Many poor and even middle-income patients, who spend their entire life savings for treatment of life-threatening ailments, such as, cancer, have been virtually priced out of the access to patented new drugs, across the world. As articulated by the American Society of Clinical Oncology in 2014, prices of these medicines are increasingly getting disconnected from the actual therapeutic value of these products.
The plight of such patients is worse in India, and would continue to be so, as there is not even a remote possibility of Universal Health Care/Coverage (UHC) visible anywhere near the healthcare horizon of the country.
There is no recent worthwhile Government action either, to give shape to its an important decision on this issue, in a meaningful way. That critical decision was also scripted in Para 4.XV of the National Pharmaceutical Pricing Policy 2012 (NPPP 2012), and was notified on December 07, 2012. On ‘Patented Drugs Pricing’, it categorically states as follows:
“There is a separate committee constituted by the Government Order dated February 01, 2007 for finalizing the pricing of Patented Drugs, and decisions on pricing of patented Drugs would be based on the recommendation of this committee.”
Just a couple of months after, on February 21, 2013, the Department of Pharmaceuticals (DoP) in a communication to the stakeholders announced that the committee to examine the issues of ‘Price Negotiations for Patented Drugs’ has since submitted its report to the Department. Simultaneously the stakeholders were requested to provide comments on the same urgently, latest by March 31, 2013.
Following this long overdue report, lack of any worthwhile action, both by the previous and the current Governments, possibly coming under a strong pressure of the self-serving interests of the constituents of ‘Big Pharma’ and their trade associations, is indeed glaring. I shall dwell on that in this article.
A brief recapitulation:
As stated earlier, almost a decade ago, an expert committee was constituted by the Government to suggest a system that could be used for price negotiation of patented medicines and medical devices ‘before their marketing approval in India’.
This committee reportedly had 20 meetings in two rounds, where the viewpoints of the pharmaceutical industry, including large multi-industry trade bodies like – FICCI, various NGOs and other stakeholders were taken into consideration. Simultaneously, it had commissioned a study of the Rajiv Gandhi School of Intellectual Property Law and Indian Institute of Technology (IIT), Kharagpur to ascertain various mechanisms of price control of patented drugs in many countries, across the world, for independent research based inputs for this report.
Salient features of the report:
The salient features of this expert committee report were as follows:
Scope of recommendations:
The Committee in its final report recommends price negotiations for Patented Drugs only towards:
- The Government procurement/reimbursement
- Health Insurance Coverage by Insurance Companies
Issues to remain unresolved despite price negotiation:
In the report, the Committee expressed the following view:
Even after calibrating the prices based on Gross National Income with Purchasing Power Parity of the countries, where there are robust public health policies with the governments having strong bargaining power in price negotiation, the prices of patented medicines will remain unaffordable to a very large section of the population of India. Such countries were identified in the report as UK, Canada, France, Australia and New Zealand.
Thus, the government should extend Health Insurance Scheme, covering all prescription medicines, to all those citizens of the country who are not benefitting under any other insurance/reimbursement plan.
Three categories of Patented Drugs identified:
The committee identified three categories of patented drugs, as follows:
- A totally new class of drug with no therapeutic equivalence
- A drug that has therapeutic equivalence, but also has a therapeutic edge over the existing ones
- A drug that has similar therapeutic effectiveness compared to the existing one
It recommended that these three categories of Patented Drugs would require to be treated differently while fixing the price.
The Apex body for ‘Patented Drugs Price Negotiation’:
The Report recommends a committee named as ‘Pricing Committee for Patented Drugs (PCPD)’ headed by the Chairman of National Pharmaceutical Pricing Authority (NPPA) to negotiate all prices of patented medicines.
As CGHS, Railways, Defense Services and other Public/Private institutions cover around 23 percent of total healthcare expenditure, the members of the committee could be invited from the Railways, DGHS, DCGI, Ministry of Finance and Representatives of top 5 health insurance companies in terms of the number of beneficiaries.
Recommended pricing methodology:
For ‘Price Negotiation of Patented Drugs’, the report recommends following methodologies for each of the three categories, as mentioned earlier:
1. For Medicines having no therapeutic equivalence in India:
- The innovator company will submit to the PCPD the details of Government procurement prices in the UK, Canada, France, Australia and New Zealand for the respective Patented Drugs.
- In the event of the concerned company not launching the said Patented Drug in any of those reference countries, the company will require to furnish the same details only for those countries where the product has been launched.
- The PCPD will then take into consideration the ratio of the per capita income of a particular country to the per capita income of India.
