- 17 minutes ago
A panel discussion examines the impact of the central government's decision to slash prices of anti-cancer drugs and deliberates whether price capping should extend to other essential medicines and hospital consumables. Panellists highlight the vast disparity between procurement costs and the retail prices billed to patients by private hospitals. While Karnataka's representative calls for transparent billing displaying landing costs alongside the maximum retail price and urges regulation based on chemical formulas rather than brands, medical experts urge caution. Doctors emphasize the need for stringent quality control and bioavailability standards for generic drugs to prevent sub-therapeutic outcomes and black marketing. Medical specialists also recommend expanding price regulation to emergency ICU treatments, including antibiotics, antifungals, and consumables like intravenous sets. The discussion underscores the urgent need for systemic pharmaceutical pricing reforms and greater regulatory oversight to curb healthcare inflation and protect patients from out-of-pocket medical expenses.
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00:00So let's raise the big question. Will cancer treatment now finally get cheaper in the country? Should the cap on
00:06these anti-cancer medicines apply to other medicines as well? Are private hospitals and the supply chain fleecing patients at
00:14the moment?
00:14Joining me now is U.T. Kader. He's the Minister for Health and Family Welfare in Karnataka. I'm also joined
00:22by Dr. S.K. Sareen, Director, Institute of Liver and Biology Sciences, New Delhi, and by Dr. Swaminathan, Dr. Subramaniam
00:32Swaminathan, Director, Infectious Diseases and Infection Control at Glen Eagles Hospital in Chennai.
00:38Dr. Kader, Mr. Kader, first you. It's good to see that you, opposition government and the centre working together on
00:45this, you had written to J.P. Nadda and the union government and they have brought down now anti-cancer
00:51medicines. Are you satisfied or do you believe now this should extend to all drug prices, not just anti-cancer
00:58medicines?
01:02Now, one way I am happy that at least a little part have been successful and I thank all the
01:09state and national media because whatever we have published, it has taken discussion by you all in national level and
01:16Supreme Court has taken the observation and suggested central government also.
01:20So, now I appreciate the centre more for reducing the prices. This will benefit a lot of patients throughout India
01:28and for other kidney, heart and eye cost prices of the drugs are there.
01:35They should be reduced. Why unnecessarily the people of India should spend from their pocket for this treatment?
01:42No, but the question is whether this steep price cut, Mr. Kader in cancer medicine will translate into savings for
01:51patients because as you yourself had pointed out earlier in the month of September when you wrote to J.P.
01:57Nadda that the worry is that there is a substantial markup between procurement costs and the prices that are charged
02:04to patients.
02:04Will that change or not?
02:07Will that change or not?
02:08Yeah, it should change. That is what the new system is. What is the landing cost means? At what cost
02:16the hospitals and pharmacy get this medicine and the MRP means and what they are selling.
02:21The both should be mentioned. At least the people will come to know how many profit they take. So, there
02:26will be a control on the price limit. This will benefit the patients.
02:29So, you are saying there will be an MRP now on all anti-cancer drugs and that will include it
02:35even at the level of the pharmacy or the hospitals. Am I correct?
02:39That there will be no difference between what is in the entire supply chain?
02:47Now, see, even now with the MRP the issue is if for example one pharma company produces an injection for
02:555,000 rupees this my selling cost in the hospital was it is 65,000 rupees and now only the
03:0330 percent cap it will be only 6,500 rupees.
03:06So, there is so much the rise this will be cut down and it should be mentioned what is the
03:13what rate the hospital pharmacy getting the medicine injection and what they are selling also should be mentioned in the
03:20bill also.
03:21So, at least there will be a transparency will be there and people will have got confidence.
03:25Others people who have lost their confidence because they think it is more 1,000 times, 200 times, 300 times
03:31more what is before that should erase.
03:35There should be a trust between the hospitals and the patients.
03:39I take your point. Let's bring in the hospital guest. Dr. Swaminathan, you are a director of a hospital.
03:45Will the benefit of anti-cancer prices being capped be passed on to the patient and do you believe it
03:53should just be anti-cancer or medicines in general should have a very clear MRP now?
