- 17 minutes ago
Maharashtra Food and Drug Administration Commissioner Tukaram Munde addressed massive pricing discrepancies in hospital consumables, revealing that surveys across the Mumbai Metropolitan Region uncovered markups ranging from 150 percent to nearly 2,800 percent over procurement prices. Speaking on the issue, Munde noted that products bought by hospitals for 11 rupees are often sold at maximum retail prices of 325 rupees without benefits reaching consumers. He confirmed submitting proposals to the National Pharmaceutical Pricing Authority and the Department of Pharmaceuticals to rationalise trade margins, enhance price monitoring, and consider inclusion under the Drugs Prices Control Order. Emphasising a balanced and transparent regulatory approach across manufacturers, hospitals, and patients, Munde also discussed the suspension of iconic South Mumbai eatery Cafe Mondegar's food business licence, citing non-negotiable Schedule IV food safety and hygiene non-compliances under licensing regulations.
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00:00All right, joining me now is Maharashtra FDA Commissioner, Mr. Tukaram Munde.
00:04Mr. Munde, thank you for taking the time out and joining us.
00:08Mr. Munde, when you expose the markups, which are as high as nearly 3,000% on hospital consumables,
00:16you haven't really even touched a raw nerve.
00:19You've spoken up for the armadme of this country who has to face this day in and day out.
00:25What made you speak on this issue, sir?
00:32See, the issue is not about speaking for just consumers, but it is as a regulator.
00:38It's my job.
00:40It's my role to look at the issues.
00:43The issue here is about markup prices of the consumables, which are consumed in the hospital,
00:48particularly in IPD, whether it's IV sets or whether it's nebulizers or other consumables,
00:54which are used daily basis for IPD purposes.
00:56Now, we conducted, based on some inputs and complaints, that there are a lot of discrepancies
01:04in the MRP price and actually the hospital price plus billing.
01:09So we conducted a survey across MMR regions and other hospitals, where we found that there
01:16there have been differences in MRP and actually the price at which the hospital gets that product.
01:24So we have found anywhere in the range of 150% to almost 2,800% difference between MRP and
01:31the trade price at which the hospital procures.
01:34But the benefit is not passed on to the consumer.
01:37It is either with the hospital or with the pharmacy industry or the manufacturer or dealer, whoever
01:43the case may be.
01:44So that is not fair track practice in a real sense.
01:48It is not a transparency.
01:51So as per the prevailing rules, we have taken up the issue with the appropriate authority,
01:57that is the NPPA in this context.
01:59So we have sent a layer of proposal to the NPPA, enumerating the discrepancies which we have
02:05found, the gaps which we have found, the markup price, MRP and the actual practices.
02:09And we have submitted certain recommendations to look it up into the issue, including interagency
02:18review, including fair trade prices, including fair trade margins and of course transparency
02:26to be brought up in.
02:27So we are well within the right as a regulator, I have to look at the issues, whatever the issues
02:33come up with me.
02:34And we have taken up the issue with the appropriate authority who is a competent authority in this
02:41sector.
02:41Sir, it's well within your rights to take it up, but rarely has any authority ever spoken
02:47about this, though there have been consumer forums across many years who have constantly
02:53brought this issue up.
02:54When you say, sir, and you know, Mr. Munday, you've tweeted this out, you've basically used
02:59a social media platform to put this out.
03:02And you write a review of these findings and clear guidelines on the permissible gap between
03:07trade procurement price and declared MRP has been recommended to the Department of Pharmaceuticals
03:13and the NPPA.
03:15A step towards closing not just the pricing gap, but the information gap patients are left
03:21to bear alone.
03:22How are you going to follow up, you know, with what you have written to the NPPA and the Department
03:28of Pharmaceuticals, because there has always been a lot of resistance and there is a massive
03:33pharma lobby, especially where even, you know, private hospitals are concerned.
03:41I believe that we have to look it up in the holistic issue.
03:44It's not a lobby or say the consumer lobby versus pharma lobby or hospital lobby versus
03:49a regulator, something is not like that.
03:51We have to look at it in a 360 degree context.
03:54Pharmacy product producers are there, manufacturers are there.
03:57They have their IP rights, they produce it, but the trade margin has to be reasonable.
04:03As per NPPA, we have what you call Essential Commodities Act and there is a DPCO order,
04:10which is revised from time to time.
04:12The current DPCO order is 2013 and in that order, essential medicines are defined.
04:18And there are MRP is also looked into.
04:22Beyond that, there are certain items which every year pharma companies or manufacturers are allowed
04:28to increase by a particular percentage point of view.
