CGHS Divide: Branded Drugs for VIPs, Generics for the Rest

For many beneficiaries of CGHS, what began as a promise of equitable healthcare has morphed into a troubling tale of two-tiers. While wellness centres across the country dispense medicines under the generic model, the dispensary at the Parliament Annexe Wellness Centre reportedly offers branded equivalents to elite beneficiaries such as Members of Parliament and ministers.

T.K. Damodaran, the All India General Secretary of the Central Government Health Service (CGHS) Association terms this as a gross discrimination. "A large number of VIPs receive branded medicines, whereas ordinary CGHS beneficiaries are given generic medicines of lower quality.” According to him, “this is one of the major concerns right now which perpetuates a perception that the system serves some better than others, undermining the trust of ordinary beneficiaries who believe they are receiving second-class treatment".

The disparity has stirred frustration and anger among ordinary beneficiaries, many of whom depend entirely on CGHS for their medical needs. The Jan Aushadhi initiative, while commendable in its aim to make healthcare affordable, has led to complaints that generic medicines distributed at wellness centres are often of inconsistent quality, produced by small-scale manufacturers with limited quality control. Damodaran explains that this problem is not confined to one dispensary. “This is not an isolated issue. It appears to be happening across India, though the Parliament Annexe case came to light first.” The implication is clear — what should have been a uniform system has evolved into a two-tier structure of healthcare delivery within the same government framework.

According to Damodaran, the association he represents has repeatedly taken up the matter with the Ministry of Health and Family Welfare, demanding clarity on why certain wellness centres appear to enjoy preferential access to branded medicines. “We have raised this matter with the Ministry asking whether any special dispensation was granted to the Parliament Annexe. Unfortunately, we have not received a response yet,” he said. The association now plans to file a Right to Information (RTI) request and, if necessary, take legal recourse to challenge what it sees as systemic discrimination. “All CGHS beneficiaries — whether ministers or ordinary citizens — are entitled to the same standard of medical care and medicines under their fundamental rights,” Damodaran asserted. For him and many others, the issue is not merely about drugs, but about dignity, fairness, and the credibility of a public health system that was meant to serve all equally.

Uneven Distribution: A System Built to Fail

The Central Government Health Scheme (CGHS) operates on a centralised structure meant to ensure equal access to medicines for all its beneficiaries. In principle, the Additional Director at CGHS headquarters, along with the Medical Stores Department (MSD), is responsible for procuring drugs from the Central Medical Store (CMS) and distributing them to wellness centres across India. In practice, however, the supply system has grown inconsistent and inefficient. Numerous wellness centres report that they receive only a fraction of the medicines listed in the official inventory, forcing them to rely on local chemists for essential drugs. This has created both logistical confusion and a significant disparity in the quality of medicines dispensed to patients.

When the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) was launched, it promised to revolutionise healthcare accessibility by making low-cost generic medicines widely available. The vision was simple: provide quality-assured generics at a fraction of the price of branded drugs. Yet, beneath the optimistic headlines, the transition has been anything but smooth. Many generic medicines supplied under this initiative fail to meet the same standards of bioequivalence and stability as their branded counterparts. The result has been growing mistrust among patients, frequent complaints of ineffective treatment, and an erosion of confidence in the CGHS system that was once seen as the gold standard for government employees.

The situation has placed CGHS doctors in a moral and professional dilemma. A directive issued in May 2023 by the Directorate General of Health Services (DGHS) ordered doctors to prescribe only generic medicines. This policy, though aligned with the government’s affordability goals, restricts medical professionals from exercising their clinical judgment. Several doctors, particularly specialists handling chronic or critical cases, have quietly voiced concerns that certain generic versions are not therapeutically equivalent to the branded formulations they replaced. Patients with complex conditions — especially those involving the heart, liver, or kidneys — are often the first to suffer the consequences of these limitations.

Adding to the strain is the widespread reliance on Authorised Local Chemists (ALCs) whenever central supply channels fail. In many cities, these ALCs account for the bulk of medicine distribution, often under irregular procurement conditions. Reports have surfaced of wellness centres receiving near-expiry or even substandard medicines through local channels, a direct consequence of weak oversight and an overburdened bureaucracy. The reliance on short-term local contracts also inflates costs, undermining the very affordability the system was designed to achieve.

