Ok. Let’s set the record straight on the so called #BJPPharmaLoot ‘campaign’ on social media. There is a lot of public sentiment getting whipped up around this hashtag. While the reach and the ability of a simple platform to shape public debate amazes, the ability to make comments without having to justify them with evidence or stand up for mistruths when you are held to account, disappoints.
The chronology of events adds good perspective to the issue. On May 15, 2013, the Dept of Pharmaceuticals under the Ministry of Chemicals and Fertilizers issued the Drug (Prices Control) Order, 2013 which is commonly called DPCO or ‘price control’. This is not the first time that such an order was issued. Amongst many other policies, a similar price control order was issued in 1995. Following increased consumer activism around high medicine prices, the order was reviewed in the National Pharmaceutical Pricing Policy in 2012 and subsequently the DPCO 2013 was made law.
Under this order, only prices of medicines that fall into the National List of Essential Medicines (NLEM) are regulated. This was done to ensure that medicines deemed ‘essential’ or life-saving (as defined by the WHO) were priced reasonably and within the affordability of a majority of India’s population that could buy them. The hundreds of millions, who didn’t have a hospital in their village or a pharmacist to buy the medicines from, were left to their fate. But that’s another story.
Under the DPCO of 1995 there were only 68 such medicines which were deemed ‘essential’. The 2013 order expanded that list considerably to include 348 molecules which were available as 650 formulations (capsules, tablets, injections and syrups of different strengths). Was it enough to create access to the 1.2 billion people of India? Of course it wasn’t. Were prices reduced enough? The order impacted prices of medicines by 22% which is in line with the reduction of prices in some developed markets.
As with most policy changes in India, the DPCO also was appreciated, critiqued and downrightly condemned in equal measure. However, as the winds of political change swept India in May 2014, the National Pharmaceuticals Pricing Authority that is tasked ‘to implement and enforce the provisions of the Drugs (Prices Control) Order in accordance with the powers delegated to it’, decided to extend the price control order by citing Para 19 and giving itself sweeping powers to regulate prices of all drugs (essential and non-essential). In July, it issued an order to bring 108 more molecules that were not a part of the essential list of medicines and cap prices. Under paragraph 19 of the Order, the NPPA was empowered to do it only under “extraordinary circumstances, if it considers necessary to do so in public interest”. Extraordinary circumstances are understood as times of national disasters, epidemics or such grave situations that require the government to step in and take control. Thankfully, neither such circumstances prevailed nor was there such a grave situation in India at the time.
Since it was clear that the NPPA may have acted in haste to regulate prices of non-essential medicines, the industry sued the body. With its bluff called, the NPPA decided to reverse the guideline that gave it sweeping powers. This means that the NPPA can no longer act unilaterally to regulate the prices of medicines. What it definitely does not mean – as the #BJPPharmLoot hashtag erroneously claims – is that medicine prices in India have been deregulated.
Emotional messages such as in the picture above, are completely misinformed and spread untruths about the policy change. Look at the prices of Imatinib (generic molecule name of Glivec) in the picture below. Do you see the prices mentioned in the emotional message anywhere there?
There are questions about whether this was hastily done to coincide with Prime Minister Modi’s trip to the United States where IPR related issues are expected to take centre-stage. The two issues seem unrelated. Firstly, the US government has never challenged India’s policy to regulate drug prices. Fighting against rising healthcare costs through the popularly known ‘Obamacare’ policy, it seems counterintuitive for the Obama administration to find fault with another government for doing exactly that. Secondly, the US has only challenged India on what it calls ‘flimsy’ patent laws. That has nothing to with the regulation of prices of non-patented medicines.
So, does the recent NPPA decision impact drug prices? The simple answer is not yet. Not only will the prices of medicines on the essential list (NLEM) continue to be capped as before, the prices of the new 108 non-essential medicines are also still capped. It is likely that the court may rule that the cap be removed, but until it does, who knows.
The only change that happened in the recent development is that the Solicitor General of India held that the NPPA over-reached its brief and therefore asked it to step back. That is all that the NPPA did. Medicine prices did not shoot back through the roof. They remain where they are. This interplay involved the Solicitor General of India and the NPPA. Whence BJP, Pharma or Loot?