A large number of health groups in the country have welcomed the capping of prices of coronary stents by the National Pharmaceutical Pricing Authority (NPPA). The NPPA has notified a ceiling price for Drug Eluting Stents (DES) at Rs.29,600 and for Bare Metal Stents (BMS) at Rs.7,260 under the provisions of paragraph 19 of the Drugs Prices Control Order, 2013.
The groups noted that the order is an important first step in checking the corrupt practices of the unethical triad of industry, doctors and hospitals that has become commonplace across the health sector. “The most shocking revelations that came to light through the extensive deliberations of the NPPA, were about the massive cuts being taken by cardiologists and hospitals,” said Dr. G. S. Grewal, Alliance of Doctors for Ethical Healthcare (ADEH).
“After months of consultations, we welcome the strong and determined action of the Government, particularly in the face of a concerted campaign by industry and profit-oriented hospitals to prevent any form of effective price control,” said Malini Aisola of the All India Drug Action Network. “We are pleased that the NPPA took note of the extraordinary circumstances in respect of the unmet health need and the prevailing conditions of extreme overpricing of stents and exploitation of patients. We strongly support the use of paragraph 19 of the DPCO to set right the balance in favour of the public interest,” she added.
“The decade long price gouging on stents had done undocumented and caused irreversible damage to patients and their families while ingraining corrupt practices at the heart of private healthcare in India. Through price fixing, the Government has increased awareness but more work is needed to regulate hospital rates and practices,” said Dr. Arun Mitra, also with ADEH.
Heralding the NPPA order, health groups are calling for further actions by the government. “This decision is a result of people-centered campaign which highlights the role the Government should play in making essential medicines and medical devices accessible to all segments of the society. However further policy measures are required to ensure that these benefits pass to the patients including controlling the cost of cardiac procedures, issuing standard treatment protocols for cardiac interventions and introducing a mechanism of medical audits,” said Amulya Nidhi of Jan Swasthya Abhiyan.
Health groups are also pointing out the need for a greater expansion of access to affordable, rational services for heart patients as necessary to ensure the fulfillment of the right to health. “Now that price controls have been notified, the government must ensure availability of stents in public hospitals at the tertiary level of care including at district, referral and medical college hospitals. It is essential that public health institutions that provide angioplasty procedures be increased so that patients from poorer sections of society are not at the mercy of private hospitals,” said Dr. Ravi D’Souza of SOCHARA, Bhopal. “This implies appropriate training of concerned government doctors as well as provision of adequate infrastructure for the procedure and post-operative care.”
The NPPA order references cases filed in Delhi High court that petitioned for making stents affordable. Despite being a result of directions issued in this case, it is likely that industry will drag the Government to court over the price notifications.
“We expect that the industry will launch a legal challenge to the Government action that has prioritised patients’ lives over industry profiteering” said K. M. Gopakumar, legal advisor to Third World Network. “It will have to be ready to face them in court because what they are really challenging is the right to life and health of millions of patients.”
“We expect the judiciary to take a strong stance in favour of patients and against the endless litigating and lobbying by the industry,” added Advocate Birender Sangwan who has filed the Public Interest Litigation that led to the NPPA Order.
Meanwhile, the Rajya Sabha continues to investigate the issue of pricing of medical devices. “Even as we welcome this strong action by the NPPA, we ask that the Rajya Sabha Petitions Committee continue to investigate and call for information on the use, availability and affordability of coronary stents in India. The pricing is only the tip of the iceberg and if we are to truly ensure universal access to healthcare for heart patients, we need to regulate and clean up every aspect of the system,” said Sulagna Chattopadhyay. “The NPPA must ensure that the prices continue to be monitored and make further revisions as required while also expanding price control to other medical devices,” she added.