Central scheme cuts its ceiling rates on stents
In a move that could reduce prices of US Food and Drug Administration (USFDA)-imported Drug Eluting Stents (DES) and encourage domestic manufacturing, the Central Government Health Scheme (CGHS) has cut down its ceiling rates on stents.
The CGHS, which used to reimburse Rs. 65,000 for USFDA-approved DES, has now revised the rates and will pay Rs. 25,000 for a USFDA-approved DES. Interestingly, this rate is on a par with rates of DES that are manufactured by Indian companies.
Persons familiar with pricing of medical devices said that CGHS is the main body in the country that fixes reimbursement rates for costly imported stents and other medical devices.
Usually, almost all the insurance and reimbursement agencies and State governments consider CGHS rates as their yardstick and fix their reimbursement rates accordingly.
Discriminatory pricing
The old prices of DES set by CGHS in October 2011 were discriminatory in nature and discouraged local stent manufacturers who sold Drug Control General of India (DCGI) approved DES, senior doctors in the capital said.
“CGHS was reimbursing Rs. 65,000 to FDA-approved and Rs. 50,000 to stents that had CE mark, the European regulatory body for medical devices.
They used to reimburse only Rs. 40,000 to drug-eluting stents manufactured by Indian companies who had DCGI approval. The new rates, however, have levelled the playing field,” a senior cardiologist analysed.
Meanwhile, the new CGHS rates have put the authorities at Nizam’s Institute of Medical Sciences (NIMS) in a dilemma. The NIMS authorities have so far followed the CGHS rates in fixing the cost of drug-eluting stents approved by USFDA.
In fact, while finalising the rate contract of stents for 2012-13, the NIMS management had claimed that it is the only hospital in Hyderabad that has implemented rates of stents based on the ceilings of Government of India.
“So far, NIMS has not affected any revision in its stent rates. But, we are expecting that the NIMS management will act on the issue soon. If not, there will be a contradiction of sorts,” doctors said.
Keywords: USFDA, drug-eluting stents, CGHS, NIMS, insurance, reimbursement
The headline is misleading. The news item only says that the ceiling fixed by CGHS has been revised. So it means that irrespective of the actual cost now the maximum reimbursement would be Rs 25000 only. This means that if the stent costs more, the patient has to pay the difference, whereas earlier depending on the manufacturer, the patient may have got higher reimbursement.
Anyway the news item applies only to beneficiaries of CGHS and some insurers only while the headline seems to indicate that it is a public information
Expenditure on healthcare is increasing day by day to astronomical proportions and this needs to be checked, controlled and monitored by DGHS establishments in view of huge population, pollution & insanity Indian environment,the root cause for many a disease. Trash-free India may help allievate the sufferings.
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