Now, Insurance Companies after Hospitals to ensure Generic Prescription
MUMBAI: Following PM Narendra Modi's public announcement to frame a new law to force doctors to prescribe medicines by their generic names, the health insurance company Max Bupa is reported to have sent notice to hospitals asking them to prescribe medicines only with their generic names in order to get refund on claims.
Medical Dialogues team had earlier reported that Prime Minister Narendra Modi indicated that his government may bring in a legal framework under which doctors will have to prescribe generic medicines, which are cheaper than equivalent branded drugs, to patients.
Taking cue from this, insurance companies are now reported to be putting pressure on private hospitals to ensure generic prescription in case. A recent report in ET states that Max Bupa Health Insurance, has written to hospitals stating that Hospital need to comply with generic prescription with Immediate Effect, implying otherwise the company may not reimburse their claims
In a letter send to hospitals, Max Bupa mentioned, “Hospitals should segregate the drugs with generic names from the branded names in the invoice before submitting such invoice at point of discharge. A clear justification of not using generic drugs under certain circumstances must be written and filed as a part of discharge documentation."
Max further stated that it has the right to retrospectively audit those claims where there are no justifications given for prescription of branded drugs.
When contacted to Max Bupa, a spokesperson told ET, “Max Bupa has communicated that every physician should prescribe the drug with generic names, legible and preferably in capital letters and should ensure that there is a rational prescription and use of drugs. We are seeking support from hospitals on implementing the generic medicine usage wherever possible without impacting the clinical outcomes and efficacy from patient safety standpoint."
Meanwhile, Dr R V Asokan, chairman of The Indian Medical Association Hospital Board of India, (IMA HBI) the lobby group of hospital chains in India has questioned the letter of Max Bupa,
“We wish to bring to your notice that Right to choose the generic drugs or brands vests with the registered medical practitioner and not with chemists or any insurance company. The MCI guideline does not make it mandatory that every physician must prescribe in generic drugs."
“In such a scenario, the insurance company compelling hospitals to write generic medicines and intruding into the right of registered medical practitioners from prescribing quality drugs for his patients is unwarranted and unethical,” Dr Asokan
Reacting on Dr R V Asokan statement, Max Bupa spokesperson further told Economic times, “The importance of the decision is underlined by PM Modi’s plea to the medical fraternity in India to enable affordable healthcare for all. We believe this is a patient-friendly announcement and aims to bring about uniformity in drug prescription, reducing confusion among patients and enabling affordability, leading to better and more transparent healthcare services. At Max Bupa, we are fully committed to putting our customer’s health first and we will continue to honour and pay all claims, as per the policy terms and conditions."