- The prices of the Patented Drug would be worked out in India by dividing the price of the medicine in a particular country by this ratio and the lowest of these prices would be taken for negotiation for further price reduction.
The same methodology would be applicable to medical devices also and all the patented medicines introduced in India after 2005.
2. For medicines having a therapeutic equivalent in India:
- If a therapeutically equivalent medicine exists for the Patented Drug, with better or similar efficacy, PCPD may consider the treatment cost for the disease using the new drug and fix the Patented Drug price accordingly.
- PCPD may adopt the methodology of reference pricing as stated above to ensure that the cost of treatment of the Patented Drug does not increase as compared to the cost of treatment with existing equivalent medicine.
3. For medicines introduced first time in India itself:
- PCPD will fix the price of such drugs, which are new in the class and no therapeutic equivalence is available, by taking various factors into consideration like cost involved, risk factors and any other factors of relevance.
- PCPD may discuss various input costs with the manufacturer asking for documenting evidence.
This process may be complex. However, the report indicates, since the number of medicines discovered and developed in India will not be many, the number of such cases would also be limited.
Negotiated prices will be subject to revision:
The report clearly indicates that ‘the prices of Patented drugs so fixed will be subjected to revision either periodically or if felt necessary by the manufacturer or the regulator as the case may be.’
Support from the domestic Indian Pharmaceutical Industry:
Pharma MNCs reportedly said that ‘Price Negotiations for Patented Products’ should be made only for Government purchases and not be linked with ‘Regulatory Approval’. They also expressed their serious concern on the methodology of ‘Patented Products Pricing’. Nevertheless, from the domestic Indian Pharmaceutical Industry, such as, Indian Pharmaceutical Alliance (IPA), Indian Drug Manufacturer Association (IDMA), Pharmexcil, Federation of Pharma Entrepreneurs (FOPE) and Confederation of Indian Pharmaceutical Industry (CIPI), there emerged strong voices of support for this Government initiative
DIPP expressed apprehensions:
Interestingly, though the DoP had proposed in the report that once the Patented Drug Policy is implemented the issuance of CL may be done away with, the Department of Industrial Policy and Promotion (DIPP) has reportedly commented with grave caution, as below:
“If it is decided that Price Negotiations on Patented Drugs should be carried out, then the following issues must be ensured:
- Negotiations should be carried out with caution, as the case for Compulsory License on the ground of unaffordable pricing of drugs [Section 84(b) of the Patent Act] will get diluted.
- Re-Negotiations of the prices at periodic intervals should be an integral part of the negotiation process.”
The status today:
The bottom-line is, a decision on the pricing policy for patented drugs is still pending with the Government, since a decade.
Post February 2013 report, without assigning any specific reasons, the whole process, intriguingly, came back to the square one. On February 2014, the DoP reportedly again decided to constitute another inter-ministerial committee to consider the subject, and recommend the pathway for its implementation in India. Nothing tangible has happened, since the first experts’ committee submitted its report, six years after it was formed, to address this critical patient-centric issue of the country. Effective governance remains a key issue in the health care space of India, even today.
The chronicle continues. On August 23, 2016, ‘The Indian Express’ reported that: “Gross negligence, lackadaisical attitude, vested interests, are some of the terms used in a report by the Parliamentary Committee on ‘Government Assurances’ on August 11, 2016, for the DoP on the latter’s inability to regulate the prices of patented medicines even after almost a decade of deliberation on this issue. While the NDA government has been in power since 2014, the second committee is yet to submit its report, it said.
However, in the end, the Parliamentary Committee reportedly said: “The Committee would like the ministry to take the proactive steps to expedite the proper follow action to finalize the requisite mechanism of patented drugs at the earliest and in the best interest of the country so that these medicines are made available to the common people at most affordable rates.” Let’s continue to wait and watch!
I reckon, a robust mechanism of ‘Price Negotiation for Patented Drugs’ would also benefit the global pharmaceutical companies to put forth even a stronger argument against any Government initiative to grant CL on the pricing ground for expensive innovative drugs in India. At the same time, the patients will have much greater access to patented drugs than what it is today, due to Government setting the purchase of these drugs at a negotiated price.
It’s about time for all those who are responsible for framing drug and health elated policies to introspect whether ‘policy paralysis’ is continuing, even today, in this area under intense pressure of vested interests. If not, the counter question that needs to be satisfactorily answered: While several secretaries have changed in the DoP since 2013, why is the policy on patented drug pricing, mooted by the Government a decade ago, not moved forward even an inch, to safeguard the patients’ health interest?
By: Tapan J. Ray
Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.