The Indian Battle of Selecting a Brand versus Generic Medicine Continues: A Cost Variation Study of Oral Fluoroquinolones

Introduction: According to the World Health Organisation (WHO), the rational use of medicine occurs when the medication received by the patient is appropriate to the clinical need, at the proper dose, for the appropriate duration and at the lowest cost that the patient can afford. Fluoroquinolones are widely prescribed medications in India. After being included in the Drug Price Control Order (DPCO) list and having ceiling prices set for a few fluoroquinolones, there is a need to assess the pricing of fluoroquinolones in the market. Aim: To evaluate the cost variation of different brands and generic medicines of oral fluoroquinolones and their combinations in India. Materials and Methods: A cross-sectional descriptive analytical study was carried out in December 2022 and August 2024 as a follow-up to observe improvements in the situation. Authors from different locations in India (Command Hospital, Air Force, Bangalore; AIIMS Gorakhpur; and INHS Ashvini) collaborated to utilise commercial drug directories for the study. The costs of specific oral fluoroquinolones were obtained from the “Current Index of Medical Specialties (CIMS) April – July 2022 and Drug Today April – July 2022,” as well as the latest CIMS April – July 2024 and Indian Drug Review May – June 2024, which are all authentic commercial drug directories. To compare the prices of branded drugs with the corresponding generics, the prices of the generic formulations available in Jan Aushadhi Kendra (JAK) were used. Results: In 2022, Norfloxacin (400 mg) and Tinidazole (600 mg) had the highest percentage variation (3,233.33%), followed by Ofloxacin (200 mg) and Ornidazole (500 mg) with 2,364.28%. In 2024, the percentage cost variation was highest for Ofloxacin (200 mg) and Ornidazole (500 mg), with 1,029.73%, followed by Norfloxacin (400 mg) and Tinidazole (600 mg). In 2022, 16 out of 25 formulations showed more than 100% variation. Conclusion: A wide cost variation in the formulations of oral fluoroquinolones was noted. There is a need to sensitise all stakeholders to this cost variation in order to achieve the goal of safe, affordable and effective medications for all.