Will price cap on knee implants mean no more free tools?

Doctors are concerned that instruments given for free with implants may now come at a price

Patients lined up for knee replacement surgeries may be overjoyed by the National Pharmaceutical Pricing Authority’s (NPPA) cap on prices of knee implants. However, there may be a dampener. Doctors are concerned that the instruments and tools that the manufacturers had provided free with the implants for the surgeries may come at a price, and this could increase the incidental expenses of a surgery.

City-based orthopaedicians said the main concern now was that the high-precision tools that are the key to any joint replacement surgery may be charged. If so, will the costs be passed on to the patient?

Also, patients who had the discretion to choose between the high-end and basic implants would now be left with no choice. “With the price cap, manufacturers may not want to continue selling the high-end implants at the capped price. The high-end brands will obviously be withdrawn from the market,” said a senior orthopaedician, who conducts at least six knee replacement surgeries every week in the State-run Bowring and Lady Curzon Hospital.

Another doctor from a private hospital on Bannerghatta Road said several surgeries in the next few weeks may have to be rescheduled if the manufacturers withdraw stocks, especially the high-end implants to comply with the government’s directive to mark down prices on their labels immediately.

However, NPPA Chairman Bhupendra Singh told The Hindu that in no case can the patient be charged separately. “Tools and instruments will come free even now as their cost is already included in the implant price,” he said.

Any hospital overcharging patients will attract punitive action, which includes heavy penalty and even revoking of licence, Mr. Singh said, adding that action has been initiated against 39 hospitals across the country for violating the NPPA order on coronary stent pricing.

Joint Replacement Surgeon Sharan Patil, who runs the SPARSH chain of hospitals, said hospitals that were procuring implants in bulk directly from the manufacturers were already doing it at reduced prices. “According to me, the manufacturers have nothing to lose as the distributors margin is likely to be hit. This is a move that will definitely benefit the patients and we are looking at how best we can further reduce the total procedure cost to help our patients,” he said.

Pointing out that over 1,200 joint replacements are done every year at his hospital, Dr. Patil was also of the view that the price cap could deter manufacturers from selling the high-end, mostly imported technology implants.

Medical Technology Association of India (MTaI), said in a statement, that the association is not for price control. The NPPA is empowered to fix/revise the ceiling price or retail price of any drug which it deems necessary in the interests of the public, but is to be used for essential medicines/devices only, said MTaI, arguing that knee replacement surgery is not a life-threatening procedure.