Freebies to doctors and patients’ pockets

Dr. Arun Mitra

The transfer of Bhupendra Singh, Chairman National Pharmaceutical Pricing Authority (NPPA), has evoked strong reaction from the medical fraternity as well as civil society groups working for affordable healthcare to all. This reaction has come in the wake of several positive steps taken by him to bring down and streamline prices of drugs, which include medicines and medical devices. His order to drastically cut down the price of coronary stents in February 2017 has been seen as a bold initiative on his part.
The NPPA in its order notified on 13th February 2017 had fixed the ceiling price of the bare metal stents at Rs.7,260 and of drug eluting stents at Rs.2,960. Till then these stents were being sold to the patients at a price of Rs.70,000 to Rs.1,50,000. This brought big relief to the patients, who had to pay such exorbitant charge for stents.
In this order the NPPA had referred to the judgment of the Supreme Court, in which the court had observed that “Profiteering, by itself, is evil. Profiteering in the scarce resources of the community, much needed life-sustaining foodstuffs and life-saving drugs is diabolic. It is a menace which has to be fettered and curbed”. It is pertinent to mention here that our first Prime Minster Jawahar Lal Nehru, while laying the foundation stone of the Indian Drugs and Pharmaceuticals Limited (IDPL), had warned against manufacture of drugs left to the private sector as their only motive is profit making.
It is another matter that the benefit of the stent price control has not reached all people because several private health providers increased their procedure charges, although the state sector units passed down the benefit to the patients. This matter had been pointed out to the NPPA in a meeting called to have a dialogue with various stake holders. The industry had been demanding revision of prices on the plea that new innovations have happened in coronary stents. The civil society and ADEH did not agree with this contention and produced evidence to refute their claim. The NPPA, after hearing all the stake holders, did not agree to increase the price of stents. No wonder it would have irked the industry, which would have lobbied intensely with the government. Therefore, irrespective of whatever the government may say to justify the transfer of Bhupendra Singh as a routine affair, many people view the transfer to be linked to the decisions taken by the NPPA.
The All India Drug Action Network (AIDAN) and the Alliance of Doctors for Ethical Healthcare (ADEH) have been working hard for reduction of prices of drugs so as to make them affordable. The ADEH had sent several letters to the Prime Minister, Health Minister and the Minster for Petroleum, Chemicals and Fertilizers. But the response from the ministers has been dismal. In fact, in all this exercise of reducing the price of stents the government has done very little. Their prices have come down after court order.
The question of price control of drugs cannot be done in a piecemeal approach. It is important to check the price at the level of pharmaceutical marketing practices. The code for the pharmaceutical industry and their marketing practices has to be implemented effectively. The Uniform Code of Pharmaceutical Marketing Practices (UCPMP) highlights that the industry must stop indulging in unethical practices to promote the sale of its products. Clause number 6 and 7 of this code are categorical in forbidding pharma companies from offering any gifts or other benefits like travel facilities because these add up to the cost of drugs. Even the Central Board of Direct Taxes in its Circular No. 5 of 2012, dated 1-8-2012 had categorically said that the expenditure incurred by the companies in offering freebies to the doctors cannot be counted as deductable expenditure for tax.
But both UCPMP as well as the CBDT order are not being effectively implemented. The UCPMP is still voluntary even after more than three years of its formation. The very first paragraph of the code mentions that this is a voluntary code for the present and will be reviewed after a period of six months; and if it is found that it is not being implemented effectively then the government may consider making it a statutory code. No more time can be lost now. It is obvious how the pharmaceutical companies are flouting the rules and spending huge amount in the name of continued medical education programmes. Worse is that this is being done at the expense of pockets of poor patients. (IPA)

Sunday, 25 March, 2018