New Delhi: The Modi government’s decision to transfer the chairperson of the National Pharmaceutical Pricing Authority (NPPA) to the National Authority for Chemical Weapons Convention, a bureaucratic backwater – has evoked dismay among patient rights groups.
As NPPA chairman, Bhupendra Singh was responsible for bringing in price controls to check the soaring price of cardiac stents and orthopaedic knee implants last February.
Both these moves have been applauded numerous times by Prime Minister Modi – who even tried to take credit for the price cut even though it came following sustained litigation by a lawyer, Birendra Sangwan – but came under strong criticism from the medical industry in India and abroad.
Singh’s transfer comes just about a week after the NPPA came out with a damning report which showed private hospitals making margins on the procurement of various medical items of up to 1737%, and passing on higher costs to patients. The report was prepared in response to public and media uproar over startling cases of high costs in private hospitals and medical laxity in treatment.
A 1985 batch IAS officer from the Uttar Pradesh cadre, Singh’s last day in office was Thursday. With an active Twitter account under his watch, the official NPPA handle tweeted, “#TeamNppa will miss him.”
— NPPA~India🇮🇳 (@nppa_india) March 1, 2018
As an officer, he was soft spoken in person but communicative on the NPPA’s social media accounts. Most importantly, he was proactive in disclosing public information on the NPPA website, including minutes of meetings and reports of expert committees. The price regulator was set up in 1997 but under his watch raised the bar for implementation, transparency, accountability and delivery in the government.
When the NPPA capped the prices of cardiac stents, the NPPA tweeted Singh’s own mobile number several times, asking people to contact him on phone or WhatsApp, with any reports of violations of the price caps. The accessibility of the price regulator brought many complaints directly to the body, cutting through bureaucracy.
Singh’s decisions to introduce price control on cardiac stents and later on knee implants, apart from the routine capping of medicines listed for regulation in the National List of Essential Medicines, won him praise from the public and the government, including the prime minister. The NPPA not just capped prices, but also monitored private hospitals and companies for violations, and followed up violations with orders for the recovery of money. The money was recovered as well.
But while the Prime Minister appeared to publicly congratulate the NPPA’s work repeatedly, including during election rallies, the Prime Minister’s Office (PMO) seemed to feel otherwise.
As reported by The Wire, the NPPA was under fire from the PMO, the NITI Aayog, the Department of Pharmaceuticals, the pharmaceutical and medical device industry in India and abroad, and even trade departments in the US.
The basic contention of the industry was that price regulation was hurting their ability to make profits, which they said caused a further impact on their ability to do research and innovation. This claim was not always supported by evidence. For example in the stent pricing issue, the NPPA asked companies several times to submit clinical data about the claimed superiority of stents made by companies like Abbott and Boston Scientific, who were demanding a higher price or threatening withdrawal from India. The companies did not submit this data.
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Watch Vinod Dua on the truth behind Narendra Modi’s claims to have reduced the price of stents
This economic argument was routinely rebutted by the NPPA with its emphasis on ethics – of “people over profit”. The NPPA was of the opinion that there is no problem with profits, but there is a problem with disproportionate profits which never trickle down to benefit the patient. The NPPA said as much in its February report, which analysed the massive margins which private hospitals were making on the procurement of medical items that were not regulated by the government.
Singh has been now transferred to the National Authority for Chemical Weapons Convention (NACW), which was set up by the government in fulfilment of the Chemical Weapons Convention which India has ratified. Under this convention, member countries are supposed to destroy any chemical weapons they have. India has already destroyed all chemical weapons stockpiles and production facilities.
‘Sudden and suspicious transfer’
“We are deeply concerned about the manner and timing of the transfer of Mr. Bhupendra Singh, Chairman NPPA, a move which seriously impacts public interest,” said the All India Drug Action Network (AIDAN), in a statement on Wednesday.
The previous NPPA chairman, Injeti Srinivas, was also transferred in under a year of working at the regulator. He had been instrumental in the price regulation of cardiac and diabetes medicine. AIDAN says that similarly, Singh had also taken many steps in the public interest which “discomforted the industry.”
“We fear that Singh’s transfer in total disregard to the public interest is due to the pressure from the industry and corporate hospital lobby,” said AIDAN.
The Swadeshi Jagran Manch also expressed surprise at this sudden transfer:
@narendramodi @PMOIndia Pl see, @Bhupendra_IAS your key man against pharma lobby, bringing down cost of stents and knee implants, exposing >1700% profiteering by corporate hospitals, working for bringing down prices of other medical consumables &devices, ‘rewarded’ with transfer pic.twitter.com/DxlSnmOw7q
— ASHWANI MAHAJAN (@ashwani_mahajan) March 1, 2018
The RSS affiliate body had also written to the prime minister on the issues reported by The Wire last year, regarding efforts by the NITI Aayog and PMO to dilute the powers of the NPPA. A few months later, the Department of Pharmaceuticals floated a draft pharmaceutical policy which also had clauses which crimped the functioning of the NPPA. The Swadeshi Jagran Manch had opposed this as well.