When it was reported in November last year that India’s drug pricing regulator, the National Pharmaceuticals Pricing Authority (NPPA), will be reviewing coronary stent prices after a year of having slashed them by as much as 85%, many anticipated that, in the face of overwhelming evidence that the price caps weren’t working, the regulator would let the market decide prices instead of imposing caps. But NPPA has instead further slashed the price of drug eluting and biodegradable stents. It did, however, relaxed the cap for bare metal stent, though not by much. It has also, capped the prices of other products used in stenting, including the guidewire, balloon cathether, etc. A host of moves that are as ill-advised as the original move to cap stent prices was.
While NPPA is learnt to have acted upon advice of eminent cardiologists who said that the caps resulted in more angioplasties, a study funded by a representative body of medical instruments MNCs claims, neither has the number of angioplasties gone up significantly nor have angioplasty costs fallen noticeably for patients bearing the expense out-of-pocket (OOP). For single-vessel angioplasty—70% of the patients require just this—price-capping resulted in a 8-12% fall in overall procedure cost in corporate hospitals, 14-18% in large private hospitals and 8-12% in medium-sized private hospitals. Total angioplasties also barely moved up, increasing by just 3% in corporate hospitals, by 5% in large private hospitals and 7% in medium private hospitals, that too largely in smaller cities—80% of government hospitals reported no change in the number of angioplasties while, in the remaining 20%, the increase was limited to a low 2-5%. Instead, Indians are fast losing access to the state-of-the art technology in the cardiac stent space—stent major Abbott Laboratories said it will not bring its latest stent, Xience Sierra, to India. A couple of months earlier, it had withdrawn its two of its high-end stents from the Indian market. The government must remember driving out top MNC stent-makers could result in public health crises, especially with the burden from cardio-vascular diseases rising in the country.