Maharashtra: Stents capped, services uncapped

The cap on prices of the life-saving cardiac stent may have had patients smiling — but not for long.

Investigations by officials show many hospitals, to make up for the losses, are increasing the cost of services, other medical devices and tests patients undergo while in hospital for treatment. And, medical insurance companies may be aiding hospitals to get these inflated bills cleared — the Food and ***** Administration (FDA) is now focussing its probe on this angle.

On February 13, the National Pharmaceutical Pricing Authority (NPPA) capped the cost of cardiac stents — the prices of drug eluting stents and bare metal stents were brought down to Rs45,000 and Rs7,623 (MRP, inclusive of vat and taxes) from the earlier Rs1.21 lakh and Rs31,080.

But officials said they have now found the hospitals and medical insurance companies have not reduced the packages offered for angioplasty procedures.

This means, while a patient will pay less for the stent itself, her overall treatment bill for an angioplasty procedure may not go down.

It was an FDA probe report from May 2015 that established the chain of profit-sharing in Maharashtra’s stent industry, eventually setting a plan in action to bring stents under the National List of Essential Medicines (NLEM) and finally leading to the nationwide cap on prices. “We are taking a lead from our previous investigations, and now focusing on medical insurance companies because we have found many distributors and companies also played a role in fleecing customers by altering MRP. Many hospitals and insurance companies have not yet changed packages. They are changing cost of other procedures to make up. Our officers are investigating details and will file a report,” said Dr Harshdeep Kamble, FDA commissioner, Maharashtra. Dr Kamble said the core aim of the move was to stop the exploitation of patients.

When HT spoke to insurance firms, their officials said they are currently reviewing market situation and will make changes. “We are observing the impact of the move (to cap stent prices). A final decision will be taken over a period of time, depending on cost of surgery and stents. We know NPPA’s guidelines and are aware of MRP of stents. No claims over and above that amount, charged by hospitals, will be settled,” said Sanjay Datta, chief underwriting and claims, ICICI Lombard General Insurance Company Limited. Some insurance firms accepted hospitals were refusing to lower package amounts, making it difficult for them to settle claims. “The move to cap prices is welcome, but many hospitals have revised charges of catheters, balloons, cathlab charges and professional fees after the NPPAs blanket ban. We are informing hospitals that no extra amount will be paid, if they are trying to compensate for the reduction of stent prices,” said Dr S Prakash, a senior executive director, Star Health Insurance.

Dr Prakash said insurance firms have a tariff chart of products used in cardiac procedures and a record of fees charged by doctors. “The change will take time. An industry that earned supernatural profits for two decades is hit by a storm. But as competition reduces prices, hospitals will follow suit.”