukund said.

Harihar Dikshit, a senior doctor at Indira Gandhi Institute of Medical Sciences (IGIMS), said the Medical Council of India (MCI), which supervises medical education in the country, has already asked doctors to preferably prescribe generic drugs.

"Another crucial factor is that some of the new chemical compositions of drugs are patented. Those cannot be produced by generic drug makers for a certain number of years," Dikshit said.

The Bihar government had, in 2012, decided to provide generic medicines to all government hospitals and health centres for free distribution among patients.

But even after five years, availability and supply of generic drugs at government hospitals is a matter of concern. No generic drugs are available in government hospitals. All generic drug stores that came up at hospitals are almost shut down, the IMA's senior vice-president said.

To create awareness and popularise generic medicines, the government had even sought the help of actor Aamir Khan, but things somehow didn't materialise.