India is urged to make stents essential medicines to help control price

The Maharashtra Food and Drug Administration (FDA) has urged the National Pharmaceutical Pricing Authority to make cardiac stents essential medicines to help control the price patients have to pay for them.

A recent survey by the Maharashtra FDA found that the maximum retail price of cardiac stents across India was 300-700% of their actual import cost. And the Economic Times newspaper reported that importers inflate the maximum retail price, domestic distributors sell the stents to hospitals at a profit margin of 125%, and then hospitals charge patients 25% more than what they paid to the distributors.1

The Maharashtra FDA has urged the pricing authority to add cardiac stents to the national list of essential medicines and to control their price accordingly. It wants to see a fixed profit margin for “importing companies, distributors and hospitals,” and noted that, like orthopaedic implants, cardiac stents are regarded as “drugs” under India’s Drugs and Cosmetics Act.

In response to press reports about the inflated costs of orthopaedic implants, the National Pharmaceutical Pricing Authority issued a letter in May to the manufacturers of such implants in India asking them to file details of their pricing mechanisms urgently.2

The letter said, “There have been reports in certain sections of print media that the prices of orthopaedic implants regulated as ‘drugs’ under the Drugs and Cosmetics Act and rules thereunder, are sold at exorbitant price with high profit/trade margin . . . No person is authorized to sell any formulation including medical devices regulated as drugs to any consumer at a price exceeding the price specified in the current price list or price indicated on the label of the container or pack thereof, whichever is less.”

Sourirajan Srinivasan, a health activist and managing trustee of the Vadodara based Low Cost Standard Therapeutics, welcomed the government’s intervention on orthopaedic implants but added that patients were also being “robbed” by the high price of cardiac stents because patients and their relatives were usually willing to pay any amount for cardiac interventions. “Overpricing and profiteering of any health item [are crimes] and denial of human rights,” he said.

Swapan Jana, secretary of the Kolkata based non-governmental Society for Social Pharmacology, said that patients pay a substantially high price for an imported cardiac stent. “Depending on the brand of the device, sometimes the price becomes Rs125 000 [£1282; €1780; $1956] and more, thanks to profiteering, which needs to be stopped,” he told the BMJ. Locally manufactured cardiac stents and orthopaedic implants were relatively cheap in comparison, “but their prices should also be properly regulated by the government,” he added.