04:30While fixing a pricing or MRP, there is a process defined in it.
04:34But when we look at this type of margins, which is to the tune of 2800,
04:39I think that is not acceptable to anybody, whether as a regulator or as a consumer
04:44or a citizen, concerned citizen, it's not allowed.
04:47Now, why does a particular product which is sold to a particular hospital
04:53at a particular, say, 11 rupees rate, whose MRP is 325 odd rupees,
04:58it is really inexplicable to me, it is very, very revealing to me that why this gap exists.
05:05If they can sell at 11 rupees, then why can't it be a MRP of a particular around that rupees,
05:10maybe 10%, 20%, 25% of margin.
05:13Why it takes to be 2800% odd to cap that MRP.
05:18And I think this is the exactly issue we have raised up after our findings.
05:22And that's why we have taken it to the appropriate forum and authority, which they are looking into.
05:26Mr. Munde, are you proposing a cap or a fixed price for these hospital consumables?
05:31What is permissible limit? Like you yourself say, certain hospitals, they have markups up to 2800 and even over,
05:39is what we've also figured out. So, are you proposing a cap?
05:44So, I'm not proposing any cap, say, because the caps will be decided, MRP will be decided from product to
05:51product basis.
05:52Now, how much the margin should be there? While deciding MRP, it has to be rational,
05:57it has to be open, it has to be transparent. There cannot be this much gap. This is inexplicable.
06:03That's where we have suggested certain things, whether that should be brought under DPCO or trade margins have to be
06:11decided,
06:12or whether it has to be inter-agency coordination has to be there, and the pricing monitoring mechanism has to
06:18be strengthened.
06:18There are certain four or five recommendations we have given.
06:21But it is for the authority to look into. They will go consult all the stakeholders in the sector,
06:27whether it's a pharmacy industry, whether it's a hospital, whether it's a regulators, whether it's a consumers.
06:32And after deliberation, consultations, NPPA will come up with appropriate interventions.
06:38That's what we have requested. There has to be intervention. There seems to be a gap, along with a regulatory
06:43gap,
06:43policy gap and interventions are required. And we have taken up the issue, we have brushed up the issue,
06:49and I believe that with due deliberation in a transparent manner, that this issue will be addressed.
06:56Have you given a time limit for this issue to be addressed, sir? Because a lot of these recommendations
07:02and reviews go into... I'm not an authority to give a time limit to the... I'm not an authority to
07:10give
07:10a time limit to NPPA. NPPA is the one who will decide it. But of course, there have been discussion,
07:16there have been interaction, and I think these interactions and discussions are on positive note.
07:21Sir, you know, most private hospitals say that what you suggest is far off from the economic
07:28realities of running a private hospital. Like when you walk into a hotel, there are certain services
07:34that you pay for. For these hospitals, they suggest to keep a sanitized atmosphere, to have round-the-clock
07:40nursing, and other exigency costs that are related to the hospital. These markups help them to offset,
07:49offset, you know, the costs of the rest.
07:56See, when this is to be done, that will be done in consultation and discussion with the pharma industry
08:02itself. It is not going to be done by me. It is going to be done by national authority. And
08:07while
08:08arriving at a decision, or if there is going to be intervention, that definitely will be discussed
08:14with hospitals as well, and the pharmacy industry as well. It is not going to be a unilateral decision,
08:18it is not going to be an arbitrary decision, and that decision does not lie with me. And I will
08:23not
08:23be able to comment to what price, how much, what intervention will be done, because that is for
08:28policy. That is a policy level matter, and policy level decision will be taken. But, just to say
08:34that, because we are running a hospital, we are aware you are running a hospital, but there has to be
08:40explanation for each and everything. If a particular product is MRP 320 odd rupees, is being sold to
08:48hospital 11 rupees, the same product which is outside will get at the same price, but where is this margin
08:54going? That is the valid question to be asked by either the consumer or a regulator for that matter.
08:59As this matter approached me, we looked into it, we studied it, we surveyed it, and we found there is
09:05some rationale in it. This needs to be addressed, this needs to be, we need answers on this. And that's
09:13why we have taken it up with the appropriate authority. And I believe that with due deliberations,
09:18this, whatever is the right approach, will have to be followed, because pharmacy industry or
09:24manufacturer will not work in white, hospitals will not work in white. At the same time, consumer will
09:30also not be work in white. They will not also be taken for right. So, as per Drug and Control
09:35Act,
09:36and rules there under, this is a major legislation along with the Essential Commodities Act. Other
09:42legislations also need to be taken into account, including consumer interest. We cannot just take
09:49that we are running the hospital, that's what we are entitled for this. What we need is a transparency,
09:54what we need is ethical practices, both from manufacturers, hospitals, as well as the consumers,
10:00along with legal practices. So, that's where our role as a regulator comes in. That's where we have
10:07taken up the issue. And while taking a decision, interest of all stakeholders will have to be taken
10:12into consideration. Mr. Munde, you know, consumer interest has always been last in the pecking order.
