The decree on the 'Regulation for the Prescription of Medicines in Conformity with their International Nonproprietary Name (INN) for the Costa Rican private market' has been promoted by the Ministry of Health since 2018 and establishes that all doctors, dentists and obstetricians are obliged to prescribe medicines by their international non-proprietary name or generic name and not by brand name. The regulation also adds that doctors will be able to include the brand name of the medicine in the prescription if there are 'clinico-pharmacological reasons' that justify recommending that product.
Several medical associations, health visitors, the Central American Federation of Pharmaceutical Laboratories (Fedefarma) and the Costa Rican Chamber of Health (Promed) have expressed their disagreement with the decree, likewise the Ministry insists that the decree is not ready and that it must be strengthened by completing a list of bioequivalent medicines so that they can be prescribed safely.
The Ministry of Health's database has 1,001 registered medicines in the country for consumption and distribution, but only 49 drugs have bioequivalence studies.
The Pan American Health Organisation (PAHO) has also recognized that prescribing by active ingredient (generic) could lower the price of medicines. In an interview with Radio Universidad, Gustavo Mery, advisor on health systems and services for PAHO and the World Health Organization (WHO) in Costa Rica, noted that ‘in general, it should produce a way to generate a more affordable price for me as a consumer’.
Subsequently, the obligation for doctors to justify the clinical-pharmacological reasons for prescribing by brand was removed from the decree, and the Minister of Health Daniel Salas Peraza said that this measure will only be applied in the case of medicines that do not have a therapeutic equivalent.
In August 2020, the Ministry of Health told Radio Universidad that it is working to increase the number of "bioequivalent" medicines that can be incorporated into this generic prescription modality and that this has delayed the presentation of the decree.
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Cost-minimization analysis of generic equivalents (bortezomib, decitabine and capecitabine) in comparison to the originator brand medicines in Colombia
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