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NPPA's directive to hospitals to mention cost of consumables to help check prices of consumables used in angioplasty

Arun Sreenivasan, New Delhi
Wednesday, February 14, 2018, 08:00 Hrs  [IST]

The National Pharmaceutical Pricing Authority’s (NPPA) decision to direct healthcare institutions to mention the cost of main consumables during angioplasty procedure will help increase transparency in hospital billing and reduce treatment cost for patients, say healthcare activists and advocacy groups.

While revising the prices of drug-eluting stents (DES) and bare metal stents (BMS), the national drug price regulator stated: “Since cardiac catheters are necessarily used during angioplasties and are an integral part of the package, healthcare institutions which are performing angioplasty and billing the patients shall also mention cost of cardiac catheters, balloon catheter and guide wire separately along with their respective brand name, if any, name of the company, batch number and specifications in order to bring in greater transparency in the billing and monitoring of compliance with the MRPs by the NPPA under para 20 of DPCO, 2013.”

Even though stent prices were capped, the cost of main consumables - cardiac catheters, balloon catheter and guide wire - used in angioplasty had skyrocketed as many healthcare institutions tried to make up for the huge margins they lost on stents, according to industry observers. The NPPA’s latest step is expected to help tackle this problem.

“We are encouraged that the NPPA has shared data on the huge trade margins involved in catheters, balloons, and guide wires. Expansion of price control to these devices is a necessary step to make procedures like angioplasty and angiogram more affordable and accessible to patients. As we have previously raised, the NPPA should write to the Competition Commission of India (CCI) to conduct an investigation on the large hospital chains for abusing their dominant position and overcharging for angioplasties post the price cap,” Malini Aisola of All India Drug Action Network (Aidan), an independent network of several non-government organisations working in the healthcare sector, said in a statement.

The regulator’s circular is clear regarding trade margins. “The ceiling prices are inclusive of the 8 per cent permissible trade margin which is sacrosanct. Trade margin in excess of 8 per cent, in whatsoever form, shall be construed as ‘violation’ by the person, institutions, manufacturers, importers, distributors, hospitals involved in the transaction and shall be liable to appropriate action including prosecution,” it said.

The NPPA’s decision on February 12, 2018 to revise the price cap on coronary stents was welcomed by industry representatives and healthcare activists alike. Post revision, the drug-eluting stents (DES) and bare metal stents (BMS) have the ceiling price of Rs 27, 890 and Rs 7,660 respectively. The regulator also refused to provide separate sub-category and higher ceiling price for latest-generation biodegradable stents despite several requests by multinational medical device manufacturers. Biodegradable stents have the ceiling price of DES only.

“We welcome the NPPA’s new decision, but we would have been very happy if the price would have been kept constant or NPPA would have increased it by the inflation rate. Nonetheless, we will continue to support NPPA by ensuring ample supply of products across India thereby focusing on high level efficiency in product supply,” Convenor of Indian Stent Manufacturers Association Ganesh Sabat said.

Rajiv Nath, Forum Coordinator of Association of Indian Medical devices Industry (AiMeD), also cheered the latest decision by the regulator to revise stent prices. “We are happy with the NPPA’s new decision to continue with their directive on price cap by not falling to the lobby of multi-national manufacturers. Single category on DES is scientific and continuation of the above stand gives confidence to the manufacturers. The manufacturers could have welcomed higher pricing to accommodate inflation. But the government can be assured of support from manufacturers,” he said.

NGOs and healthcare activists call for regulating the prices of accessories used for implanting stents. They also want the accessories be classified as essential drugs bringing them under price controls. However, the latest move by the NPPA is a step in the right direction, they say.

“The NPPA has taken a decisive step in favour of ensuring affordability to patients. We welcome the decision and the marginal reduction in prices of DES. We are glad that the government did not cave in to massive pressure that was being exerted by the industry for differential pricing without any scientific basis,” the Aidan official pointed out.


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