BENGALURU: Capping of life-saving coronary stent price was the most advertised decision of the National Pharmaceutical Pricing Authority (NPPA) last year, so much so that even Prime Minister Narendra Modi used it as one of the poll planks while campaigning before the Uttar Pradesh Assembly elections.
A year on, however, patients continue to pay the same price for angioplasty. Hospitals have hiked procedure cost to make up for the loss of margins (as much as 650 per cent) in stents. The drug pricing watchdog slashed stent prices by 85 per cent on February 13, 2017.
Narayana Hrudayalaya, which runs 30 hospitals and heart centres across India, did 12,000 angioplasties in 2016-17; but patients are not paying any lesser now. Cardiac Sciences accounts for 42 per cent of NH’s revenue. Previously, an angioplasty for a general ward patient cost Rs 2.1 lakh and it continues to be so.
As on January 31, 2018, NH reported a total operating income of Rs 553.8 crore as against Rs 455.3 crore in the third quarter of 2017, reflecting an increase of 21.7 per cent.
In a post earnings conference call on August 4, last year, it said, “Curbing of stent prices by the government significantly affected our heart centres’ business resulting in the segment’s revenues dropping by almost 3 per cent year on year.” NH is said to have anticipated around Rs 40 to Rs 45 crore loss of earnings from the cardiac stent pricing on an annual basis.
There was a six-month period fixed by the NPPA where the procedure cost couldn’t be hiked by hospitals from the date of price capping. Once the period ended in August last year, hospitals hiked the prices.
Ashutosh Raghuvanshi, CEO of Narayana Hrudayalaya Ltd, had told the media last year that procedure costs would be hiked to compensate for stents once the six-month period was over. He, however, told The New Indian Express, “The procedure costs went up only by 15 per cent.”
Fortis Hospitals had also admitted that in metros, where high-end stents were used, the impact was more; and over time, there would be a “ramp up of mitigation, offsetting the stent pricing impact.”
Dr S Venkatesh, interventional cardiologist, Fortis Hospital, Bannerghatta Road, said, “Bare metal stents (that cost Rs 7,400 post inflation) are barely used, 95 per cent of patients opt for drug eluting stents (which cost ‘30,000).”
Govindaiah Yatheesh, Assistant Medical Director, Apollo Hospitals Group - Karnataka Region, said, “We are charging Rs 1,40,000 for angioplasties for a general ward patient. Prior to price cap we used to charge Rs 1,25,000 for the procedure. Previously, the doctor’s charges were 15 per cent of the bill; now it is 30 per cent.”
Rama Sekhar Reddy G, General Manager, Finance, Apollo Hospitals Group - Karnataka Region, said, “We have hiked Rs 15,000 for procedure cost. Our earnings have declined by 3 per cent to 3.5 per cent over the past nine months. Apollo Bannerghatta Road hospital alone has seen Rs 3 crore to Rs 3.5 crores decrease in earnings.”
While all hospitals have hiked the procedure cost (the fee charged for surgery by doctor), only a few hospitals are passing on the benefit of the price cap to the patient there by bringing down the price of the package cost (procedure cost + stent cost + consumables + drugs). While in Apollo and Fortis hospitals, the package costs have come down, it remains the same in Narayana Hrudayalaya.