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Journalism of Courage
The National Pharmaceutical Pricing Authority (NPPA) revised the price cap on coronary stents on Monday wherein the drug eluting stents (DES) and bare metal stents (BMS) would now have the ceiling price of Rs 27, 890 and Rs 7,660. Moreover, the price regulator has refused to provide separate sub-category and higher ceiling price for latest-generation biodegradable stents, as requested by multinational medical device companies.
Biodegradable stents will have the ceiling price of DES only. The revised ceiling prices would be applicable from Tuesday itself. On February 13 last year, the NPPA capped the prices of coronary stents for the first time. The ceiling price of BMS were fixed at Rs 7,400 per piece and that of DES and biodegradable stents were fixed at Rs 30,180 apiece. Even then, the NPPA did not put a separate price cap for biodegradable stents as requested by multinational companies such as India Medtronic, Abbott Healthcare and Boston Scientific India.
Coronary stent is inserted in the heart valves during a medical procedure called angioplasty. The NPPA also stated on Monday that angioplasty billing will need to mention the prices of cardiac catheters, balloon catheter and guide wire separately. “No healthcare institutions such as hospitals/nursing-homes/clinics performing angioplasty procedures coronary stents shall solicit any patient to purchase coronary stents from it, in case, the patient is interested in procuring such stents from any other third-party sources,” the NPPA stated.
On March 28, the Department of Industrial Policy and Promotion (DIPP) had informed the Prime Minister’s Office (PMO) that “price control of cardiac stents has led to cheaper Chinese stents entering the Indian market”. Thereafter, PMO asked the health ministry’s expert panel to examine if stents with ‘futuristic innovations’, such as biodegradable ones, can be excluded from the “current two categories of stents” that were under price cap. However, the panel, which met on June 29, found “no evidence or data” for such exclusion.
“The decision is disappointing. It will limit patient choice and the availability of innovative technologies in the market. The only saving grace in the order is NPPA’s expression that it is open to receiving stakeholder views. Taking that in earnest, we will stay engaged,” said Pavan Choudary, Director General of MTAI (Medical Technology Association of India).
In a related analysis, the authority also found major profiteering in the trade margins of ballloon catheters etc used in cardiac procedures. It found that prices ranged from 62 per cent to the stockist to 405 per cent in MRP – in other words for an item like balloon catheter the patients pays more than four times the actual cost of the item while the distributor pays more than double.
