The novel coronavirus infection (COVID-19) pandemic caused a supply crisis for the antipyretic and analgesic 'Tylenol.' The increase in hospital prescriptions due to more patients experiencing body aches after vaccination led to a surge in demand at pharmacies and convenience stores. Although there were other medications containing the same acetaminophen ingredient, doctors prescribed Tylenol, causing people to flock to that option.
Claims are rising again that a 'prescription by ingredient' system should be introduced to address the issue of demand being concentrated on a single drug despite having the same ingredients. Lee Jae-myung, the presidential candidate from the Democratic Party of Korea, included 'promoting alternatives, such as prescribing by ingredient for essential medicines' in his campaign promises, which sparked controversy. Pharmacists welcomed the idea, but the medical community is concerned about patient safety and the infringement of clinical rights.
Tylenol is a fever-reducing and pain-relieving brand of Johnson & Johnson (J&J) in the United States, which has been sold in Korea since 1985. It is the most famous among medications containing acetaminophen. Although there were 70 types of medications with the same ingredient, only the supply of Tylenol faced issues during the COVID-19 pandemic.
'Prescription by ingredient' is literally a system where doctors prescribe based on the ingredient name instead of the product name. For instance, writing acetaminophen instead of Tylenol on a prescription. The pharmacy community has long been demanding the introduction of prescription by ingredient. Pharmacists believe that if this system is implemented, they can prepare medications in line with the supply situation, preventing concentration on specific drugs and avoiding supply crises.
Even now, it is not impossible to substitute with another medication containing the same ingredient. According to current law, if the medication listed on the prescription is not available at the pharmacy, the pharmacist may exceptionally substitute it with another medication that has the same ingredient, content, and form.
However, in this case, the pharmacist must notify the doctor of the substitution via phone, fax, or other means. If they cannot notify due to lack of a fax machine or failure to connect by phone, it constitutes a violation, and the pharmacy may face administrative penalties or suspension of operations. Following criticism of the outdated and ambiguous notification method, the Ministry of Health and Welfare has required notifications to be made through the Health Insurance Review and Assessment Service's work portal system since February.
Despite this, pharmacists are reluctant to make substitutions. They are concerned that if doctors learn about the substitutions, they might impose disadvantages on the pharmacies. A pharmacist at a pharmacy in Gangnam, Seoul, said, 'Just because we are located nearby and the local residents are our customers, if doctors speak negatively about a specific pharmacy to patients due to the substitution, it will be difficult to operate.'
The pharmacy community is demanding complete prescriptions by ingredient. Kwon Young-hee, president of the Korean Pharmaceutical Association, noted, 'All medications with the same ingredients approved in Korea are officially recognized by the government as having equal therapeutic effects,' and added, 'The World Health Organization (WHO) also recommends prescribing by ingredient for patient safety.'
The Korean Pharmaceutical Association argued that prescribing only by ingredient could lead to confusion in the medical field. The WHO recommended the 'International Nonproprietary Name (INN)' system in 1953 to help healthcare professionals and patients distinguish between drug ingredients. For example, the INN for Tylenol is 'Janssen acetaminophen.' Countries like the United States, the United Kingdom, France, Canada, and Japan are already utilizing the INN system. The Ministry of Welfare is also considering the introduction of INN.
However, there is significant pushback from the medical community regarding prescriptions by ingredient. Doctors argue that this practice constitutes 'an infringement on scientific medical practices' and strongly oppose it.
The Korean Medical Association stated, 'Prescribing medication is not merely listing ingredient names,' adding that 'it is a specialized area that considers various elements such as a patient's medical history, other medications being taken, possible side effects, and absorption rates to select the optimal medication based on medical judgment.'
Kim Sung-keun, the spokesperson for the Korean Medical Association, said, 'Even if the ingredients are the same, the pharmacokinetic properties or clinical responses may vary depending on the formulation, and if substitutions are made arbitrarily without a doctor's judgment, it could pose serious risks to patient safety.'
Some argue that prescribing by ingredient would help eliminate the rebates that doctors receive from pharmaceuticals in exchange for endorsing drugs. In response, the medical community argues that this positions doctors as potential criminals.