Together, these systemic flaws have created a two-tier reality within what was meant to be a uniform public health network. On one side, a privileged few continue to receive branded medicines without disruption; on the other, millions of ordinary beneficiaries depend on inconsistent generic supplies that vary in efficacy and availability. The promise of “universal care” has, in effect, splintered into unequal access — exposing not just administrative inefficiency, but also deeper ethical and structural imbalances in India’s public healthcare delivery model.

Doctors’ Autonomy and the Structural Deadlock

The 2023 directive from the Directorate General of Health Services (DGHS), requiring all doctors under the Central Government Health Scheme (CGHS) to prescribe only generic medicines, has deepened the tension between affordability goals and professional medical judgment. The order was intended to curb costs and promote the government’s vision of accessible healthcare. Yet, in reality, it has constrained doctors’ autonomy and disrupted patient care, especially for those dependent on critical or chronic medication.

Under existing CGHS rules, doctors are permitted to procure alternative or branded medicines through Authorized Local Chemists (ALCs) when generics are unsuitable or unavailable. However, this flexibility has been rendered ineffective. Many doctors report that while the provision exists on paper, exercising it often triggers bureaucratic resistance or administrative scrutiny. In practice, requests for alternative medicines are either delayed or denied, and patients end up receiving whatever generic drugs happen to be available in stock—regardless of their efficacy or suitability.

The problem is compounded by a culture of compliance over clinical discretion. Doctors say they are hesitant to deviate from the directive, fearing disciplinary action if they prescribe branded medicines—even when a patient’s condition warrants it. The system thus encourages caution rather than care, creating a climate where following orders becomes more important than ensuring effective treatment. This has particularly serious implications for patients suffering from kidney, liver, or heart ailments, who often require precise formulations that some generics fail to match in potency or bioavailability.

When such cases arise, the prescribed route of escalation adds another layer of delay. Complaints about ineffective medicines are first routed to the Additional Director of the region, who then forwards them to the CGHS headquarters in Delhi. From there, they move to the Standing Technical Committee (STC), a body that meets only once a month to review pending requests. In many cases, the committee simply recommends continuing with available medicines rather than approving alternatives. For patients, especially the elderly, this bureaucratic loop can mean weeks of untreated illness or forced reliance on expensive drugs from the open market.

This slow-moving chain of approvals has made the system appear indifferent to patient suffering. Pensioners—who form the majority of CGHS beneficiaries—often spend their limited savings on purchasing branded medicines outside the system, effectively defeating the purpose of a government-run healthcare network. The financial and emotional toll on these families is immense, and it reflects a wider failure of accountability within the organization.

In recent months the CGHS has issued a revised office memorandum specifying that when a specialist’s prescription cannot be matched by the wellness centre’s generic stock, the equivalent branded drug may be indented via an authorised local chemist. This change acknowledges longstanding complaints about generic-only supply and aims to give doctors more flexibility. At the same time, a migration to a new health-management information system (HMIS) has triggered technical glitches, leading to medicine-supply disruptions in major cities. Patients report delays of ten days or more for basic drugs at their dispensaries.

Yet the reforms and digital upgrades themselves bring fresh headaches: the revised rules are not yet uniformly implemented, and patients in many zones still face the old-gen generic-only protocol. The technology rollout has exposed a fragile supply chain—where missing data, connectivity issues and inefficient routing combine to leave senior citizens stranded. Meanwhile, the gap between policy and practice has widened: supply of approved branded medicines remains uneven, and many wellness centres continue to give out multiple generic alternatives rather than one branded equivalent. The result: unplanned out-of-pocket expenditure for older patients, erosion of trust, and a sense that reform announcements are not matching ground realities.

At its core, the crisis stems from a disconnect between policy intent and operational execution. While promoting generic medicines is a commendable policy goal, the absence of a reliable quality-control mechanism and the over-centralisation of decision-making have crippled the scheme’s efficiency. Doctors on the ground feel disempowered, patients feel neglected, and administrators remain locked in procedural formalities that do little to improve outcomes.

Unless the CGHS headquarters acts decisively to clarify guidelines, empower doctors, and establish transparent quality testing for all medicines—generic or branded—the very principles of equality and accessibility that the scheme was founded on will continue to erode. Without such reform, the CGHS risks losing its credibility as one of India’s flagship public healthcare systems.