03:59We have already started that process.
04:02Many of the antibiotics were already capped by the government of India which I believe was a positive step because
04:08healthcare inflation is something which is really scary and the cost of healthcare today is becoming astronomically high.
04:15There are various factors to this and one of the important factors is obviously medications.
04:20This reminds me of the Salk-Friedman discussion where Jonas Salk who invented the polio vaccine refused to patent it
04:26and his question was would you patent the sun?
04:29Now, obviously when we talk about life-saving medicines it has to be in the public domain and it has
04:35to be for the greater good of the humanity while at the same time there has to be skin in
04:39the game and some incentivization for research and further development.
04:44No, but how will hospitals disclose the actual procurement or will they disclose the actual procurement prices of these medicines,
04:52the implants, the other medical supplies along with the margin charge?
04:56Will there be a disclosure from the hospital?
04:58I don't expect that to happen.
05:00The point is that the only thing that can be regulated is the MRP.
05:05The only thing that can be regulated is the MRP and I think that's the only way to go because
05:09procurement price again is a negotiation.
05:12Very often a larger institution when it has larger volumes can negotiate better prices.
05:18So therefore the procurement price even for the same brand may vary from hospital to hospital and that's not something
05:24we should use as a benchmark.
05:25I think the government setting a clear MRP for the important drugs is definitely a good idea and that's the
05:31only way to do it.
05:32You know, Dr. Sareen, during the proceedings in the Supreme Court an example was given.
05:37An injection reportedly purchased for around 11,000 was billed at rupees 1.3 lakh by the hospital.
05:44Do you believe now therefore that there needs to be what has been done with anti-cancer will have to
05:50go to other medicines
05:51and that there will have to be complete clarity?
05:54Should the centre amend the drug price control order to place a clearer, in a way a clearer limit on
06:01hospital markups?
06:05I also salute you and Justice Vikram and Justice Mehta for having taken this.
06:13It is a very important issue and we face it every day.
06:16A simple IV drip, you know, drip set costs about 15 rupees but patients are charged to 50 rupees.
06:23It's just not the drugs but it is also the consumables.
06:27Clearly there is a need for us to define the process and I'll list out the things.
06:33What is the factory output price and what is the cost for the retailer?
06:39What is the procurement cost to the hospital and what is the selling price?
06:43Selling price is MRP.
06:45All these four should be clearly mentioned that the production is only for 2 rupees and you are selling it
06:51for 500 rupees.
06:53This is not acceptable.
06:54Number two, we should prioritise which are the drugs.
06:57Besides anti-cancer, there are more, you know, cancer may still, patient may still live for a few months.
07:02But a patient in ICU needs antibiotics, antifungals, anticoagulants, maybe albumin, maybe many such ICU related drugs, drugs for the
07:13lungs and for the kidney.
07:14There is really a need for at least 5 to 7 such top areas which should be prioritised and the
07:20drugs should be discussed by a group of people.
07:23Yes, for first top 100 drugs which are used every day in emergency must become now price kept.
07:29So, what you are saying is what's happened with anti-cancer must now extend to other drugs and medicines as
07:35well.
07:36Yes, but I want to put two things before you that WHO in fact have said that you should have
07:42a regressive price, you know, markup system.
07:45More expensive the drug, lesser the margin.
07:48The weaker, the cheaper the drug, then you should give more margin because you have to go to the rural
07:53area.
07:53If the drug costs 50 rupees, the guy will, the store, you know, pharmacist will never store it and you
07:59will have no simple aspirin or paracetamol available.
08:02So, we should make sure that this is available.
08:05The also government and maybe the Supreme Court has a huge mandate that the quality control of genetic drugs should
08:11be maintained.
08:12But it must extend to drugs which are essential, life-saving drugs.
08:16You know, how are you going to monitor it, Mr. Kader?
08:19It's one thing from November 9th that these anti-cancer drugs will get cheaper.
08:23How are you going to monitor it?
08:24How will the government monitor that hospitals, pharmacists are all adhering to this MRP?
08:35See, we have got a system in the drug, our food and drug department.
