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Medicines in India: Quality, Antibiotics, Prices and the Pharmacy

How good, rational and affordable the medicines Indians take are, how antibiotics are misused, and what a signed prescription changes.

AuthorPawan Kalyan
Updated6 November 2026
Reading time3 min
Key Points
  • India makes about 20% of the world's generic medicines and about 60% of UNICEF's vaccines[1].
  • At home, 76% of pharmacies in one city sold antibiotics without a prescription[2], and most antibiotics used are ones WHO says to use sparingly[3].
  • Drug-resistant bacteria directly caused about 2.14 lakh deaths in India in 2019[4].
  • Medicines alone pushed 3.8 crore Indians into poverty in a year[5]; generic stores now sell at 50–80% below brand prices[6].

The Pharmacy of the World

3rdIndia's rank in medicine production by volume (11th by value)Government factsheet, 2026[1]
~20%Of the world's generic medicines, from over 3,000 companies and 10,500 unitsGovernment factsheet, 2026[1]
~60%Of UNICEF's vaccines; 90% of WHO's measles vaccine needsGovernment factsheet, 2026[1]

Exports reached $30.5 billion in 2024–25[1]. The question for patients in India is different: are the medicines they get good, rational, affordable and correctly dispensed?

Are Medicines in India Good Quality?

India's largest drug quality survey (2014–16) tested 47,012 samples of 224 medicines in 654 districts[7].

Government supply chain10.02% not of standard quality
All samples3.16% not of standard quality
Spurious (fake)0.0245%
Figure 1. Results of the National Drug Survey 2014–16, drawn on a 0 to 12% scale[7]. Outright fakes were rare; substandard medicine was more common, especially in government supply.

How Antibiotics Are Used

54.9%Of antibiotic doses in 2019 were WHO "Watch" drugs, meant to be used sparingly; WHO's target is at least 60% "Access" drugsLancet Regional Health SE Asia, 2022[3]
48.7%Of antibiotic fixed-dose combinations were combinations WHO discouragesSame study[3]
76%Of 200 pharmacies in Coimbatore sold antibiotics to a simulated patient without a prescription (82% for a cold, 70% for diarrhoea)IJCMPH, 2025[2]
2.14 lakhDeaths in India in 2019 directly caused by drug-resistant bacteria; 6.87 lakh more associated with themGRAM, The Lancet, 2024[4]
  1. 1No prescriptionAntibiotic bought over the counter for a cold
  2. 2Wrong drugA broad-spectrum or irrational combination
  3. 3ResistanceBacteria that survive spread
  4. 4DeathsInfections that no longer respond
Figure 2. How careless antibiotic use becomes resistance. India has no formal surveillance of antibiotic use; sales data comes only from private companies[3].

The law already expects a prescription. Since 2014, 46 drugs in Schedule H1, including many antibiotics and anti-TB drugs, may be sold only with a prescription recorded in a separate register (prescriber, patient, drug, quantity) kept for three years, and must carry a red Rx label[8]. The register assumes a prescription exists. In practice it often does not.

Can People Afford Their Medicines?

3.8 croreIndians pushed into poverty in one year by spending on medicines alone (5.5 crore by all health spending)PHFI study in The BMJ, 2018[5]
18,646Jan Aushadhi generic medicine stores (February 2026), selling 2,110 medicines at 50–80% below brand pricesRajya Sabha reply, March 2026[6]

India has nearly 60,000 generic brands[1], so the same molecule is often sold under many names at different prices. Printing the generic name beside the brand on every prescription lets the patient and pharmacist choose a cheaper equivalent; India's medical ethics regulations already ask doctors to prescribe by generic name "as far as possible"[9].

The Pharmacist's Place

India has about 16 lakh registered pharmacists and adds about 3 lakh graduates a year[10]. Pharmacists dispense against a slip of paper: they rarely see the diagnosis, the patient's allergies or what else the patient takes.

What This Means for 1Heath

  • 1

    Create the prescription the law assumes. A signed digital prescription gives the Schedule H1 register something real to record.

  • 2

    Print the generic name. Every line shows the generic in capitals beside the brand, so the cheaper equivalent is visible.

  • 3

    Flag irrational combinations. 1Heath checks prescriptions against the 711 combinations India has banned.

  • 4

    Give the pharmacist what they need, and no more. The pharmacy sees the signed prescription, never the consultation note.

Sources

  1. Government factsheet on India's pharmaceutical sector, as reported by Medical Dialogues, 23 March 2026. health.medicaldialogues.in
  2. Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study (Coimbatore). IJCMPH, May 2025. ijcmph.com
  3. Consumption of systemic antibiotics in India in 2019. Lancet Regional Health Southeast Asia, 2022, as reported by Down To Earth. downtoearth.org.in
  4. GRAM Project (University of Oxford and IHME), The Lancet, September 2024, as reported by ThePrint. theprint.in
  5. Public Health Foundation of India researchers, study in The BMJ, 2018, as reported by Pallium India. palliumindia.org
  6. PTI via The Week. Over 18K Jan Aushadhi Kendras opened in last 11 years, 24 March 2026. theweek.in
  7. National Drug Survey 2014-16 (Ministry of Health), as reported by The Tribune. tribuneindia.com
  8. BioSpectrum. Govt takes steps to contain anti-microbial resistance (Schedule H1), July 2014. biospectrumindia.com
  9. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, clauses 1.3.1 to 1.3.4 (Indian Journal of Medical Ethics reprint). ijme.in
  10. Lok Sabha reply on registered pharmacists, Millennium Post, February 2023. millenniumpost.in