Ask for paracetamol at a pharmacy in Kathmandu and you may be offered three or four different brands, made in Nepal or India, at prices that can differ by several times for the same strength. The obvious question is whether the expensive one is better.

Almost everything in Nepal is a "branded generic"

In some countries "generic" means a plain box with only the chemical name on it. In Nepal that is rare. Once the patent on a medicine expires, many companies make it, and nearly all of them give it their own brand name. So the cheaper option is usually not a no-name product. It is a different company's brand of the same molecule.

That is why reading the active ingredient and strength on the pack matters more than the brand name. "Paracetamol 500 mg" is paracetamol 500 mg whatever is printed in large letters above it.

What is the same

To be registered with the Department of Drug Administration, a medicine has to contain the declared active ingredient at the declared strength and be made to Good Manufacturing Practice standards. A properly registered generic is meant to work the same way as the original brand: same ingredient, same dose, same intended effect.

What can differ

  • Inactive ingredients. Fillers, binders, coatings and colours vary. This rarely matters, but it can if you have a specific allergy or intolerance, for example to lactose or a dye.
  • How the tablet releases the drug. For most medicines this is controlled closely. For a small group of medicines where tiny changes in blood level matter, switching brands back and forth is something to discuss with your doctor. Examples include some epilepsy medicines, thyroid medicine and warfarin.
  • Quality control. This is the honest part. Recall notices in Nepal show that quality problems happen with both cheap and expensive brands, from both local and imported manufacturers. Price alone does not tell you which batch is good. A company's track record and the pharmacy you buy from tell you more. Our post on spotting fake or substandard medicine explains how to check recalls.
  • Price. You are also paying for brand marketing, packaging and import costs.

Why some medicines cost so much more

Newer medicines that are still under patent, or that only one or two companies make, are expensive because there is no competition. Imported medicines carry shipping and import costs. Medicines that need cold storage cost more to move around. And some brands are priced high simply because they are heavily promoted to doctors.

Whatever the brand, the pack should have the MRP printed on it, and a pharmacy should not charge more than that.

How to save money safely

  1. Ask the pharmacist if there is a cheaper brand of the same medicine at the same strength. This is a normal question. A good pharmacist will tell you.
  2. Ask your doctor to write the generic name on the prescription, or ask whether they mind you using a different brand.
  3. For long-term medicines, pick a brand and stick with it, especially for the sensitive medicines mentioned above. Switching constantly makes it harder to notice if something changes.
  4. Buy a full course, not partial strips, for antibiotics. Stopping early because the strip ran out is a false saving.
  5. Compare prices at your regular pharmacy over time rather than chasing the lowest price from unknown sellers online. A deal that looks too good is often the one to worry about.

The same thinking applies to supplements

A more expensive vitamin is not automatically a better one. Look at what is actually in it, at what amount, and whether it is registered. Paying extra for a nutrient you are not short of is still paying for nothing. See which vitamins you actually need.

This article is general information, not medical advice. Talk to your doctor or pharmacist about your own medicines and health.