With reports of hospitals see king to beat the price cap on stents by shifting charges under other heads, the National Pharmaceutical Pricing Authority (NPPA) plans to seek billing data from the insurance regulator and insurance providers to ensure price reductions are passed on to patients.
The drug pricing authority is in talks with the Insurance Regulatory and Development Authority of India seeking information on billing so that data can be analysed to detect possible circumvention of price caps. “Most patients who undergo angioplasty and procedures involving stents have in surance and claim reimbursement. Insurance companies therefore have all billing data.We are trying to tap that data to monitor the situation,” a senior NPPA official told TOI.
While hospitals and cardiologists were found earning most of the margins on stents, up to 650% in some cases, there are concerns hospitals will find ways to maintain profits under other heads. “We are taking all possible steps to ensure benefits are passed on to the patients and no artificial shortage is created,” NPPA chairman Bhupendra Singh said.
NPPA is hopeful billing data from insurance companies will also help track violations.For instance, it will show a sudden spike in bed charges. Or if the overall billing does not come down as a result of price control for stents, it will prompt authorities to investigate.
NPPA has already asked hospitals, nursing homes and clinics performing cardiac procedures using stents to disclose separately the cost of the stent while billing a patient. Medical facilities, including retailers and dealers of stents, will also have to display price list of stents on a part of their premises which is easily accessible to any person wishing to consult the same.
It has also written to all state chief secretaries to ensure price cut compliance, availability and uninterrupted cardiac care services. It has also asked states to ensure manufacturers and importers do not cut down production and supplies.
The decision to rein in hospitals which inflate stent prices is hopefully the beginning of an exercise to make good healthcare affordable and accessible to all. Besides checking pricing of devices, the national pharma authority must track the overall cost of cardiac treatment to ensure private facilities do not try to inflate bills under other heads to make up for the loss in earnings from implants