Sunday, March 24, 2019

Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP)
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Jan Aushadhi scheme provides quality generic medicines, consumables and a few medical devices at very affordable prices. It has been redesigned and vastly expanded to benefit a larger group of people. It creates retail opportunities for PSU sites looking to diversify sales, private entrepreneurs and NGOs. For rapid establishment of distribution and improved viability, incentive were increased as well as the basket of drugs and diseases covered. People have complained about gaps in coverage e.g. cancer drugs, and these could be dealt with soon.

☀ Range of products - All types of diseases were covered, number of medicines expanded manifold from 100 to 630, and consumables and devices added

☀ Testing - Batch testing by accredited labs was incorporated

☀ Private sector involvement - WHO certified private pharma can become suppliers

☀ Incentives - Higher margins were allowed to distributors & retailers. Higher grants were given to establish new outlets

☀ Distribution - JA shop numbers have scaled up from 80 to 2800 'till date. PSU channels like railway stations & petrol shops, are being added for further rapid expansion. PSUs will need to hire or lease premises to qualified pharmacists.

Revenues of JA are small (Rs.74cr in 6 months of 2017/18) though growing extremely fast. National coverage is still limited. When campaign for JA stores was started in Assam, state govt agreed to open them in all govt hospitals. TN & Karnataka already have a low-cost state sponsored retail scheme in place. Yet 200 stores will be opened in KA. Kerala is very interested in JA stores (a change of stance).

Hot press 1/18: Govt has approved 36,000 new JA stores for private entrepreneurs (B Pharma/ D Pharma qualified). There are 3050 JA stores & 652 generic medicines presently. Factors driving sales in JA stores: Govt will make generic drugs compulsory & drugs sold in JA stores cost 90+% less than equivalent branded generics.

The story of Jan Aushadhi into the future
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JA stores don't sell patented or branded drugs, and stock just 630 medicines and 150 consumables. Yet these stores are gaining popularity among lower and middle classes and retirees. JA scheme has picked up pace in the last 15 months. Shop openings are racing towards the 3000 stores target to cover every tehsil or admin block. Govt has now cleared opening of stores at railway stations and petrol pumps. Maybe domestic pharma will start feeling the squeeze, just when exports have become volatile.

❦ "Jan Aushadi can be as destructive as Patanjali. All it needs is for pharma to stop bribing doctors and doctors to stop promoting branded products." ❦

PM Modi has spoken about profiteering and indeed action was taken this year on cardiac stents and knee implants. Jan Aushadhi scheme sets out to tackle the menace of overpriced drugs and consumables. A small scale trial in 2013 didn't elicit a very good response. Govt felt Jan Aushadhi could be more impactful if it covered more diseases and more people across India.

❦ "Govt could have gone national immediately via e-pharmacy. Instead it chose the route of opening stores in a phased manner and gradually building the basket of medicines." ❦

Govt decided to ramp up JA stores to 3000 by 2017, but this is too slow to make ‘affordable healthcare for all’ happen even by next decade. Looking ahead there may be 10,000 stores by 2019, but this is just 1% of chemists already in operation. Subsidy is a barrier to new store openings. Sustainability in the long-term means doing without subsidy and adopting least-cost methods of distribution.

An industry report states that e-Jan Aushadhi portal should be set up. It reasons that Digital India will provide national internet access to all citizens, and large efficiency gains in distribution will lead to much cheaper prices. Just targeting cardiac, diabetes and blood pressure drugs will bring 200m people into the scheme, provided medicines are delivered by e-Jan Aushadhi.

Entire range of medications can be added over time, through continued efforts of BPPI -- a central PSU. But distribution should be left to the market-place, accessible through multiple channels. JA stores have a role if well-sited like in hospitals & main shopping places. But e-commerce players also have vital logistics capability to offer, being very cost-effective, very reliable and already present across the country. Policy change in favour of unbranded generic prescriptions and e-Jan Aushadhi can bring rapid structural change!

My Thoughts
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If Government E-marketplace portal is used, it will create huge volumes for the portal, though good logistics must be established for it. Secondly e-pharmacy can use pharmacists more efficiently because they work centrally and medicines can be put in temper-proof packaging. Thirdly e-pharmacy can sell to JA stores, local delivery sites or post directly to the public. JA stores in or near hospitals is a good idea. If operations are scaled up, they will be very cost-effective and highly accessible.
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