10:17And I am sure as a regulator, you have seen that happen. The arbitrariness of markups in hospitals,
10:24you have rightly pointed out. But you do understand, it's not the first time. A lot of consumer interest
10:31bodies have constantly brought this up and they have hit a wall against very, very strong lobbies.
10:36You do understand, by bringing this up, once again, you could be in the crosshairs of certain
10:41very influential, powerful bodies. No, I am not at crossroads with anybody. I am basically
10:52performing a role which I am expected to perform. Being a regulator, being a public servant, that's my
10:58role, being FDA commissioner of Maharashtra, drug administration in Maharashtra. Whatever the
11:03issues are in drug sector, whether from drug industry size, pharmacy industry size, hospital
11:08side or consumer side, we have to look into the issues. This is one of the issues. There are other
11:13issues which we have taken up about other sectors also. So, it has nothing to do against a particular
11:19lobby. We are here as a public servant. I am just trying to perform my role as a public servant.
11:24That's it. So, nobody has to take it in a negative context. We have to take it in a holistic
11:28context.
11:29The interest of all the stakeholders, including hospitals, including pharmacy industry,
11:33manufacturer, including consumers and of course, the government has to be taken into consideration
11:39while arriving at a decision. Last question, sir. You are a regulatory body and as per you,
11:47what do you think would be a fair percentage markup? Because what you yourself said, right now,
11:52you are looking at anything over 2800? That will be very difficult for me
11:58because that will be very, very difficult for me to comment upon because that role is of NPPA and
12:05the industry. So, they will deliberate upon it and they will decide upon it. I am no way
12:11authorized nor am expertise in that. But definitely, as a regulator, if there are issues that I have to
12:17take up, we are taking it up, the issues along with other many, many other issues.
12:20Well, thank you so much, Mr. Munde, for taking it up. Like I said, you have echoed
12:24what has been, you know, the grouse of lacks of common men in this country where you go into hospitals
12:32and you are handed inflated bills without any explanation at all. And you have to pay for that.
12:38So, thank you for bringing it up. And you are right. You said you have little control,
12:41but you have flagged it. Let's hope that, you know, whatever your submissions are,
12:46are taken seriously and some tangible changes made. I just want to ask you one quick question,
12:50sir, before I let you go. And that, for Mumbaikas, could be, you know, as sensitive for some of them
12:57who followed Mondegar Cafe through the many years and decades and you have shut it. Now, what led you,
13:04Mr. Munde, to shut down Cafe Mondegar, which is iconic to Mumbai and South Mumbai?
13:15It's not about, I say, a view for me, whether it's a big or small. I have said many times
13:20on your
13:21channel as well. So, there are violations, scheduled for violations. There are non-compliances and after
13:27non-compliance were found, we have suspended the license. We have not cancelled it yet. If they comply
13:32with that, we'll reinstate their license. If they don't comply, we'll go for a cancellation of it.
13:38So, it's basically about the public health issue. It is about standards and regulations not being
13:42followed and detailed press note I have issued yesterday. So, the reasons are also mentioned
13:47therein. I need not repeat it. Only issue is that whoever is a food business operator,
13:53either a licensee or registered one, please follow these regulations because we are dealing with the
13:58health of the people. Mr. Munde, I know you do want to repeat what the issues were with Cafe Mondegar,
14:03but what was the biggest glaring issue that you said that there has to be a suspension letter,
14:10not a warning? Yeah, it's not. As I say, Schedule 4 violation is the non-negotiable thing and there
14:18are violations about Schedule 4 as per regulations of registration and licensing regulation 2011.
14:24So, Schedule 4 has a lot of many components and they have been pointed out to them. It's not
14:28something which is opaque, it's absolutely transparent. In the suspension notice itself,
14:33those have been pointed out which are compliances, which are non-compliances, which are partial
14:36compliances. It is intimated to them. They have to come with compliances and further process will take
14:41place. Mr. Munde, thank you so much for joining us. You know, Cafe Mondegar might be just one
14:46cafe there, but what you have raised in terms of hospital is something that is going to resonate
14:51way beyond Maharashtra. Lacks of, you know, common middle-class families face the brunt of this.
14:58Thank you, sir, for joining us. Thank you.
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