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Several health groups and doctors advocating for healthcare have demanded urgent intervention of the government to end the nexus between hospitals, doctors and the industry that is resulting in exorbitant prices of life saving coronary stents. Government must immediately implement a legally binding code for marketing of health products including devices, they said in a statement issued here.
Ã¢ÂÂWe have consistently highlighted the unconscionable prices that patients across the country are paying for stents that are pushing patients and their families into increasing indebtedness or leaving them without life-saving treatment,Ã¢ÂÂ said Dr. Mira Shiva of the All India Drug Action Network (AIDAN). Ã¢ÂÂThe pricing data which was submitted by the industry to the NPPA has made it clear beyond doubt,Ã¢ÂÂ she said.
The analyses of industry data published by the National Pharmaceutical Pricing Authority (NPPA) on its website, which show the massive margins charged at each step in the distribution and supply of stents. The data indicates that by the time the patient gets the stent, the increase from the original cost of the stent is often in the range of 1000-2000%.
Ã¢ÂÂWith the evidence of over-pricing now crystal clear, the government must act immediately to control the prices of these life saving devicesÃ¢ÂÂ said Advocate Birender Sangwan. Ã¢ÂÂThere is a clear obligation under the Constitution for the government to fulfill the fundamental right to health and ensure the affordability of medical devices such as stents.Ã¢ÂÂ
The inclusion of coronary stents in the National List of Essential Medicines, which prompted the current efforts by the NPPA towards price fixation, arose from a petition filed before the Delhi High Court by Advocate Sangwan. In a second petition, also filed by Sangwan, which is pending before the same court, the Government has been directed to make a report to the Court after the ceiling prices have been notified. Even as the NPPA is examining different formulas to fix an affordable price for stents, industry lobbying to thwart these efforts appears to have increased in recent weeks.
The All India Drug Action Network, Alliance of Doctors for Ethical Healthcare, Third World network, Jan Swasthya Abhiyan and the National Working Group on Patent Laws have demanded. That the price fixation of coronary stents should be limited to two categories Ã¢ÂÂ Bare Metal Stents and Drug Eluting Stents Ã¢ÂÂ as instructed by the Department of Pharmaceuticals in its notification dated 21 December 2016. The ceiling prices fixed by the NPPA must meet the objective of ensuring true affordability and should be fixed on the basis of the CGHS reimbursement rates.
Also, the government should act in the public interest and uphold fundamental right of right to health and not succumb to pressure from the industry or the medical establishment, and should develop standard treatment guidelines for cardiovascular interventions with the help expert doctors free from conflict of interest and implement medical audits of procedures.
It also asked the Medical Council of India to investigate the professional misconduct of doctors, particularly office bearers of the Cardiological Society of India that have allegedly indulged in unethical lobbying.
Ã¢ÂÂReports indicate that companies and industry associations are lobbying intensely for a ceiling price based on a simple average of hospital prices which will ensure that the profiteering continues unabated and hospitals can take huge cuts on the stents. There is an urgent need to fix the price at an affordable price that does not expose people to the exploitation of hospitals and stent manufacturersÃ¢ÂÂ alleged Malini Aisola of AIDAN, in a statement issued by the groups.
There are also attempts, primarily by foreign companies and cardiologists acting on their behalf, to exclude from price control the highest priced stents, which also happen to dominate the market, the statement said. The NPPA data also shows that the largest cut goes to the hospital, which can be as high as 650% more than the price at which the hospital purchases the stents from the distributor.
Ã¢ÂÂWe are extremely alarmed at the role that doctors and hospitals are playing in the exorbitant pricing of stents,Ã¢ÂÂ said Dr. Arun Mitra of the Alliance Of Doctors For Ethical Healthcare (ADEH). Ã¢ÂÂWhile the government fixes the prices of stents, it must also take urgent action to investigate and haul up the medical establishment for corrupt practices and overcharging. A mandatory ethical marketing code that covers medical devices must be immediately implemented,Ã¢ÂÂ he added.
The issue of the high pricing of stents has also attracted the attention of the Rajya SabhaÃ¢ÂÂs Committee on Petitions, which is undertaking its own investigation into the matter in response to a petition submitted by Sulagna Chattopadhyay.
Ã¢ÂÂThis whole sordid saga of high pricing at the expense of helpless patients has highlighted not only the importance of the price control of stents but also the lack of standard treatment protocols and as well as the high costs of medical procedures,Ã¢ÂÂ said Mr Chattopadhyay. Ã¢ÂÂThere must be a holistic regulation and rationalization of the treatments, medicines, medical devices and procedures available for heart patients without which the exercise of price control will be in vain.Ã¢ÂÂ “