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DeezNuz

Medicine Prescription practices in the Philippines

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Have you been to your Doctor/Physician's office here in the Philippines and noticed the large number of Medical Reps in the waiting area with you??? Here's their story...

A majority of the Doctor's in the Philippines prescribe particular medicines, not based on how well they benefit the customer, as we would believe. More so, on the amount of kickback (rebate) they receive every month from prescribing the medication.

 

Example, my friends Pulmonary Physician prescribed a very expensive medication (Expensive for Philippine Standards), which runs approximately $5/pill. Now, there are a few generic types available for this...namely Pharex (Amplodopine) that only runs $0.58/pill. I know, the same medication was prescribed to me for my hypertension.

 

What I ended up being told by my friends that are Doctor's here, is that the Prescription Medicine Manufacturers/Suppliers here in the Philippines pay them this rebate on a monthly basis. So the Docotor's prescribe the medication to the patients based on the kickback...Doctor's Office sends the itemized list of prescriptions to the Medical Rep every month...the same Medical Rep visits those pharmacy's to confirm the prescription...then make the cash payment to the Doctor's offices every month.

 

Feel free to ask for an alternative medication...they would be more than happy to prescribe one that works just as well..

 

Today, I had two extractions...my Dentist tried to prescribe me a very expensive medication for the pain ($2/pill)..I asked if it was really necessary and if the Advil I have at home would work just as well. She told me it would work perfectly fine and just recommended I take two when I get home, then only 1-pill every 4-6 hours if the pain comes back.

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The strategies the Pharma companies use in the Phils depend heavily on whether the locally registered MNC or National company is a PHAP (Pharmaceutical & Healthcare Association or the Philppines) member. Non PHAP members have a much freer free reign greasing physicians palms with kickbacks & oversees symposia.

 

 

The code of ethics guidelines for the PHAP members make if very difficult to compete with non PHAP members (and a number of PHAP accreditied MNC's are evaluating whether to stay in Phils)

 

Philippine government interventions for reduced healthcare costs/access to medicines include

  • The cheaper medicines bill
  • The Maximum retail price (MRP) on 22 selected products (primarily dealing with hypertension, Statins & antithrombotic & cancer drugs)

GSK even dropped their prices in march 2009 prior to the MRP cutting in

The Philippine government can be congratulated as the cost of some therapeutic class medicines has decreased (unlike Indonesia where the costs of medicines escalated from similar government efforts)...but its not all good news...the Philippine gravy train is still very long, and most medicines are still far more expensive than their counterparts in Indonesia, Thailand, Hong Kong & Vietnam

 

Examples of Kick backs include

  • The Physician gives you a script and an additional card where you sms the number, provide details (like the doctors code) and get additional free medicines sent to you. (something for you & a recognition for the doctor)
  • The Pharmacy presented loyalty card (Like the Pfizer one) the customer gets a discount for loyalty, the Pharmacy gets a gift for dispensing the product & the company gets intimate patient details such as how often you repeat scripts (or switch - or cut the pills in half).This data assists marketing. The best example in Norvasc...there are 17 generic versions avail in the RP and Norvasc is still #1 (some loyalty indeed)

The government has done a little to reduce patient costs/access to needed medicines but NOTHING to regulate the supply chain code of ethics. (ie the level playing field)

 

The biggest gainers in this current set up is not big pharma - its the National Companies. Indonesia & Philippine in particular obstruct the growth of MNC pharma, for example in RP a local company can Patent a New Chemical Entity for 99 years - on Philippine soil - sadly...and in a country where clinical trial patients are in the millions (access to medicine) nothing is being developed.

 

This post is not designed to attack, but to inform. And I really cannot blame a company or a physician for wanting to improve their position whilst doing their job.

 

The healthcare profession is an honorable one...

Edited by Malipayon Puti

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Is there any area of day-to-day living that the Filipino is NOT dishonest ??

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Is there any area of day-to-day living that the Filipino is NOT dishonest ??

I hope so

If you are referring to dishonesty in my post I need to disclose to that you would find some Aussies, Americans, Poms, Indonesians, Thai's etc that I have worked with equally dishonest.

 

Corruption is a many splendid thing: I wan't to eradicate it...or more opportunity to participate in it LOL

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In answer to Big Rob's comment regarding the Rep's seemingly outnumbering patients in the clinic. Sales force sizes have diminished dramatically in the West as the law of diminishing returns is well established. The bright eyed interns that used to wonder why the reps were so friendly and generous have since found out why. Sales force sizes have typically gone to 10% of their 2002 size. Other marketing channels are now employed in conjunction. Prizer started the share of voice war (by adding up to 6 rep teams in a territory) - and it used to work very well for them (and others) .

 

This is just not the case yet in developing Asian countries...A rule of thumb is a high potential prescriber is still visited 4 times per month (and this is largely by doctors desire in the RP). You will continue see lots of reps in the immediate future, labour is cheap as they generally work on a 50% salary 50% Bonus scheme

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Is there any area of day-to-day living that the Filipino is NOT dishonest ??

 

It's not really about being honest or not. They are promoting a medicine that will of course treat the condition you may have. It's just letting people know that they do have options. I would think most doctor's would prescribe a different medicine if you ask for it.

 

Like my Physician...he is the one that recommended Pharex to me as a cheaper alternative...so I suggested my friend ask his Doctor about a switch to generic as well..most should be very accomodating to the patient.

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Is there any area of day-to-day living that the Filipino is NOT dishonest ??

 

It's not really about being honest or not. They are promoting a medicine that will of course treat the condition you may have. It's just letting people know that they do have options. I would think most doctor's would prescribe a different medicine if you ask for it.

 

Like my Physician...he is the one that recommended Pharex to me as a cheaper alternative...so I suggested my friend ask his Doctor about a switch to generic as well..most should be very accomodating to the patient.

 

May be you are an optimist, maybe a realist, possibly neither :scratch_head:. It has been a pleasure interacting with you on this forum for some time now: hope to meet you in real life one day. Have a happy birthday!

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Is there any area of day-to-day living that the Filipino is NOT dishonest ??

If you don't think western Drs write scripts based on kickbacks you're buying your meds from Carlos.

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Well...you can get just about any drug (other than controlled substances) without any prescription at all here on Cebu. If price is a worry, do some research on the Internet, and figure out what the generics and alternatives are before you go to the pharmacy...maybe even before you go to the doctor. Now that Ultimatecare has a pharmacy, I no longer have to worry about it. I just pick up my prescriptions and Tricare takes care of them.

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Is there any area of day-to-day living that the Filipino is NOT dishonest ??

 

Yes.

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