Stents' exorbitant prices due to doctor-industry nexus: Health

Health groups today alleged that a doctor-industry nexus was resulting in exorbitant prices of life saving coronary stents and demanded Centre's imtervention and implementation of a legally binding code for marketing of health products.
The analyses of industry data published by the National Pharmaceutical Pricing Authority (NPPA) show "massive" margins charged at each step in the distribution and supply of stents and by the time the patient receives them, the increase from the original cost is often in the range of "1,000-2,000 per cent", they said.
Asserting that the Centre should uphold fundamental right to health by not succumbing to "pressure" from medical industry, the health bodies also demanded an investigation by Medical Council of India (MCI) on the alleged professional misconduct of office bearers of the Cardiological Society of India indulging in "unethical lobbying".

"We have consistently highlighted the unconscionable prices that patients across the country are paying for stents that are pushing them and their families into increasing indebtedness or leaving them without life-saving treatment.
"The pricing data which was submitted by the industry to the NPPA has made it clear beyond doubt," said Mira Shiva of the All India Drug Action Network (AIDAN).
The health groups included AIDAN, Alliance of Doctors for Ethical Healthcare, Third World Network, Jan Swasthya Abhiyan and the National Working Group on Patent Laws.

The groups said that price fixation of coronary stents should be limited to two categories - Bare Metal Stents and Drug Eluting Stents - as instructed by the Department of Pharmaceuticals in its notification on December 21 last year.

"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.
"The government should develop standard treatment guidelines for cardiovascular interventions with the help of expert doctors free from conflict of interest and implement medical audits of procedures," they demanded.
The inclusion of coronary stents in the National List of
Essential Medicines (NLEM) had prompted the current efforts by the NPPA towards price fixation. In another petition, 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 allegedly to thwart these efforts appears to have increased in recent weeks, the groups said.
"There 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," said Advocate Birender Sangwan, who filed the two petitions.
Malini Aisola of AIDAN said, "The reports 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 manufacturers," she said.
They alleged that 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 industry is making unsubstantiated claims of superiority of the newer model stents such as bioreabsorbable stents. This is a ploy, in conspiracy with the hospitals, to charge ungodly sums of money for minor changes to existing products in order to exploit patients," Dinesh Abrol from the National Working Group on Patent Laws said.

The NPPA data also shows that the "largest cut" goes to the hospital, which can be as high as 650 per cent, more than the price at which the hospital purchases the stents from the distributor, they claimed.
"While 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," said Arun Mitra of the Alliance Of Doctors For Ethical Healthcare.