As conflict over ingredient-name prescribing escalates in medicine, drugmakers' calculations have grown complicated.
Ingredient-name prescribing is when a doctor prescribes a drug by its ingredient name instead of its brand name. If a doctor prescribes acetaminophen (ingredient name) rather than Tylenol (brand name), a pharmacist selects one of the medicines with that ingredient and provides it to the patient.
Pharmacist groups believe that introducing ingredient-name prescribing would ensure a stable supply of key medicines and improve patient convenience. Doctor groups oppose it, saying ingredient-name prescribing infringes on medical practice.
In the pharmaceutical industry, some say, "The sales structure for medicines could change," and voice concerns that "in the fight between doctors and pharmacists, it may be the shrimp whose back gets broken."
According to the Ministry of Health and Welfare on the 19th, the government is reviewing the introduction of ingredient-name prescribing for drugs with unstable supply and demand. The National Assembly has also introduced amendments to the Pharmaceutical Affairs Act and the Medical Service Act to allow ingredient-name prescribing. It says that failure to comply could result in criminal penalties such as imprisonment or fines.
Even now, if a pharmacy does not have the medicine written on a prescription, a pharmacist may exceptionally substitute with the same ingredient. However, because the pharmacist must notify the doctor of the substitution, there is reluctance to do so.
The Korean Pharmaceutical Association is calling for more proactive ingredient-name prescribing. It notes that original and generic drugs approved in Korea have equivalent therapeutic effects, so prescribing by ingredient name is acceptable. Overseas, including Japan and Australia, ingredient-name prescribing is encouraged or mandated.
Doctors oppose ingredient-name prescribing, saying accountability becomes ambiguous if a patient experiences side effects. The Korean Medical Association Organization held a national rally of physician representatives in front of the National Assembly in Yeouido, Seoul, on the 16th and said, "Forcing ingredient-name prescribing breaks the principle of separation of prescribing and dispensing (doctors treat, pharmacists dispense)."
Drugmakers' sales concerns are also deepening. Pharmaceutical sales representatives usually prioritize large general hospitals, then private clinics, and then pharmacies. A pharmaceutical industry official said, "If the authority to choose medicines is dispersed from doctors to pharmacists, the number of targets for sales efforts increases accordingly," adding, "The sales landscape could be upended."
A representative of a drugmaker said, "If ingredient-name prescribing is introduced, there will likely be more cases of expanding in-house sales staff or using CSOs (contract sales organizations)." Contract sales is when a pharmaceutical company outsources sales and shares a portion of the sales revenue tied to prescriptions. The company can instead focus on new drug research and production.
Another pharmaceutical company official said, "Doctors sometimes prefer original drugs, but pharmacists are comparatively less so," adding, "Top drugmakers that mainly supply original drugs could be affected, while small and midsize companies supplying generics could find new opportunities."
The industry hopes the introduction of ingredient-name prescribing will eradicate illegal rebates (kickbacks). This is because there has been a practice of doctors receiving money or valuables from drugmakers and choosing specific medicines. Illegal rebates inflate drug prices and shift the expense onto the public.
The National Health Insurance Service union said, "With brand-name prescribing, there is a possibility that doctors may prioritize medicines from companies that provided larger rebates over patients' conditions, leading to the administration of less effective or unnecessary drugs," adding, "It undermines the fairness and trust of medical care by deciding patient treatment based not on medical judgment but on financial interests."
A pharmaceutical industry official said, "We cannot rule out the possibility that rebates could shift from doctors to pharmacists," adding, "Rebates are not a problem caused by a lack of systems or regulations, but by the will of the recipients."