08:41How we have found out the landing cost and the MRP, what they are doing till now, our officers will
08:45find out this also.
08:47And along there, I want to tell one more thing.
08:49The rate shouldn't be for the medicines on high-risk, high-cost drugs on the brand.
08:55It should be on the formula.
08:56The formula is same, the brand is different, why the rate should be different on brand?
09:03Any formula is same, then the rate of this medicine should be same only.
09:09The medicines for the common people given should not come on brand.
09:13It's common formula, that we should see.
09:15Let me ask Dr. Swaminathan that. Is that possible, Dr. Swaminathan?
09:20So, the problem is that the manufacturing process also varies.
09:24Please understand that the same molecule may be manufactured by two different processes, and that makes a difference to the
09:31bioavailability of the drug.
09:32We have had situations where we have had generic drugs, good companies, where they show a good amount of drug
09:39in the tablet or the preparation.
09:42But unfortunately, in the patient's body, the levels may not be adequate.
09:46So, what we need is also, like Dr. Sareen pointed out, we need to have stronger systems in place, where
09:51we just don't look at whether, let's say, 300 milligrams.
09:54Not just whether 300 milligrams is there in the drug, but also whether it achieves blood levels in the patient,
09:59which are comparable to the original molecule and things like that.
10:02So, please keep in mind that this is a very complex area, and there are multiple moving parts.
10:06All of it has to be accounted for.
10:08Dr. Sareen, you remain hopeful though.
10:11Are you hopeful that we will, that finally there is at least a recognition that this is an important step
10:17forward?
10:17Is the hospital community going to be, the medical community on one page on this, or will there still be
10:23a temptation for profiteering?
10:26Well, the medical community will certainly like the patients to benefit, but we don't want to have a cheap drug,
10:32as Dr. Swaminathan says, which also costs something, and also you lose a life.
10:37You must have quality standards for generic drugs before we issue pre-qualification bits.
10:42We must have testing facilities.
10:45I give you a very simple and useful formula.
10:48WHO, as well as the nation, has an essential drug list.
10:52Now, you can have pricing at two levels.
10:55One, you have X price.
10:56But if you want to get into the essential drug list, means everybody will have to have their drug.
11:01You negotiate at that time.
11:03Look, you were selling it for 5,000.
11:05But if you want to be in the national drug list, essential drug list of WHO, bring it to 1
11:10,000.
11:10So, you maintain the quality, but you give the pharma a huge market space.
11:15I also would like to say that there is a need for us, all the citizens also to be aware.
11:22You go to a drug store, don't buy over-the-counter.
11:25Make sure it is a doctor's prescription and that you take the right drug from the right company.
11:31But I am afraid that if you give same pricing to everybody, with all respect to the Karnataka, sir, minister,
11:38you will have black marketing coming.
11:40You will say, I want that company's drug.
11:43Sir, it is not available.
11:45Sir, I pay you some extra and the drug comes out.
11:48I think we have to be careful.
11:49Okay.
11:50We have to be careful.
11:51But I want to today say, I don't say this too often on the show.
11:54But, Mr. Kadar, both to you and J.P. Nadda, the health minister, I think both of you and the
12:01courts deserve compliments for at least having taken a major step forward.
12:05We want to see more such public interest moves made by the government.
12:09So, good on you, Mr. Kadar.
12:11Good on you, Mr. Nadda.
12:12We need to see that happen more often in this country.
12:15Health and education are the key, really, to the future.
12:18Yes, Mr. Kadar, very quickly.
12:20Yes.
12:20If I get it, one second.
12:23One second.
12:24Yes.
12:24See, I request central government.
12:26Why always the court should come in between?
12:29The central government should come forward, take a decision for the benefit of the public.
12:34We shouldn't wait for the court always.
12:36I think that's well said.
12:38I think that's well said.
12:40If Mr. Nadda, you are listening to this, please move beyond anti-cancer to other essential medicines as well.
12:46Do not wait for the courts to intervene.
12:48Mr. Kadar, Dr. Swaminathan, Dr. Sareen, thank you very much for joining us.