In a relief to patients suffering from coronary artery blockages, the National Pharmaceutical Pricing Authority has invited all stakeholders to discuss capping of prices of stents at a three-day summit in New Delhi from January 4 to 6.
While fixing the ceiling price may help bring down exorbitant costs of stents, some stakeholders fear that companies will stop selling new generation products if the ceiling is reduced drastically.
The NPPA has invited representatives from medical devices manufacturing companies, chambers of commerce representing the medical devices sector, hospitals and nursing homes, eminent cardiologists, medical devices distributors, civil society associations and non-government organisations to put forward their suggestions at the meeting.
Coronary stents are tiny metal tubes that are placed in diseased or narrow arteries that hinder the flow of blood to the heart. The most basic bare metal stents, which were widely used a decade ago, today cost about Rs. 8,000. But they are used in merely two per cent cases. The widely used drug eluting stents, which help in opening up narrow arteries and releasing drugs to avoid further cell proliferation, are priced from Rs. 20,000 to Rs. 1.60 lakh.
The most recent entrant in the stent market are the bio-absorbable scaffolds. They dissolve two years after clearing the blockages and are priced at Rs 1.90 lakh.
“The decision to put a cap on stent prices is definitely a great relief to patients who often get exploited. However, the government will have to consider all aspects before deciding on the cap as it should not result in lack of availability of new generation stents in the market,” said Dr. V.T. Shah, interventional cardiologist, who practices in several Mumbai hospitals. Dr. Shah annually performs over 1,000 coronary artery procedures.
Dr. Shah said, “About 40 per cent of the population is covered by various government schemes under which there is ceiling on the stent prices. The deliverability and implantation result varies from stent to stent. An older generation stent may not give a good result in a complex blockage as compared to a new generation product. As doctors, we want good products so that we can give good results and tackle complex cases in a better way. The government has to carefully consider all these aspects before the final decision.”
Stakeholders’ fear
Last month, a notification from Ministry of Chemicals and Fertilizers and Department of Pharmaceuticals to include coronary stents in Schedule I of the Drug Pricing Control Order triggered several discussions among the stakeholders as the drug eluting stents and bio-absorbable vascular scaffolds were listed under the same serial number.
The stakeholders fear that both types of stents may be treated as the same for the ceiling price. “If the fear comes true, all companies will withdraw the advanced products from Indian market. While self-paying and insurance patients will lose out on getting new generation stents, medical tourism will also suffer a blow,” said Dr. Prince Surana, director of Surana Group of Hospitals. whihc performs over 200 angioplasties a month.
According to Dr. Surana, 50 per cent of patients are covered under the Central Government Health Scheme and another 15 per cent are covered under the Rajiv Gandhi Jeevandayi Yojana, which has now been renamed after social reformer Mahatma Phule.
The exorbitant prices of coronary stents has been a topic of discussion for a long time. In 2015, the Food and Drug Administration, Maharashtra, had conducted a six-month-long inquiry on the pricing of cardiac stents, revealing that their MRP was exaggerated by 300 to 700 per cent. The inquiry also revealed that the profits earned by importing companies, distributors and hospitals went up to over 125 per cent while the patients paid escalated price always.
The FDA commissioner had submitted the report to the NPPA. “It is very common that the hospital offers a large discount on the MRP but the reality is that the patient is paying a high price anyway,” said an FDA official. He added that the NPPA should also re-look at the FDA’s bare-all report before fixing the price cap for stents.
