National Pharmaceutical Pricing Authority (NPPA) has said that its price rationalization-initiated February 2019 has had a far-reaching impact on its decision leading to huge price reduction in anti-cancer drugs. Invoking extraordinary powers in the public interest, NPPA launched a pilot on Trade Margin Rationalization for 42 anti-cancer drugs to make healthcare more affordable for the suffering patients.
NPPA said in a statement as part of Observing the National Cancer Awareness day on 7 November 2020 that the decision received unanimous support from all the stakeholders. Based on the pharmaceutical companies’ feedback after implementing the NPPA notification, it was observed that, under this exercise, 526 brands of 42 anti-cancer drugs showed a price reduction of up to 90%.
For example, the MRP of the drug Erlotinib 150 mg tab under Brand Birlotib was revised from Rs 9999 to Rs 891.79, showing a decrease of 91.08%. Similarly, the MRP of Pemetrexed 500 mg injection sold as Semester 500 was revised from Rs 25,400 to Rs 2509, which was 90% less than the pre-revised price. Of the 124 medicines which used to cost more than Rs 20,000 pre-regulation, only 62 did so subsequently.
The pilot has affected annual savings of Rs 984 crore to cancer patients. It is also a matter of great satisfaction that the pilot has received immense support from all the stakeholders, including patients support groups.
All India Drug Action Network (AIDAN) has also appreciated the steps taken by NPPA to curb profiteering in the sale of anti-cancer medicines by capping the trade margin in the public interest. Today also, cancer remains one of the leading causes of adult illness and death due to chronic and non-communicable diseases (NCD) world-over, including in India.
According to World Health Organization (WHO), says NPPA, cancer is the second leading cause of death globally, and in 2018 there were approximately 18 million cases globally, of which 1.5 million were in India alone. There were around 0.8 million cancer deaths in India in 2018 against 9.5 million globally. The numbers of new cases are estimated to double in India by 2040.
The financial burden associated with cancer can force patients and households to acute misery, destitution, and even insolvency. Therefore, cancer drugs need to be affordable so that whenever required, the treatment can be provided at the earliest in the early stages when the cancer is curable. Availability and affordability of cancer drugs will give impetus to treatment outcomes bringing down the cost of treatment.
The Central Government supplements the State Governments’ efforts to prevent and control cancer and provide affordable and accessible care. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) is being implemented under the National Health Mission (NHM) for up-to-the district-level activities.
Under the ambit of Ayushman Bharat, Pradhan Mantri Jan ArogyaYojana (PM-JAY) is being implemented to reduce the financial burden for poor and vulnerable groups arising out of catastrophic hospital episodes and to provide access to quality health services. It offers a benefit cover of Rs 5,00,000 per family per year (on a family floater basis).
NPPA regulates the prices of all Drugs as per the Drug Price Control Order (DPCO) 2013. It fixes the Ceiling Price of scheduled formulations as per the list of medicines specified in the National List of Essential Medicines (NLEM), included in the First Schedule of Drug Pricing Control Order (DPCO), 2013.
By regulating prices of Scheduled Drugs, NPPA roughly covers only 16-17% of the Pharma sector universe. First Schedule of DPCO, 2013 also includes select drugs used for the treatment of cancer. However, a long-standing felt needs to regulate the Non-Scheduled segment further, also where high markups have led to arbitrary pricing practices.