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HOPE, SPELT OUT IN 72 WORDS

Health activists may not always be at loggerheads with the government. A set of 72 words tucked in multiple government orders issued last month that could impact households across the country in times to come has prompted sections of public health activists to assert their support for a new government initiative.

The orders, issued on July 10 by the National Pharmaceutical Pricing Authority (NPPA) under the department of pharmaceuticals of the Union chemicals and fertilisers ministry, imposed price caps on 108 medical formulations used to treat cardiovascular diseases and diabetes.

The move will add more medicines to the list of 348 drugs already under price control in India. But it is the 72 words in Paragraph 9 of the NPPA order that has stirred support from health activists.

They signal that the government has plans to impose price caps on several other groups of medicines — anti-cancer drugs, anti-HIV drugs, anti-TB drugs, anti-malarial drugs, anti-asthmatic drugs, and vaccines.

“This would be a great Independence Day gift from the government to the people of India,” said Malini Aisola, a health researcher with the Public Health Foundation of India, New Delhi, who is involved in a project analysing drug pricing policies. “Households across India would benefit through reduced medical bills.”

India, through its thriving pharmaceutical industry that produces inexpensive generic medicines for the domestic and international markets, has earned itself the title, “the pharmacy of the world”. But several studies over the past decade on health expenditure patterns in the country suggest that many households cannot afford medicines.

Although the number of people covered by health insurance in India — through a combination of private health insurance and public-funded schemes — has grown from less than 50 million persons in 2007 to over 300 million, most of these plans cover hospitalisation and not medicines consumed at home.

A study by Aisola and her colleagues at the PHFI released last year estimated that the money spent on medicines accounted for about 66 per cent of the total personal expenditure on health.

The Union health minister, within days after taking over in May this year, had asked health officials to work with state governments to determine the logistical details to procure and distribute free drugs through government clinics, a plan announced two years ago by the UPA government but has remained unimplemented.

But while the health ministry seeks strategies to scale up the free-medicines programme, the NPPA’s proposal to expand the list of drugs under price control to new therapeutic classes of drugs is being hailed by civil society groups.

“We broadly support this move — more medicines should come under price control,” said Amitava Guha, convenor with the Jan Swasthya Abhiyan, a network of non-government organisations campaigning on public health issues.

In two independent cases filed in Delhi and Mumbai courts, associations of the pharmaceutical industry have challenged the NPPA decision to impose price caps on the 108 formulations on cardiovascular and diabetes drugs, claiming that the caps will cause an annual loss of over Rs 600 crore to the industry.

But Guha believes this is an overestimate. “We have analysed the impact of the order product-by-product, and we believe that the loss should be about Rs 350 crore,” Guha said. “This is a loss of only 2 per cent in the set of anti-diabetic drugs and a 2.5 per cent loss in the cardiovascular medicines.”

The NPPA proposal to expand price controls to the other classes of medications promises relief to patients with chronic conditions as well as infections such as tuberculosis and malaria that still infect thousands of people in India each year. The challenge for the government is to ensure that it delivers on its promises.