Generic drug consumption in Lebanon can cut health costs.

Byline: Dana Halawi

Summary: Cutting health spending and buying effective cheaper medications have become the obsessions of many LebaA[degrees]nese families in these dire economic times. One of the ways to reduce the pharmaceuticals bill is to buy what is known in medical terms as generic drugs. There is a general consensus among pharmaceutical professionals.

BEIRUT: Cutting health spending and buying effective cheaper medications have become the obsessions of many Leba-nese families in these dire economic times. One of the ways to reduce the pharmaceuticals bill is to buy what is known in medical terms as generic drugs.

There is a general consensus among pharmaceutical professionals that generic drugs is the best possible way to ease the financial pressure on the citizen as well as social funds and insurance firms who have to fork the bill at the end.

Generic drugs are products which are produced and distributed without patent protection. They are available once the patent protections afforded to the original developer have expired.

However, a strong disagreement emerges between them over the percentage of generic products available in the Lebanese market and the necessity of creating a central laboratory for drugs and food testing in the country.

According to the consumers' protection association, pharmaceuticals represent the major item of health spending in Lebanon, constituting 27 percent of the total medical bill which also includes hospitals and physicians fees.

The pharmaceuticals bill in Lebanon today has reached $900 million yearly which is very high relative to the country's Gross Domestic Production," said Zouhair Berro, head of the consumers' protection association.

Berro believes that the drugs policies that have been prevailing in Lebanon for the past few years have always worked against the introduction of generic drugs, which make up only 2 percent of drug consumption in the country according to the World Health Organization.

"Once these products are introduced in great quantities in the Lebanese market, prices of pharmaceutical drugs with brand names are going to dec-rease by 40 percent," he said.

However, he added, it is not in the interest of pharmaceutical firms to focus on importing generic drugs because they do not generate the same profit that branded ones do. Berro goes further by mentioning the existence of partnerships inside the government and the private sector to prevent a fair introduction of generic drugs in the Lebanese market. "They are benefiting from this situation, and every time this subject comes up, it creates problems in the country," he said.

Former MP Ismail Sekarieh, a strong critic of the policies of the Health Ministry, raises concerns similar to those of Berro, saying that generics are not profitable enough to importers, and for this reason they do not focus on importing them much.

"We are dealing with the pharmaceutical drugs market in Lebanon as being a market for business and money maki-ng which should not be the case," he said. "We are at the mercy of a mafia constituted of the big traders and importers who do not have any interests in importing generic products," he added.

Sekarieh believes that a high consumption of generics in Lebanon will highly compete with branded drugs unless the awareness of people has been raised as to the questionable safety of generics.

"The availability of generic drugs in Lebanon is not as important as having a central laboratory because we cannot make sure that they are of a good quality in the absence of a lab to control these products," he said.

"Outside Lebanon you have good and bad quality drugs. There are hundreds of factories around the world that formulate questionable drugs. We cannot depend on other countries be-cause they usually send the worst quality of drugs to the third world countries," he added.

Sekarieh gave the example of a drug named Pitocin which is used by pregnant women to strengthen the contraction of the uterus when the baby wants to come out. "This drug is made of water, that's why almost 90 percent of pregnant women are delivering their babies in a cesarean way," he said.

The central laboratory in Le-banon was closed in 2007 with no clear plans for reopening it until today.

A book that was written by Walid Ammar, the director general of the Health Ministry states that the confiscation of the central laboratory building, neighboring the residential palace of the speaker of Parliament, without relocation of the chemistry branch that is responsible for drug analysis, has a negative impact on professionals and public confidence in generic drugs.

Ammar told The Daily Star that premeditated media campaigns damaged the image of the Health Ministry by affecting public confidence in the whole registration process, and thus reorienting the demand toward branded drugs manufactured by "entrusted" multinational firms.

"Ironically, one constant allegation of the repetitive campaigns has been the civil servants' conspiracy with the international drugs mafia against generics and national products," he added.

