Observational studyBMJ open2026
Do publicly supported generic pharmacies improve financial risk protection? Findings from a nationally representative cross-sectional survey in India.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe Government of India launched the
designA cross-sectional observational study was conducted across nine Indian states in 2022-2023.
settingOutpatient (OPD) and inpatient (IPD) departments of secondary and tertiary government hospitals, private pharmacies and JAKs in 18 districts of India
participantsA total of 10 336 patients were recruited from OPD (n=2881) and IPD (n=1009) departments of government hospitals as well as pharmacy settings (n=6446). Data on sociodemographics, disease severity, number of generic prescriptions, source of acquiring medicines and medicine-related OOPE were collected through semistructured interviews and periodic follow-ups. PRIMARY AND SECONDARY OUTCOMES: Primary outcomes included mean OOPE on medicines, incidence of CHE (≥40% of non-food consumption expenditure on medicines), IR among JAK and non-JAK users were the primary outcomes of the study. Secondary outcomes comprised awareness of JAKs, generic prescribing rates in hospitals and the factors associated with OOPE, CHE and IR.
resultsPatients procuring medicines exclusively from JAKs reported the lower mean OOPE (OPD: ₹172; IPD: ₹275; pharmacy: ₹307), compared with significantly higher spending at private pharmacies (OPD: ₹1085; IPD: ₹3165; pharmacy: ₹1031). After adjusting for covariates, OOPE among exclusive JAK users was significantly lower relative to private pharmacy users by 60.6%-89.3%. Furthermore, matched analysis confirmed 42% lower expenses, compared with private pharmacies. The likelihood of CHE was also significantly greater among private pharmacy users. However, utilisation of JAKs remained limited, mainly due to low awareness, perceived stock shortages and low rates of generic prescribing.
conclusionPMBJP is associated with significant reduction in OOPE and financial hardship, positioning it as an effective cost-containment intervention within India's universal health coverage framework. Strengthening supply chains, promoting generic prescribing and integrating JAKs with public facilities would further maximise its impact.
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