During the mid 2017, NPPA( National Pharmaceutical Pricing Authority) regulated several medicines and medical devices like cardiac stents, Artificial knee joints to curb profiteering and bring health care afforable to the Indian public under under the Drugs Prices Control Order (DPCO) 2013. NPPA achieved this by radically slashing prices 86% for cancer drugs, 40% for Diabetes and 69% for Artificial Knee joints.
This move by NPPA has boosted local companies but the problem is that these products are replica of their imported version.
What has changed post NPPA price regulation?
The cost of a knee replacement surgery and cardiac stent placement has only increased as hospitals have increased the cost of consumables used and surgery to compensate losses to stay afloat.
Medical device giants, Zimmer Biomet laid off 20 employees and postponed their robotic surgery launch, Stryker laid off 44 employees, Smith & Nephew launched their Syncera range, generation old knee implant, Depuy Synthes( Johnson & Johnson ) launched their generation old Hip replacement implants; which resulted in much publicised failure and ongoing conflict of compensation to patients. Abbott cancelled launch of their bio absorbable stent, Boston Scientific shut down their cardiac stent and sutures division. Medical Industry has made India their last preference for new product launches due to which latest medicines and implants are not accessible any more.
“It can jeopardize India’s long-term health goals and patient access to new technologies. There are countries that suffer from large fiscal deficits and their usual inclination is to pressurize drug or medical device firms into either reducing prices, or intimidate them through the use of compulsory licenses. Most of these countries also use severe drug price controls to curb prices. The drugs and pharma sector is almost always particularly vulnerable. Drug prices are so easy to clamp down upon given the emotion and ideological basis that abounds1.”
Amirullah Khan, Policy Advisor , Bill & Melinda Gates Foundation
Why are medical devices expensive?
- Every new product undergoes years of R&D, clinical trials and clinical support mandated by FDA.
- Import duties and 18%-28% GST on medical equipments.
- Medical industry demands capital intensive skill enhancement programmes for Health care Professionals to help improve efficacy of surgeries and outcome.
Core of the problem?
Only about 20% of Indian population are insured, 82% of urban and 86% of rural population remains uninsured. For poverty ridden population, RSBY ( Rashtriya Swasthiya Bima Yogana) still remains inaccessible due to administrative challenges and impact of MODI care is yet to be witnessed.
What about Public Health care set ups in India?
India spends only 1.4% of its GDP on health care; public health care is not accessible – one hospital for 2000 patients, one doctor for 10189 patients and one state run hospital for 90,343 patients respectively.
The quality of health care in public health care set up is among the poorest, with incidents like death of infants due to lack of ventilators in Uttar Pradesh to Hepatitis B infections to dialysis patients and HIV infection during blood transfusion in Tamil Nadu. Public health care is still the last option even for the poorest of the poor.
Way forward by NPPA
15 widely used medical and surgical device like heart valves and intraocular lenses would be categorized as “drugs” under India’s Drugs and Cosmetic Act 1940 and price capped.
References
2. https://www.dr-hempel-network.com/health-policies-in-india/health-insurance-in-india-future/
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