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Gireesh Babu, New Delhi October 03 , 2022
The Department-related Parliamentary Standing Committee on health and family welfare has recommended to the Central government to look at regulating the price of services such as radio therapy, under the provisions of the Essential Commodities Act in line with the regulations on the drug prices, to make cancer treatment affordable to the public.

It has also recommended to the government to look at group negotiation for cancer drugs, equipment and consumables to bring down the cost of cancer treatment in the country.

The Committee, under the Chairmanship of Member of Parliament Prof. Ram Gopal Yadav, in the 139th report on Cancer Care Plan & Management: Prevention, Diagnosis, Research & Affordability of Cancer Treatment, said that the cost of cancer treatment is not only the price of the medicine but the cost of healthcare for any patient in the country includes a variety of charges viz. doctor consultation and nursing fee, room charge, pathological and maintenance charges thereby increasing the overall cost of the treatment.

The government is providing subsidised food, heavily subsidised power, however, inaccessible and increasing cost of cancer treatment is a matter of concern for the Committee, as not only the patient but the whole family undergoes tremendous psychological and economic pressure in bearing the cost of the treatment and sailing through troubled phase of life.

“The Committee, therefore, considers it pertinent, on the part of the government, to take suitable measurers not only for regulation of medicines having focus on reducing the cost of the medicine but to provide subsidised healthcare by regulating the cost of diagnostic and treatment kits and service charges for various components of healthcare rendered not only in government hospitals but also in the private hospitals,” it said.

For instance, the high cost of radio therapy is resulting in unaffordable cancer treatment. The Secretary, the Department of Pharmaceuticals has appraised the Committee that the National Pharmaceutical Pricing Authority (NPPA) is mandated only to control drug charges through DPCO and not the service charge because radio therapy service has not been declared an essential commodity/service under the Essential Commodities Act-1955 or by National List of Essential Medicine.

“The Committee, therefore, recommends the government to examine as to the types of services should be regulated in terms of price and therefore be made provision of the Essential Commodities Act-1955. The Committee hopes that the ministry of health & family welfare would take the matter on board for final decision,” averred the report.

It noted that the anti cancer drugs as well as equipment are very expensive and the cancer centers would find it difficult to negotiate competitive prices with equipment manufacturers and the pharmaceutical industry. It has also been informed that exploiting the volumes of individual cancer centres, the National Cancer Grid (NCG) has negotiated with pharmaceutical companies for high value cancer drugs.

By aggregating the demand from many centres, the NCG worked on a solution wherein “price discovery” of commonly used, high-value items are negotiated with industry, thereby passing on the benefits to member centres and onwards to patients. Using transparent policies for tendering and a web-enabled e-tendering platform, this initiative has brought down current costs of cancer care significantly (average of 55% discount on MRP) while maintaining the quality of drugs, it observed.

“The Committee believes that Group negotiation for cancer drugs would facilitate better price for the anti cancer drugs by increasing the bargaining power. The Committee accordingly recommends the government to take measures to encourage such group negotiation for cancer drugs through a transparent central tendering platform. The Committee notes that such group negotiations by Tata Memorial Centre have led to a 20 to 80 % discount on cancer drugs. The Committee further recommends the government to extend such price negotiation to equipment & consumables also,” said the report.

Appreciating the efforts of Pharmaceutical and Medical Devices Bureau of India (PMBI) in implementing Pradhan Mantri Jan Aushadhi Pariyojana (PM-BJP) that intends to provide quality generic medicines at affordable costs through 8,700 Jan Aushadhi Kendras the Committee opined that it should incorporate into its strategy to open the Jan Aushadhi Kendras at the block level to ensure the accessibility of affordable and accessibility of cancer medicines to the patient at the doorstep.

In response to the Committee's query regarding the measures that have been taken by the Department of Pharmaceuticals to strengthen the supply-chain so as to ensure that the availability of anti- cancer medicines in public hospitals and Jan Aushadhi Kendras, the Department stated that the logistics system of PMBJP is being strengthened. At present four modern warehouses at Gurugram, Guwahati, Chennai and Surat for storage and distribution of drugs are functional with storage area of approximately 2,15,000 Sq. Fts. PMBI is doing direct supply to stores from our warehouses to ensure sufficient availability of medicines at all the stores. Besides this, PMBI has a distributor network of 39 distributors in all corners of the nation to support the supply of medicines to remote and rural areas.

In order to ensure availability of medicines, an Information Technology (IT) enabled End-to-End supply chain system with Point-of-Sale (POS) application for value added services has been implemented by PMBI to monitor end to end supply chain management systems. All kendras have a choice to place orders from any of the distributors or from Gurgaon Central Warehouse or Chennai/Guwahati/Surat warehouse also. These are backed by SAP based inventory management systems. Thus, a competitive system has been created where stores have an option to procure from a distributor or PMBI directly, said the Department of Pharmaceuticals.

“The Committee appreciates the supply chain arrangement made by the Department of Pharmaceuticals, however, it is expected that the structural arrangement of supply chain management must have adequate functional operational mechanism to have the robust management for ensuring availability of medicine in all the PM Jan Aushdi Kendras,” observed the report.

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