Paying More For The Same Pill? New Study Challenges Branded Drug Bias

For decades, most of us have walked into pharmacies believing that a higher price guarantees better medicine. But a new citizen-led study called Citizen-Generic vs Branded Drugs Quality Project, has now challenged that assumption. The research has sparked a conversation about affordability, trust and the true value of generic drugs. The findings have come from a large independent initiative by doctors, scientists and citizens through laboratory testing and real-world samples from across the country.

The study aimed at comparing the quality of commonly prescribed branded and generic medicines sold in Indian markets. It concluded that widely used generic medicines in India match the quality of their far more expensive branded counterparts. This raises uncomfortable question about why patients continue to pay more.

What is the Study about?

Conducted by Kerala-based non-profit Mission for Ethics and Science in Healthcare, it assessed 22 widely used drugs for conditions such as diabetes, heart disease, gastric disorders, infections and chronic liver ailments. In total, 131 samples were tested, including top-selling branded medicines, branded generics, local trade generics and medicines supplied through government schemes like the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP).

Each sample was evaluated against five Indian Pharmacopoeia standards, including drug content, impurity levels, dissolution rate, physical characteristics, and uniformity. According to the study’s findings, all tested generic medicines met these benchmarks and it showed no measurable quality disadvantage when compared with branded alternatives.

How branding drives up medicine prices

The study was led by hepatologist Dr Cyriac Abby Philips, popularly known online as The Liver Doc, who also publicly communicated the project. He took to his X (formerly Twitter) account and outlined how the testing process revealed price disparity despite identical quality outcomes. In some cases, branded drugs were found to cost up to 14 times more than their generic equivalents, even though both contained the same active pharmaceutical ingredients and met the same quality standards.

Interestingly, what stood out was the price gap. The average price per tablet of branded medicines was Rs 11.17, compared with Rs 2.4 for Jan Aushadhi drugs. Several trade generics were also found to be cheaper. For medicines like pantoprazole, atorvastatin, and rifaximin, branded versions cost five to 14 times more than the cheapest quality-tested alternatives.

Same medicine, higher price tag

In a country where out-of-pocket medical expenses remain among the highest in the world, about 62%-69%, medicines alone account for a large share of household healthcare spending. This often forces patients with chronic illnesses to ration doses, delay treatment or discontinue medication altogether. The study points out how price, rather than efficacy, often becomes the decisive factor in treatment adherence.

India’s paradoxical position as both a global pharmaceutical powerhouse and a domestic market wary of generics lies at the centre of this debate. The country supplies nearly 20 per cent of the world’s generic medicines and is often called the “pharmacy of the world.” Yet within its own borders, generics continue to suffer from a credibility gap.

The study’s findings challenge these perceptions. It shows that lower-priced generics, including those sold at government-run Jan Aushadhi stores, perform just as reliably as premium brands when subjected to standardised testing.

Fear not Science

Dr Philips argues that the molecule itself determines efficacy, not the label on the packaging. His post on X states that misinformation around drug quality fuels unnecessary financial burden and worsens health outcomes. “It is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like my patient,” he wrote in his testimony.

He also shared an anecdote of a patient with cirrhosis that had aggravated to hepatic encephalopathy (brain failure due to high ammonia levels). He prescribed him a medicine called Rifaximin, which he wrote is a non-absorbable antibiotic that reduces ammonia in the body. The patient was advised a follow up in six weeks. Instead, he returned in four weeks with liver coma (the worst stage of brain failure - due to very high ammonia).

“He spent two days in the ICU and six days in total in the hospital. His hospital bill was close to INR 80,000. He had no insurance, and his wife borrowed the money from neighbours and friends to clear hospital dues.”

Upon questioning, Dr Philips found that the patient was taking the same medicine he had prescribed, but only for 15 days and thereafter he could not afford it. The doctor takes responsibility for the post that he prescribed an expensive medicine because he wasn’t sure if the cheaper one had the same benefits. “I was confused and scared about prescribing a cheaper version of Rifaximin because one, I was unsure about the quality of Rifaximin that was not "a good promoted brand" and two, I was "scared" that his family would scold me for prescribing a cheaper Rifaximin and if that got him into trouble.”

Trust remains the missing link

While it is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like Dr Philips’ patient.

At the same time, experts caution against oversimplification. Some international studies done in the past have flagged quality concerns in certain manufacturing contexts, particularly when regulatory oversight is weak or inconsistent. For instance, research from the United States had earlier suggested higher adverse event rates linked to some overseas-manufactured generics.

However, the authors of the Indian study stress that their findings are rooted in pharmacopoeial testing rather than anecdotal experience. The testing was conducted at a laboratory accredited by the National Accreditation Board for Testing and Calibration Laboratories and the US Food and Drug Administration.

Policy efforts to promote generic prescribing have gained popularity in recent years. Several state governments have instructed public hospital doctors to prescribe medicines by their generic names.

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