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The National Pharmaceutical Pricing Authority on Monday revised the price of drug eluting stents (DES) downwards by about Rs 2,300 to just under Rs 28,000, while marginally raising the cap on bare metal stents from Rs 7,400 to Rs 7,660. These caps are excluding GST. With DES accounting for about 95% of all stents used in India, this means most stents will become cheaper.
The authority, which had received several complaints about overcharging on catheters, balloons and guide wires used for angioplasty, also made public its analysis of trade margins on these consumables which ranged from over 150% to 400% over import price. In light of this, NPPA has asked for the price of catheters, balloons and guide wires to be mentioned separately in hospital bills.
With 5% GST, the new price cap on DES will be Rs 29,285 and on bare metal stents Rs 8,043. The trade margin allowed on stents remains the same at 8%. The revised price caps will be effective from from Tuesday and remain in effect till March 31, 2019.
On Feb 14 last year, NPPA had capped the price of bare metal stents at Rs 7,400 and of DES at Rs 30,180, bringing down prices by as much as 85% in an effort to make angioplasty affordable. There were howls of protest from hospitals which made huge amounts of money on stents alone.
The latest order sticks to categorising stents as bare metal and DES, which will come as a huge disappointment to the stent industry, which has been demanding a separate sub-category under DES for ‘innovative’ stents. The request for a separate category had been sent to the health ministry where a committee of senior cardiologists had shot it down.
After the cap on stent prices, hospitals had jacked up charges for catheters, balloons and guide wires, making these consumables more expensive than the stent, thus minimizing the benefits of the price cap. The NPPA’s analysis of trade margins on these consumables has shown that the highest margin was on balloon catheter, where the MRP was on average 400% over the import price and 234% higher than the price to distributors. The NPPA has invited comments from stakeholders on the analysis by March 15.
Even as the NPPA sets into motion an examination of the price of consumables, which could lead to a price cap, hospital procedure charges continue to be jacked up by hospitals with widely varying charges being extracted from patients across India. There is no law at present which allows the government to regulate these charges.
All India Drug Action Network (AIDAN) issued a statement welcoming the price revision and asked for expansion of price cap to consumables as a necessary step to making procedures like angiography and angioplasty more affordable and accessible to patients. AIDAN also demanded that NPPA write to the Competition Commission of India to conduct an investigation on the large hospital chains for abusing their dominant position and overcharging for angioplasties post the price cap.