The survey throws up many questions. In spite of having State-run agencies to purchase medicines, government hospitals are doing parallel procurements. Also, there is no common rate list for hospitals and agencies. Should there be price variation in public sector hospitals? Why are the agencies not buying adequate quantities of medicines required by the facilities? It can only be concluded that the reason for the failure of a centralised system is lack of transparency and accountability.
Another important aspect that came to light during the hearing of the case was the sale of large quantities of drugs in “irrational combinations”. According to the petitioners, the system by which the drugs are certified for human consumption does not appear to be very effective, not only because of a lack of adequate laboratory and testing facilities but also because of a lack of human resources within the agencies which are supposed to subject such drugs to testing before clearing them for bulk manufacture and use by consumers.
“The easy supply of drugs produced from an irrational combination of salts is one of the major concerns today,” says Gopal Dabade, a member of the All India Drug Action Network. He gives the example of Dixorin, a medicine prescribed to cure anaemia in pregnant women. “It is the sixth largest-selling drug in the country today and the companies that are manufacturing it are using ‘alcohol’ in different proportions in their formulation. Likewise, there are other medicines which claim to have therapeutic qualities but they are of no help,” says Dabade.
The price control order does not address this issue at all. The irrational combination of drugs is a major issue. It hikes the overall price of medication unnecessarily and also increases the side effects.
However, the biggest drawback of the price control order is that it fails to include life-saving drugs into its ambit. Medicines needed for major health issues like diabetes, hypertension, tuberculosis, anaemia and HIV have been included in the list of drugs but not under the price control order. Even patented drugs have been excluded from it.
There are only a few essential medicines that are listed under the price control order. The government was operating under the assumption that market forces will keep the prices of the medicines in check but this hasn’t happened. Taking the average price of the three top-selling branded medicines as the criteria for price fixation has not lowered the prices since 2011. Instead, cheaper products, which are similar in nature, have had to raise their prices in order to remain in the market. Therefore, the costlier brands are deciding the market price. There is also no transparency on how the manufacturers are setting the mrp for their respective products.
The government has accepted that the issues raised are already under examination. But the question here is whether the government is ready to modify the NPPP. Most importantly, the government should be keen to improve the supply chain management in public hospitals, which is the only place for the poor to get quality treatment at an affordable price. Today, the irony is that the government takes great pride in calling itself one of the biggest exporters of medicines in the world but it has failed to look at the thousands of people who cannot afford to buy even the most essential of medicines.
In the coming months, we will get a real picture as to how serious the government is when it comes to the well being of its citizens. The situation of health care in the country is alarming and addressing the issue of price regulation of drugs should be a priority.