Multinational stent companies claim that the ceiling price fixed by the National Pharmaceutical Pricing Authority (NPPA) is commercially unviable, but they are selling at far lower prices in much richer countries with smaller markets than India such as Germany, the UK, Italy and many other European countries.
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A look at the prices of stent brands in these countries shows that people in India have been defrauded of crores of rupees over years in the absence of any price control or law.
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Before price control, patients in India paid among the highest prices for stents globally even higher than in the US. In the US, the price of a drug-eluting stent (DES) ranges from Rs 62,000 ($950) to Rs 78,000 ($1,200).
In India, hospitals were charging almost double with DES prices typically ranging from Rs 65,000 to Rs 1.7 lakh.
In the case of the bioabsorbable stents, which have come under a cloud for their safety and efficacy, the US paid about $100 to $200 (Rs 6,500 to Rs 13,000) over the price of the most expensive DES, or roughly $1,200 to $1,500.
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In India, patients were charged Rs 1.9 lakh (over $2,900) for Abbot's bioabsorbable stent.
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After price control, Indians are paying over Rs 31,000 for any DES, lower than the price in the US but similar to the price being paid in the UK and other European countries.
This is despite India having a much bigger market for stents than the UK or any of the European countries. In a bigger market, firms make up for smaller margins from higher volumes.
In Europe, the premium for so-called newer generation of DES or innovative DES ranges from 40 to 100 euros (Rs 2,800 to Rs 7,000) at best.
In India this variation, before price control was Rs 30,000 to Rs 1 lakh. In UK, DES prices range from the equivalent of Rs 20,750 to a little below Rs 30,000.
Absorb price varies from Rs 58,100 to Rs 83,000. In the UK, about 1.5 lakh stents are sold annually. Yet, they manage to get a better price than India, where six lakh stents are sold per year.
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In the UK, barely 400 bioabsorbable stents were used in 2014 against 8,500 in India in 2013, each being sold for about Rs 2 lakh. Similarly, in Germany, the price of DES is about Rs 14,000, less than half the ceiling price fixed in India.
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They pay about Rs 6,300 for bare metal stents, the ceiling price of which in India is about Rs 7,500. An estimated 4 lakh plus stents are sold every year in Germany. The only stent for which the price in the UK appears to be more is Synergy of Boston Scientific, about 600 pounds (almost Rs 50,000).
However, in many European countries, it appears to be sold for the equivalent of about Rs 32,000. In India, before price control, it was being sold for about Rs 1.8 lakh.
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"Why did the government, which knew such overpricing was going on, allow firms and hospitals to collude to loot patients for so many years? After all, the health ministry knew what was happening, which is why they capped stent prices for patients under the Central Government Health Scheme (CGHS) at Rs 24,000 in April 2014," wondered a senior cardiologist, who had worked abroad before coming to India.
"The companies will threaten withdrawal to crack the ceiling on prices. It remains to be seen whether the government will give in. We are not leveraging the advantage of having such a large market and one that is still growing, unlike most Western markets that are saturated or stagnant," he added.