AFTER the National Pharmaceutical Pricing Authority (NPPA) in February ordered a cap on the prices of coronary stents and directed hospitals to issue separate bills specifying their cost, the drug pricing watchdog has started receiving consumer complaints against hospitals which are allegedly hiking the prices of the non-stent components in their bills.
“We have received some complaints against hospitals where prima facie it appears that they have increased the prices of other components. The stent price has been kept the same. This is to neutralise the dent on profits that has occurred due to the cap on stent price. The NPPA is getting these cases investigated,” said a senior government official on condition of anonymity.
Responding to specific queries on the issue, Bhupendra Singh, NPPA chairman, told The Indian Express that “examination of hospital records is in process”. Hospitals, meanwhile, claimed that angioplasty costs have come down by 20-25 per cent after the NPPA’s intervention.
According to a senior executive from one of the major medical device companies, many hospitals continue to overcharge through other ways. “There are hospitals which have capped the stent prices, but they have increased the prices of all other expenses that are incurred during the angioplasty. Ultimately, in many cases, the patient is still not getting the full benefit of this price cap,” he said.
Between February 13 and March 15, the NPPA received such complaints against 40 hospitals, including Metro Hospital in Faridabad, KEM Hospital in Mumbai and Max Hospital in Delhi.
But a Max Healthcare spokesperson said that after the NPPA order, the cost of angioplasty — where a stent is used — has come down by “approximately 20-25 per cent in Max Hospitals”.
Asked about the complaints of overcharging, the spokesperson said: “No complaint has been filed against our hospitals for overcharging in respect of coronary stents which are covered under NPPA order. One of the patients of Max Super Specialty Hospital, Saket has complained to NPPA regarding high price of stent charged, in response to which the hospital has already submitted its detailed response clarifying that the stent used for the treatment of that patient was not a coronary stent and is not covered within the purview of NPPA order. We have already submitted all the documents and information (including number of stents used and price charged in respect thereof) as required by NPPA and drugs control department.”
A spokesperson for Apollo Hospitals maintained that the “the benefit of the lower cost of the stent has been passed on to the patient”. The spokesperson also said there was no such complaint against the hospital.
On the issue of hospitals overcharging the non-stent components, Ananth Kumar, Minister of Chemicals and Fertilisers, said at a May 12 briefing: “We have said that if you drop the price of stents and increase the price of the treatment, it would not be allowed. Whatever package you have kept in last three years — there used to be a stent package in which there was an investigation cost, procedure cost, post-procedural cost etc — it should remain the same. It should not go up and down.”
The department of pharmaceuticals as well as NPPA come under the chemicals and fertilisers ministry.
Meanwhile, after the price cap was announced, two multinational companies submitted applications to NPPA to withdraw their latest stents. On April 21, Abbott Healthcare filed two applications to withdraw “Absorb GT1-Bioresorbable Vascular Scaffold (BVS)” stent and “Xience Alpine Medical Device (cardiac stent)”. On April 3, India Medtronic filed an application to withdraw “Resolute Onyx Zotarolimus Eluting Coronary Stent System”.
Both the companies filed their applications — under Para 21(2) of the DPCO, 2013 — on the ground of “commercial unviability post fixation of ceiling price”.
On April 26, the NPPA reminded the firms that as per the order of February 21, 2017, all companies have to maintain uninterrupted supply of all their stents for six months. Therefore, “no request under Para 21(2) can be considered during the period of restriction”.
Abbott Healthcare and India Medtronic had told the NPPA that the latest generation stents — biodegradable stents — need to classified as a third class altogether, with a higher price cap.
A similar request was made by Boston Scientific, which said that its latest stent — named “Synergy” — needs to be classified in a third class with a higher price cap, as it is technologically advanced. On May 2, the NPPA expert panel turned down the request stating that there was “inadequate” data for this stent to be considered therapeutically “superior”.
Commenting on this issue, the NPPA chairman told a press conference in Mumbai on April 27 that “the issue of generation of stents was debated for seven months (before the price cap) by 18 eminent cardiologists in the country and they finally reached the conclusion that all the drug-eluting stents available in the country at that time and also as of now is the same. This verdict of expert cardiologists was incorporated in the drugs price control order. NPPA, legally and otherwise, also had no option but to put all the DES (drug-eluting stents) together.”
On May 5, Shobana Kamineni, CII president, told The Indian Express: “I will do anything and champion anything that will make healthcare affordable for all. But I will also do anything and everything to champion that India remains the best destination for healthcare.
So we need to have something that allows the best in technology to come. Don’t give it to everybody. I will feel horrible if I am forced to have a stent in India and I get a fourth generation stent and not the latest. If I am forced to go abroad and I could not have it in my hospital, this will make me feel worse. Please do not bring India to that situation.”
The ceiling price of bare metal stents was fixed at Rs 7,260 per piece and that of drug-eluting and biodegradable stents at Rs 29,600 each. On March 31, the price caps were increased by NPPA to Rs 7,400 and Rs 30,180 respectively, as it took into account the latest wholesale price index (WPI). NPPA did not put a price cap for biodegradable stents.