How to write a Prescription: Check out NMC's Prescription guidelines for doctors

New Delhi: Prescribe Rational, Prescribe Generic. These are the two major dictums the National Medical Commission has laid down in the recently released National Medical Commission Registered Medical Practitioner RMP (Professional Conduct) Regulations, 2023 for all doctors to follow.

Dedicating a separate section to "Generic Medicine and Prescription guidelines" that is going to act as a benchmark for doctors to write their prescriptions, the guidelines lay down the various Dos and Don'ts, when it comes to writing prescriptions. The guidelines also give a template of a model prescription, which may be followed while writing a prescription.

More importantly, the new code of Conduct lays stress on generic prescriptions by doctors only, making violation of the same a punishable offence where punishment can lead to suspension of licence for up to 30 days. Section 8 of the National Medical Commission Registered Medical Practitioner RMP (Professional Conduct) Regulations, 2023

Prescribing Generic Medicines: Every RMP should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets. (L1 and/or L2)(Generic Drugs and Prescription guidelines)

Meanwhile section 12 (b) of the said regulations state:

RMP can prescribe or supply drugs, remedies, or appliances as long as there is no exploitation of the patients. Drugs prescribed by RMP or bought from the pharmacy for a patient should explicitly state the generic name of the drug. (L2)

"India’s out-of-pocket spending on medications accounts for a major proportion of public spending on health care. Further, generic medicines are 30 to 80 % cheaper than branded drugs. Hence, prescribing generic medicines may overtly bring down health care cost and improve access to quality care," the  guidelines stress.

Generic medicines vs Generic names:

The guidelines also give clear definitions to various terms surrounding prescription, including generic names, Generic drug/medicine as well as Branded Generic drug which is given as follows

• Generic Name: Non-Proprietary or approved name of a drug is also known as the generic name of the drug. Non-proprietary name is the name accepted by a competent scientific body/ regulatory authority.
• Generic drug/medicine: A generic drug is defined as a “drug product that is comparable to brand/reference listed product in dosage in dosage form, strength, route of administration, quality and performance characteristics, and intended use”
• Branded Generic drug: A branded generic drug is one which has come off patent and is manufactured by drug companies and sold under different companies' brand names. These drugs may be less costly than the branded patent version but costlier than the bulk manufactured generic version of the drug. There is less regulatory control over the prices of these “branded” generic drugs.

Guidance to RMPs:

In a separate section, for the first time, NMC has released the Generic Medicine and Prescription guidelines for doctors, which lays down 10 important pointers for medicos while writing prescriptions. These are as follows

1. Prescribe drugs with “generic”/“non-proprietary”/“pharmacological” names only

1.1. In the case of drugs with a narrow therapeutic index, biosimilars, and similar other exceptional cases, this practice can be relaxed.

2. Prescribe drugs rationally and optimally

2.1. Both overprescribing and underprescribing are to be avoided keeping in mind possible drug interactions

3. Fixed-dose combinations are to be used judiciously

3.1. Only approved and rational fixed-dose combinations are to be prescribed

4. Advocate for hospitals and local pharmacies to stock generic drugs. Prescribe only those generic medicines that are available in the market and accessible to the patient

5. Avoid prescribing “branded” generic drugs.

6. Encourage patients to purchase drugs from Jan Aushadhi kendras and other generic pharmacy outlets

7. Educate medical students, patients, and the public regarding the equivalence of generic medicine with their branded counterparts

8. Should actively participate in programs related to promotion and access to generic medicines

9. MBBS & PG students will be trained in the value of prescribing generic medicine

10. Written Prescriptions should be legible and preferably in full CAPITALS to avoid misinterpretation. As far as possible prescriptions should be typed and printed to avoid errors.

The guidelines also provide a model template for rational prescription writing which has been reproduced as below