THE Malaysian Medical Association (MMA) has voiced firm opposition to the blanket implementation of a mandatory generic drug prescription policy, arguing that such a move undermines professional ethics, limits patient autonomy, and risks compromising the management of non-communicable diseases (NCDs).
MMA President Datuk Dr Thirunavukarasu Rajoo said the association had taken note of a recent circular issued by a third-party administrator (TPA) on behalf of a prominent financial institution. The directive compels doctors to prescribe long-term medication using only the generic name of the active pharmaceutical ingredient.
“While MMA supports the use of quality generics to improve affordability and access, a policy that enforces their use in all cases is unacceptable as it interferes with doctors’ clinical judgement,” he said in a statement on Friday.
He cited the Code of Professional Conduct of the Malaysian Medical Council (MMC) and the MMC’s Position Paper on Managed Care, both of which explicitly state that clinical decisions must remain with the treating doctor and cannot be overruled by corporate policy.
“Formularies may serve as guidance, but they must not dictate treatment. Patients have the right to informed choices in their medical care,” he added.
Dr Thirunavukarasu pointed out that in cases involving drugs with a narrow therapeutic index or where patients experience adverse reactions to specific formulations, branded medications may be necessary for safety and efficacy.
“Any substitution must be explained to and agreed upon by the patient,” he said.
He warned that the circular in question goes beyond encouraging generic use and instead shifts prescribing power away from doctors and into the hands of corporate payers.
“This opens the door to procurement-driven decisions, placing commercial interests above clinical considerations.”
Over time, he added, such interference could erode the primacy of patient welfare in medical decision-making, particularly in the treatment of chronic conditions like diabetes, cardiovascular disease and cancer — which collectively cost Malaysia nearly RM10 billion annually.
“The real solution lies in focusing on prevention and lifestyle change, not merely cost-saving through mandatory generics. The number one priority must always be patient treatment outcomes, not procurement costs,” he said.
The MMA also expressed long-standing concerns over the influence of TPAs in clinical decisions, noting that the association has raised alarms since 1998 about the lack of regulatory oversight.
“Despite increasing regulation of the medical profession, the government has yet to properly regulate TPAs,” he said. “This circular is a direct consequence of that failure and threatens to erode the trust at the heart of the doctor–patient relationship.”
As such, the MMA has urged the government to immediately regulate TPAs and managed care organisations under the Private Healthcare Facilities and Services Act (PHFSA) and align such practices with the MMC’s ethical standards.
“Policies should encourage generics as the first-line option but must never enforce them. Doctors must retain professional autonomy, and patients must be informed and empowered to choose their treatment,” he said.
Dr Thirunavukarasu concluded by warning that more is at stake than just cost control.
“What’s being threatened is the integrity of medical practice and the public’s trust in their doctors — and that cannot be compromised.” - September 26, 2025
