As cardiovascular diseases emerge as the number one killer among the billion plus population of India, the country has finally slashed the prices of stents by 85 pc. Heartening news indeed! The question is, whether the manufacturers and hospitals will fall in line.
After reducing the price of anti-cancer, HIV and malarial drugs, India has now slashed the price of coronary stents that help prevent heart attacks.
The prices were cut by the nation’s drug regulator, the National Pharmaceutical Pricing Authority (NPPA) last week. The drug-eluting stents (DES) will now be available in the range of INR 40,000 to INR 198,000. Similarly, bare metal stents cost patients between INR 30,000 and INR 75,000 on an average. The NPPA has capped the prices of DES and bioresorbable vascular scaffolds (BVS) at INR 29,600 and bare metal stents (BMS) at INR 7,260 inclusive of value-added taxes. Consequently, these stents are expected to cost INR 31,080 and INR 7,623, respectively.
What are stents?
Stents are tiny wire mesh tubes used widely by cardio surgeons to unclog arteries and prevent heart attacks. There are various kinds of stents used. About 95 pc are DES that slowly releases a medicine, while two pc are BMS and another three pc are BVS.
Currently, 60 pc of the market for stents is shared by multinational companies, such as Abbott, Medtronic, Meril Life Sciences and Boston Scientific.
After a petition in the Delhi High Court, the federal government amended the Drugs Price Control Order (DPCO), 2013 that envisaged the inclusion of coronary stents in the National List of Essential Medicines (NLEM).
A BMS, on an average, costs about INR 10,000-20,000, while a DES ranges between INR 25, 000-80,000 and more.
However, the prices of stents vary and skyrocket depending on the company that produces it, the distributors, and the hospital where a patient is undergoing a treatment.
According to an NPPA report, the coronary stents are currently sold at a highly inflated price, keeping them out of reach of a large number of people requiring angioplasty, and compelling many others who go for it to spend way beyond their capacity.
It is estimated that around 25 pc of deaths in India is attributed to cardiovascular disease (CVD), and coronary artery disease (CAD) is the most common CVD accounting for 90-95 pc of all CVD cases and deaths.
The decision of the pharma and drug watchdog has caused heartburns for all those who were making a killing and laughing their way to the bank.
They argued that price cap reduces the options available for Indian patients and sought 45 days’ transition time for compliance with the NPPA order. “The singular focus on controlling ceiling price of stents, without attempting to address the larger picture and correct inefficiencies in the healthcare ecosystem will not achieve its stated benefit, in the long run,” said AdvaMed, the lobby group that represents large multinational stent manufacturers. Expressing similar concerns, Rajiv Nath, forum co-ordinator, Association of Indian Medical Device Industry (AiMed), said that the price cap would cause inconvenience. “The decision is absurd and harsh. They asked us to recall stocks forthwith. Each of these is worth tens of thousands of rupees. How can it be done overnight?” he asked.
Medical Technology Association of India (MTaI) points out that the drugs with revised prices are given 45 days’ transition time, but stent manufacturers have not been allowed a similar window.
Need to guard against substandard imports
A significant factor for the NPPA to investigate in the coming weeks would be the substandard stents that may flood the Indian market from China and Canada, argue many medical practitioners.
However, the decision has been welcomed by others, including the Swadeshi Jagran Manch (SJM) – an outfit of the Rashtriya Swayemsevak Sangh, the ideological mentor of the current BJP government – that focuses on economic issues.
In its letter to Prabhat Jha, chairman of the Rajya Sabha’s Committee on Petitions, the SJM urged the centre to not discriminate between the cost paid for a stent in a government-run institution and a private hospital.
“As an MP, you would be aware that the CGHS (Central Government Health Scheme) reimbursement rate for these stents is just INR 23,625. We would like to state that there should not be any discrimination between the costs reimbursed to government officials and the prices paid by the public,” the RSS thinktank asserted.
The SJM letter comes at a time when the NPPA has released different formulae to cap the price of cardiac stents.
As a normal practice in India many hospitals charge the patient a price that is inclusive of its own profit margins by hiking it more than 50 pc. Bear in mind this is in addition to the price paid by the patient for hospital services and medical procedures.
Fearing artificial scarcity, the NPPA has shot off letters to all chief secretaries of the states to ensure “compliance of stents price capping, its availability and uninterrupted cardiac care services”. Moreover, the regulator has also asked the stent manufacturers to provide a report on “price revision compliance along with evidence” by March 1.
Jai Priye Prakash, secretary, Department of Pharmaceuticals in the Ministry of Chemicals and Fertilisers, warned that various provisions of the Essential Commodities Act would be invoked to penalise those found illegally and unethically profiteering.
It is to be seen whether the industry and business will seek legal recourse or fall in line on matters of life and health for the millions of Indians. Hope they have a heart!