Hospitals would be soon required to disseminate relevant information about Cardiac Stents that are being used in their cathlabs. These are the recommendations put forward in the National Pharmaceutical Pricing Authority, in its latest report on Pricing of Stents.
The report was commissioned by the Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers on account of media reports regarding huge mark-up in prices of stents due to unreasonable margins to distributors and hospitals. Post the analysis, NPPA indeed reported existence of high margins as high as 1200% in certain types of stents.
Besides giving detailed examination on the stent market in the country, the report highlighted typical challenges faced by patients with respect to choice of stents, which have had a distorting effect on the market, and gave many recommendations that are of concern hospitals are well as medical practitioners. The first recommendation only stated that hospitals have to be transparent and provide details of the stents available outside their respective cathlabs
Patients are often deprived the opportunity of understanding the difference between different types/ qualities of Stents, and as a result their choice is governed almost entirely by the cardiologist‟s recommendations. It is necessary to educate patients about the treatment, including various options along with therapeutic value and cost implication. Every Hospital must display outside the Cath Lab the Stents available with the Hospitals along with their MRP.
Another major recommendation, probably an advisory to the physician in questions talked about the assistance that a patient should be given in order to make an informed decision.
In most cases, the patient is given negligible time to decide on the choice of Stent, as the physician expects instant decision at the time of angiography procedure itself. Under such circumstances, the decision-maker is left with no alternative but to accept whatever is recommended by the doctor. It is desirable to adequately prepare the patient and give him time to decide unless it is an emergency case.
Not undermining the role of the apex medical regulator, the report recommends detailed MCI guidelines to medical practitioners to address the issue
…… Medical Council of India (MCI) should also come out with standard procedural guidelines, specific to each medical device including cardiac stents that puts a check on the entire proceedings from the initial stage of admission till patient is discharge after implantation of medical device.
And finally, there is the clear cut recommendation to regulate the profit margins of the hospitals, as well as the suppliers
The margin for distributor/importer/supplier and hospitals should be regulated in order to keep the price of DES and BMS at reasonable level.
The last recommendation comes in the light of the shocking markup figures for manufacturers/distributors etc that were revealed by NPPA in its report. NPPA detailed the prices of 9 companies, including those of market leaders such as Abbott, Medtronic and Boston Scientific that together account for nearly 60% of the market share of stents in the country and found
- In the case of Abbott, the difference between landed cost (LC) and price to distributor (PTD) ranges between 68% to 140% across different brands; that between PTD and MRP ranges between 72% to 400%; and finally between LC and MRP ranges between 294% to 740%. Abbott makes institutional supply to CGHS with a margin of 100% to 200% only. This indicates the quantum of margin in the distribution channel, which is totally detrimental to consumer interest.
- In the case of Medtronics, the margin between LC and PTD ranges between 82% to 232%across different brands; that between PTD and MRP ranges between 170% to 325%; and finally that between LC and MRP ranges between 498% to 854%.
- Similarly, in the case of Boston Scientific, the margin between 43% to 105% across different brands; that between PTD and MRP ranges between 175% to 809%; and finally that between LC and MRP ranges between 464% to 1200%.