NEW DELHI: The government has a Telecom Regulatory Authority of India (TRAI) to regulate prices of telephony, an electricity regulator to control power prices and so on. But India has no body to ensure that medical device companies do not overcharge patients. The result is loot.
Most patients are forced to pay anything between Rs 60,000 and Rs 1 lakh or more for cardiac drug eluting stents (DES) though the same stents cost Rs 28,000-Rs 48,000 even in rich European countries and the UK, where there is price control or a fair pricing mechanism for medical devices.
As senior doctors pointed out, almost all the over-priced stents are imported and hence the government has the bill of entry giving the price at which the stent is being imported, typically a third of the price charged to patients or even less. Yet, the government has done nothing to stop companies and hospitals from looting patients.
The Food and Drug Administration (FDA) of Maharashtra had done a detailed investigation into the overcharging of various medical devices including stents and had submitted the report to the National Pharmaceutical Pricing Authority (NPPA) over a year back, recommending that medical devices including drug eluting stents be brought under price control. The FDA's report included pricing details of other devices too such as cochlear implant, bone cement and orthopaedic implants and pointed out that the price of most devices was hiked by over 100% at least.
The Maharashtra FDA report cites the example of drug eluting stents manufactured by Abbotts Vascular Devices Holland BV, a Holland-based firm. These stents were imported into India by Abbotts Healthcare Pvt Ltd at Rs 40,710 and sold to the distributor Sinocare at Rs 73,440 against a marked MRP of Rs 1.5 lakh. The distributor then sold it at Rs 1.1 lakh to Hinduja hospital, which in turn charged the patient Rs 1.2 lakh, a near three-fold jump over the import price.
Medical devices including drug eluting stents, orthopedic implants, disposable syringes, ocular lens and heart valves are notified as drugs under the Drugs and Cosmetics Act, 1940 but not included under the Drug Price Control Order (DPCO). Hence, their prices are neither monitored nor controlled. The multinational companies that dominate the market import the devices and mark MRP at whatever level they think the market can bear in the absence of any regulation. These devices even get customs duty concessions, the duty on cardiac stents being zero.
The NPPA has neither replied to the Maharashtra FDA after the report sent over a year ago nor has taken any action on pricing. When contacted, NPPA chairperson Injeti Srinivas told TOI that he was not aware of the FDA report as he had joined recently (in June this year) and that he would look into it.
"If the government was serious about doing something, it would have brought in price control as is done in even rich Western countries. The government knows this is happening because they can see the huge difference in cost between the import price and the price at which these devices are being sold to patients even in government hospitals. They just choose to close their eyes to this," lamented a senior doctor in a government hospital.
The above was published in the TOI on 24th September, 2014
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Each and every doctor in India who are performing angioplasty and using drug eluting stents are taking cash as bribe from the supplier to use their stents. There are USA based companies and Indian companies who manufacture and supply Drug Eluting Stents in India through distributors. Each Doctor decide which company’s stent he or she will use and it depends on who pays them maximum cash as bribe. Big private hospitals in big cities can charge high because they have patients who are financially strong. In big private hospitals, USA based companies stents are sold at Rs 90,000 to Rs 120,000 per stent and doctors get Rs 40,000 to Rs 50,000 from distributor. Cath lab technician gets Rs 2000 to Rs 4000 for using each stent. Distributor buys at Rs 25,000 to Rs 28,000. But they sell at Rs 90,000 to Rs 120,000 as they have to pay half of the price to doctors. Distributor can-not sell any stent without bribing doctors who are using stent.
In government hospitals since price is fixed by government at near Rs 25,000 per drug eluting stent the USA based companies are not ready to supply there, though they have some type of drug eluting stents which they are supplying to distributors at less than Rs 20,000. In government hospitals Indian companies are strong supplier. Different company sell to distributor at different price and it range from Rs 10,000 or Rs 12,000 or Rs 15,000 per drug eluting stent. In government hospitals distributor pays Rs 4,000 to Rs 7,000 to doctor and pays 1500 to Rs 2,000 to Cath lab technician to sale each stent.
In smaller cities and big towns, Indian manufacturer are selling Drug Eluting Stents at Rs 50,000 to Rs 75,000. Here the distributors are force to pay Rs 25,000 to Rs 35,000 to doctors and they pay Rs 2,000 to Rs 3000 to Cath Lab Technician for selling each drug eluting stent. There is no doctor in any private hospital or government hospital or army hospital or railway hospital who uses drug eluting stent without taking bribe. Doctors are the chronic terminal cancers of health care system of India.
Government knows everything but do not do anything. How long we can tolerate this. If government do not take steps public should do something.
In western countries doctor’s practising licence is cancelled.
Manufacturing cost for each drug eluting stent is less than Rs 2000 but patient pays more than Rs 100,000 for each stent used.
Patient and patients party are helpless murgas or bukras.
Any doctor who is doing angioplasty or cath lab technician you know is highly corrupt person. They are richest people of the society with lot of black money. Huge black money can be recovered if government investigate pan card of these doctors.
Do you think MCI & Health Minister do-not know what is going on?
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