Pharmacy

JSS has perhaps one of the lowest priced pharmacy around. It utilizes only essential and generic drugs, promotes rational pharmacy and dramatically lowers costs of therapy.

The pharmacy stocks nearly 250 different essential medicines. Drugs are dispensed with pictorial slips for the benefit of patients who cannot read. With very few exceptions, drugs are available to patients at about 20-35% of market rates. For example, a month's course of amlodipine 5mg and hydrochlorothiazide 25mg (given every day) for high blood pressure costs Rs. 18 at our pharmacy, while a full course of chloroquine for treating a 60kg adult patient with malaria costs Rs. 5 only. All this has been made possible by the following means:

Procurement

As far as possible, we procure our drugs from LOCOST (Low Cost Standard Therapeutics), which is a non-profit trust based in Vadodara, Gujarat State. This organisation produces good quality generic medicines - about 80 drugs in all - at low prices on a 'not-for- profit' basis. LOCOST sells its medicines only to NGOs and social action groups working with the poor, through three depots at Vadodara, Guwahati and Bangalore.

Drugs that are not made by LOCOST are procured from the local market in generic form (that is, without brand names) manufactured by reputed companies.

Drugs that are not available in generic form are purchased in the branded form. Since there is a wide range of prices among the brands of a particular drug made even by reputed companies, we monitor prevailing prices and choose the brand with the lowest price, while ensuring quality.

All drugs are purchased at wholesale rates and also in large quantities to take advantage of bulk purchase discounts

Drug Selection

The development of our pharmacy has gone hand in hand with some decisions that have kept the inventory of the pharmacy as small as possible without affecting its utility. These are,

Using the concept of drug classes and stocking only one representative of each drug class. For example, enalapril is the only ACE inhibitor (a type of anti-hypertensive) and doxycycline is the only tetracycline (a type of antibiotic) stocked by our pharmacy. An exception to this rule is made if a second member of a class can be used orally. For example, among third-generation cephalosporins without anti-Pseudomonas activity, we stock both ceftriaxone because of its higher and sustained tissue levels and cefixime because it can be given orally.

Avoiding recently developed congeners of established drugs that offer therapeutically insignificant benefits. For example, rabeprazole may offer a small advantage over omeprazole in terms of greater bioavailability but that advantage is nullified by the price difference.

Avoiding all drugs that are not of proven clinical value. For this reason, we do not stock so-called 'hepatoprotective' drugs containing sorbitol, silymarin etc. For the same reason, tonics are not stocked in our pharmacy.

Choosing the best value for money. Iron tablets stocked in our pharmacy contain ferrous sulphate and no other iron salt. When stocking an iron syrup for children, we choose from only two brands in the Indian market that have the maximum iron content per unit volume. Doses are measured accurately by using disposable plastic syringes with the needles removed.

Prescribing practices that limits patients' expenses

Prescribing practices that, along with the low-cost pharmacy, have helped reduce the patients' expenses include the following:

Avoiding injectables when an oral preparation would do.

Prescribing by generic names only. It is a matter of pride that more that 90% of the prescriptions made by our eight allopathic doctors mention drugs by generic names. All of our VHWs use drugs only by their generic names.

Using syrups only for children who are too small to swallow tablets. Children of four years or above generally accept tablets. We have developed a simple tablet breaker to divide tablets accurately into three or four parts.

Avoiding shotgun therapy. For example, many cases of aches and pains in the body resolve into depression, osteomalacia, hypothyroidism, or other specific disorders when worked up properly, thus doing away with the need for analgesics, apart from increasing patients' (and doctors'!) satisfaction. In this regard, the diagnostic laboratory also plays an important role in enhancing the clinic's ability to provide rational therapy.