On Friday morning, news broke of a Mumbai-based pharmaceutical company, Abbott Pharma, withdrawing its bioresorbable stents from all hospitals in Mumbai.
The move reportedly came immediately after the National Pharmaceutical Pricing Authority (NPPA) released a notification, that clamped down on the cost of cardiac stents, putting a price cap of Rs 29,600 on coronary stents.
This new pricing is approximately five times lower than the maximum rate asked for drug eluting stents, used in 90 percent of angioplasties in India.
A more expensive, but less frequently used variety – the bioresorbable stents – also fall under the ambit of this price regulation.
A stent is inserted into a blood vessel to hold it open and prevent blockage. Bioresorbable stents are made of a material than can be absorbed by the body.
Prior to the price capping, Abbott, reportedly the only supplier, sold the bioresorbable stents for Rs 1.9 lakh a piece.
On Thursday, these stents were withdrawn from major hospitals on the pretext of “relabelling” them, to reflect the new MRP.
Reacting to the reports, Anand Kadkol, Director of Public Affairs at Abbott, maintained that the pharma company “continues to market its full range of coronary stents available in India.” He added that in certain cases, the company had started the process of relabelling, to comply with the NPPA notification.
“The stocks are invoiced to hospitals through a distributor and the company cannot take those back,” he said, in Abbott’s defence.
Speaking to cardiologists at Apollo Hospitals and Sir Ganga Ram Hospital in New Delhi, The Quint learnt that the bioresorbable stents had indeed been withdrawn, but the company continues to supply the drug eluting stents.
What Is the Impact?
Bioresorbable stents are expensive, and doctors are still testing out their benefits over regular stents. In other words, it’s not the ‘go to’ method when it comes to an angioplasty.
Dr SK Gupta, a cardiologist at Apollo Hospitals, didn’t seem surprised by the withdrawal of the product.
Naturally, they’ve withdrawn the stents because the government has changed the rates. But it has not affected our practice. We don’t use these stents very often.
An expert who has tracked the pharmaceutical industry for years said on condition of anonymity that the NPPA’s notification has come after assessing the benefits of these stents, given its exorbitantly high price.
The experts who advised the NPPA looked at the comparative benefits of “higher quality stents” and found that they’re not hugely beneficial, or more beneficial as compared to the drug eluting ones. If prices are so high, it also needs an extraordinary healthcare benefit. It’s no doubt that high-calibre, expensive research has gone into it, but it didn’t provide much benefit apart from the stent getting dissolved in the arteries after a few years.
Dr Sumit Ray, head of the critical care unit at Sir Ganga Ram Hospital is confident that if the government sticks to its price controlling, the stents will come back.
It’s a huge market and pharmaceuticals are looking to expand further. Whatever their reasons for withdrawing the product, if the government keeps the price cap on, the stents will be back.
Profit Making and 'Profiteering' by Firms & Hospitals
The conundrum of balancing profits with social responsibility has challenged pharma firms for decades.
A representative of a reputed pharmaceutical company, who did not wish to be named, said:
We do think about profit, but not at the cost of making access difficult. There has to be a balance between access and price. There are different models in the country and pharma companies have been at the forefront of figuring out the model that works. Now with the NPPA coming in, there are enough consultations that happen. Whether they’re followed through or not is another matter, but at least the process is there.
Dr Ray argued that at every step in the supply chain, a considerable profit is made by all involved, including hospitals and doctors. The final cost, borne by the patient, is considerably inflated.
The landing price of these stents is not high. But it’s scaled up for huge amounts of profits to hospitals and doctors. Companies are pressured to push for such profit margins – and so an artificial shortage is created. Yes, private healthcare is modeled on the profit motive. But there’s a difference between profit-making and profiteering.
According to a The Times of India report, the most stark leap in price seems to be at the hospital level. Quoting data provided by NPPA, the report says the profit margin on stents ranges from 270 percent to a shocking 1,000 percent.
While the supposed withdrawal of the bioresorbable stents may not affect a large number of patients, even a few hundred or thousand affected are perhaps too many.
A doctor-hospital corruption nexus, pharmaceutical arm-twisting or even a simple, untainted case of wanting to provide affordable healthcare, but struggling to mitigate the costs – the collateral damage is a hapless patient, in desperate need of a miracle to make life more comfortable, or even to survive.
(With inputs from Mumbai Mirror, The Times of India)
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