ON February 16, while addressing an election rally at Hardoi, Uttar Pradesh, Prime Minister Narendra Modi announced that the government had succeeded in capping the prices of cardiac stents to make them affordable for all. The announcement came in the context of the National Pharmaceutical Pricing Authority (NPPA) fixing ceiling prices for the two main categories of cardiac stents on February 13, ensuring a drastic reduction in the markup rates to the end-consumer. The ceiling prices that include the cost of production and a trade margin are valid for a period of one year.
While the move has been welcomed by those in public health, the timing is not entirely above suspicion. It took more than two years for the prices to be brought down to affordable levels and that, too, after a Delhi High Court order as far back as on February 25, 2015, directing the government to include coronary stents in the National List of Essential Medicines (NLEM).
A cardiac stent is made typically of a metal mesh in the form of a small expandable tube to treat weak and narrowed arteries. The process of implanting a stent involves no major incisions in the procedure of angioplasty. Stents are drugs under the Drugs and Cosmetics Act, 1940.
The NLEM 2015 was notified on December 2015, but only in July 2016 were coronary stents included in the NLEM. The government set up a subcommittee to consider the essentiality of placing coronary stents in the NLEM, which submitted its report in April 2016.
But it was only on December 21, 2016, a full five months after the inclusion of coronary stents in the NLEM, that the Department of Pharmaceuticals notified coronary stents as part of Schedule I of the Drug Price Control Order, 2013, paving the way for the NPPA to fix the ceiling price of stents. Within one and a half months, the exercise was done. Bare metal stents (BMSs) were to cost not more than Rs.7,260 a unit, and the maximum price of a drug-eluting stent (DES) was to be Rs.29,600. Of the 52 stent manufacturers who submitted their prices, the rates of only nine were found to be above the ceiling price for the DES, it was reliably learnt.