Lens on stent bills to ensure lower prices

PSM News /

NEW DELHI, FEB 2017: 
With reports of several hospitals seeking 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 national drug pricing authority is in talks with the Insurance Regulatory and Development Authority of India seeking information on billing so that the data can be analysed to detect circumvention of the price caps.

NPPA is hopeful billing data will also help track down violations. Most patients who undergo angioplasty and procedures involving stents have insurance and claim reimbursement. Insurance companies therefore have all billing data. We are trying to tap that data to monitor the situation," a senior National Pharmaceutical Pricing Authority (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 that hospitals will find ways to maintain profits under other heads of medical expenditure.

"We are taking all possible steps to ensure compliance and to ensure that stent price capping benefits are passed on to the patients and no artificial shortage is created," NPPA chairman Bhupendra Singh said.

The data is also expected to point towards changing trends providing leads to authorities for further investigation or action in case of established violation. For instance, if there is a sudden spike in bed charges, the billing data is likely to point at it. 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. Apart from IRDA, the pharma pricing authority is also in talks with four to five major health insurance providers for billing data.