Uniform Pharma Marketing Code: All Great Suggestions, But No Bite

While the code has addressed numerous issues ailing the pharma industry, and by extension, the country’s healthcare system, it still leaves loopholes for firms to exploit.

Pharma firms have already been voluntarily complying with the codes of marketing introduced in 2015. But just like the 2015 code, the new UCMP doesn’t make the code mandatory.

Before dwelling on what the new code lacks, here are the key takeaways from the UCMP. The code has outlined the relationship between healthcare professionals and pharma firms or their representatives by spelling out some restrictions.

The code has explicitly restricted gifts, travel and hospitality benefits, as well as monetary benefits, to get doctors to prescribe more medicines from the firm which is providing favours. 

To know its impact on people, one needs to rewind to the Covid-19 outbreak when people were at the mercy of doctors and their prescriptions. One of the most prescribed medicines was Dolo 650.

In 2022, allegations came to light that Micro Labs, the Dolo 650 makers, were giving freebies to doctors worth Rs 1000 crores to push it. Even though Micro Labs got a clean chit from the Indian Pharmaceutical Alliance much later, such allegations underscored the need for a better regulatory framework to end these malpractices. 

Even a layman is aware of the corrupt prescription business in India. But the fact remains that people can still be taken for a ride over medical assistance. 

The Pressing Issue Of Kickbacks In Marketing Pharmaceuticals

A recent film, ‘Hustling Pain’, illuminates a similar story that the new UCMP tries to address and mitigate. A dialogue in the film while describing the issue of kickbacks says, “It’s a legal grift, and everybody was doing it.”

Perhaps, it holds some truth, given how pharma companies often use kickbacks to boost prescriptions. More importantly, industry insiders believe that unlawful kickback practices, considered among the most common pharmaceutical frauds across the globe, are a prevalent issue in India as well.

“A lot of big pharma companies would offer gifts, monetary benefits, travel and hospitality plans to doctors in return for prescribing drugs of their firm. However, such types of backdoor deals are not happening as often as they used to, but it is still a prevalent issue,” a health practitioner told The Secretariat on condition of anonymity.

On how the kickback system works and what doctors are expected to do, the healthcare practitioner said, “Reps of big pharma firms used to come and ask us to give daily prescriptions of their medicines. They used to set prescription targets for doctors to achieve.” 

The practitioner also explained that many like her are often lured into such offers. She noted that this type of quid pro quo relationship can’t only be blamed on the pharma reps as it needs a willing participant.

Recalling an anecdote, the health practitioner said someone she knew got a car as a gift to prescribe medicines. Many also got to go on international trips.

“At one point in time, I was also given a favour by a pharma firm. I was given a travel package. However, in retrospect, I feel such favours shouldn’t be taken by healthcare professionals as it may lead to grave implications on patients in the long run,” another health professional told The Secretariat.

It is important to mention that kickbacks for prescriptions are not limited to a particular speciality of medicine, but to all specialities. 

What Does The Uniform Code Say

The UCMP has tried to deal with an array of unethical measures that have plagued the healthcare ecosystem. Apart from prohibiting gifts and incentives given to healthcare practitioners by pharma firms and their reps, a cap on sample distribution has also been put in place. 

Moreover, ethical forms of promotions and claims for medicines have been outlined in the new code. The UCMP spells out how claims by the firms regarding the efficacy of a drug need to be based on an up-to-date evaluation of all available evidence. Moreover, it has also been defined in the code that details of the side-effects of the drugs need to be mentioned (if there are any). 

The UCMP addresses that promotional material, such as mailings and journal advertisements, should not be designed to disguise the fundamental quality of the medicine. It has been noted that the promotional material can’t resemble the editorial matter of journals. 

Moreover, the names or photographs of healthcare professionals have been barred from being used on promotional material.

The UCMP details that pharma or medical representatives need to be well-informed and adhere to the code. Especially that medical representatives shouldn’t employ unethical practices to get an interview with a medical practitioner. 

To ensure that UCMP won’t be neglected, the firms have been advised to add a clause in the employment agreement. The UCMP has requested all the associations to constitute an Ethics Committee for Pharmaceutical Marketing Practices (ECPMP) that will oversee the redressal of complaints. 

Moreover, pharma associations have been asked to share details of complaints received on their website, which will also include action taken by the ECPMP. Additionally, the complaints shall be uploaded on the UCMP portal.

Why UCMP Is All Talk And No Bite 

If only it were true that it is the thought that counts the most, then the newly notified Uniform Code for Marketing Pharmaceuticals would have been revolutionary in how pharmaceuticals and doctors operate. However, in this particular case, the code lacks teeth to enforce it.  

The notified UCMP doesn't mention if the codes are mandatory and to be complied with. There are no legal implications if pharma firms don't adhere to the code.

This is the jarring thing which circles back to 2015 when the Centre came out with similar codes but made them voluntary. Given the pressing nature of pharma kickbacks and their impact on the country, it is imperative that the code be made enforceable with penalties for non-adherence. 

Stakeholders note that if the code is made mandatory for compliance, then it can revolutionise the healthcare ecosystem.

"These codes, if made compulsory, can benefit the healthcare system immensely by ensuring that only well-labelled drugs are prescribed by doctors. This will enable us to make unbiased decisions without any influence from external factors, as well as strengthen the doctor-patient relationship," another health practitioner told The Secretariat. 

Some stakeholders believe making these codes statutory would bolster the pharma sector as well. “The UCMP could help level the playing fields for all pharma firms. It could also perhaps inspire innovation and research for firms as they can't employ unethical ways to claim an edge, and would have to rely on the quality and efficacy of the drug,” he added.

In all, the new code seems to be like a tailored suit for a groom who has no plans to marry. The code could have played a key role in overhauling the pharma firms but lack of penal action renders it toothless.

Therefore, it is time the code is implemented with statutory powers to breathe new life into the pharmaceutical industry.