A lawyer calls the Prime Minister’s bluff on coronary stents

At an election rally in Gursahaiganj, Kannauj on February 15, Prime Minister Narendra Modi took credit for massively slashing the prices of stents—which are used to treat narrowed or weakened arteries in the heart. The decision, which was taken the previous day, he said, would help the poor suffering from heart ailments to get stents at just ₹8,000, which was earlier sold at ₹45,000. Why had the Congress for years failed to revise the prices of stents, he asked.

Indeed the decision was a huge relief for many cardiac patients across the country as the ceiling price of bare metal stents was brought down to ₹7,260 from ₹45,000; and that of drug eluting stents were fixed at ₹29,600 from about a whopping ₹1.2 lakh. Clearly there was much profiteering happening on the sale of stents.

However, the PM as usual was economical with the truth on why and how his government had to slash the stent prices.

The fact is that the Modi government had not put 'stents' on the list of essential medicines on its own and had dithered with slashing the stent prices as long as possible till the Delhi High Court left it with no option by issuing it a March 1, 2017 deadline. And, behind all that were the efforts of a lawyer—Birender Sangwan, who through his persistent efforts since 2014, made that all happen.

"The UPA Government did bring in important reforms such as the National List of Essential Medicines (NLEM) in 2011 and also issued the Drug Price Control Order (DPCO) in 2013," said senior Congress spokesperson Abhishek Manu Singhvi, who along with Sangwan, addressed a party press briefing in New Delhi on Wednesday.

"However, the Congress doesn't claim to have listed stents in the essential medicines list nor should the BJP take credit for the decision," he said.

The Stent Stunt

The various copies of complaints and PILs filed by Sangwan do indeed chronicle his efforts, and puncture the NDA government's claims.

"After being shocked by the offensive price of around ₹1.2 lakh charged for stents when his friend’s father was admitted at a Faridabad private hospital, Sangwan took up the battle thereon to stop the profiteering on stents."

Sangwan first got a reply to a Right to Information query on December 9, 2014 from the National Pharmaceutical Pricing Authority (NPPA), which regulates the prices of medicine in India. In 2013, through the Drug Price Control Order, the NPPA had got the power to fix the maximum price limit for essential drugs.

The RTI reply stated that the stents were notified as “drugs” under the Drugs and Cosmetics Act. But stents were not included in the National List of Essential Medicines (NLEM) — a prerequisite for it to be covered under the Drug Price Control Order. Therefore, there was no “ceiling price” fixed and profiteering was rather the norm when it came to stents.

Sangwan says he then filed his first Public Interest Litigation (PIL) in the Delhi High Court in February 2015 and that the Court thereafter on February 25, 2015 directed the Centre to include ‘coronary stents’ in NLEM.

However, with nothing happening from the government's side, Sangwan says he filed a contempt petition against the Centre in July 2015. Finally, after a long wait, he says, when the High Court considered the contempt petition in October 2016, he got a copy from the government that said that stents had been already put in the essential medicines list in July that year. "I wasn't aware of it till October," he says.

The Health and Family Welfare Ministry had issued a notification on July 19, 2016 to include coronary stents in NLEM “with immediate effect”. But that was all. The next necessary step was still not taken—of the Department of Pharmaceuticals, which comes under the Ministry of Chemicals and Fertilizers, notifying stents as a ‘Schedule-I drug’, without which it wouldn’t be eligible for price control.

The stents, meanwhile, continued to be sold at high rates and beyond the reach of many people.

There were reports that the Ministry of Chemicals and Fertilizers in the meantime had talks with the US-India Business Council which has among its members Abbott Laboratories, Boston Scientific, Medtronic and other US-based companies that were said to be opposed to stents coming under price control.

“If the Modi government was sincere about slashing the prices of stents, then why didn’t it do anything after July 19? The price of coronary stents had not been fixed despite it being included in the essential list of medicines,” says Sangwan. He says he then filed his third petition in November 2016.

On December 7, 2016, the Delhi High Court asked the Centre on its stand on fixing the maximum retail price of coronary stents. Then on December 22, the court gave the NDA Government a deadline of March 1, 2017 to fix the maximum retail price of coronary stents.

The government subsequently included stents in the first Schedule of the Drug Prices Control Order in December 2016. And, finally, on February 14, 2017, capped the prices of stents. And, the PM presented a contrary narrative to the people the next day at the Kannauj rally.

“It was only the fear of the contempt notice that made the NDA government reduce the prices of stents—not because of public interest,” said Abhishek Manu Singhvi.