Ammar mentioned in his book that the order of pharmacists and sometimes the order of physicians have been participating in the propaganda, despite the fact that they have a determinant role in drug registration. He added that the two orders are represented n the committee by four members out of seven, and the chairman has never used his tipping voting prerogative.

"Professional associations and universities are actively in-volved in quality assurance and registration of drugs through a technical committee chaired by the Health Ministry director general in accordance with the 1994 pharmacy practice law," he said.

The country of origin is a key notion in the 1994 law stipulating, as a prerequisite for registration, that the product conforms to the same specifications as registered and marketed in the country of origin including the trade name, pack form and size as well as pharmaceutical characteristics.

"In the absence of the central laboratory, we request analysis from reference laboratories in the United States and Europe. We trust that they are sending us the best quality of drugs because these are central labs and they have very good reputations," he said.

"Moreover, why would any pharmaceutical company send us a bad drug, is this conspiracy theory?" Ammar asked. "They want to make profit so they should sell good quality products," he added.

"We do not register low-quality drugs and we have many demands that are rejected by the committee," he said.

On the other hand, Berro showed a great concern about the huge quantities of drugs registered n Lebanon saying that it has reached 6,000 while in France they are only 2,000. Ammar commented on that saying that the ministry decreased the number of registered drugs, those which are not going to be imported again by their dealers. "We decreased this number although it is not wrong to have 6,000 registered drugs because this encourages competition which is in the interest of consumers," he said.

Rita Karam, head of the Health Ministry's import-export department, said that the registered pharmaceutical drugs in Lebanon today reached 5,231, including 1,083 (20.7 percent) locally manufactured and 4,148 (79.3 percent) imported. "All of the locally manufactured drugs are generic of course, but the total percentage of generics available in the market including the locally manufactured and the imported ones is 48.67 percent today," she added.

Ammar said that the availability of generics in Lebanon is high but the consumption is low due to the prescription habits of physicians who do not know about generics when they are registered. "The marketing of generic drugs is not as aggressive as it is for branded drugs. Generics are cheap so firms do not pay much for their marketing," he said. "We have on the website of the ministry a list that includes equivalents of each branded drug making it easier for physicians and patients to reach them," he added.

Armand Phares, president of the Lebanese pharmaceutical importers association, explained the possible reason behind Berro and Sekarieh's claims on the unavailability of generic drugs in Lebanon, saying that drugs in general are divided into three categories: the branded originator drug, branded generic and non-branded generic with its scientific name.

"I think that the head of the consumers' protection was speaking about the non-branded generic when he said that generic products are not highly consumed in Lebanon, because 99.99 percent of generics in Lebanon are branded. That's why people think that we don't have generic drugs in Lebanon" Phares said. "People usually mix between the branded ge-neric and the originator drug," he added.

"The problem with generic drugs named after their scientific composition is that they might not get sold. That's why they are rare," he added.

Saleh Dbeibo, head of the pharmacists' syndicate, believes that a good way of encouraging the use of generic drugs is by adopting a common Health Ministry and National Social Security Fund (NSSF) list of reimbursed drugs that is biased towards generics. "In France, generic drugs are widely used because their NSSF provides 100 percent coverage for these products compared to only 60 percent for branded generics and 30 percent for the originator drug," he said.

"If NSSF in Lebanon adopts this system, then 80 percent of people will go for generics," he added. On the other hand, Berro said that using generic drugs will save 50 percent if not 70 on the NSSF pharmaceutical bill.

Dbeibo commented on the central lab closure, saying it should go back to work but ad-ded that its presence does not guarantee a 100 percent safe drug because labs that provide a 100 percent safety are very so-phisticated ones and they cost a lot. "Lebanon has very limited monetary capabilities and we cannot afford to pay a huge amount of money for a lab."

"Documents from the country of origin usually accompany drugs that are imported to Lebanon and they are submitted to the Health Ministry. Their guarantee is equivalent to the guarantee of the unavailable sophisticated lab in our country," he added.

However, he said, the central laboratory is necessary for the testing of drugs and food. "In the US, the lab is called Food and Drugs Administration (FDA) because these two products are essential to people's lives" he added.

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