An enduring feature of India’s pharmaceutical regulatory regime has been its intervention in regulating prices of essential medicines — something that the NDA government has progressively expanded over the last six years to now include even medical devices. Paracetamol, ibuprofen, amoxicillin — all molecules with multiple Indian producers, near demand-supply equilibrium and a competitive market environment — are among the 950 plus drugs under price control at the moment.
When it comes to vaccines to protect the population amid surging cases in the midst of a pandemic, however, the scenario is diametrically opposite. India currently has just two Covid-19 vaccines in what is clearly a market overwhelmingly dominated by just one player. There is a proven supply constraint and demand is outstripping the availability of the jabs, with 30-odd states and multiple private hospitals chasing the two manufacturers. Here, however, the government has chosen a free market policy when it comes to price setting despite the evident shortage situation, in deviation with its stated policy for essential drugs and even devices.
Analysts, economists, lawyers and public health activists that The Sunday Express reached out to maintain that the stances taken by the Centre are in contradiction, especially given the fact that the government has pushed the burden of payments for these vaccines down to consumers — something that no other country has done.
The lack of pricing intervention — other than a requirement that manufacturers publicly disclose the prices at which consumer categories would be served — runs counter to the government’s stance on other drugs, most of which are operating in a competitive market scenario.
Take, for instance, paracetamol. All variations of this antipyretic have been under price control for years. Over 200 companies are involved in this market, which has given patients various brands like Calpol, Crocin, Dolo and Paracip. As of April 1, the ceiling price of a 650 mg tablet of paracetamol was less than Rs 2. Including the trade margins and taxes, the maximum retail price of this tablet would still only be a little over Rs 2.
Coronary stents, brought under price control in 2017 when their prices were slashed over 70 per cent, are offered by various multinational and Indian companies. These include Abbott, Medtronic, Boston Scientific, Sahajanand Medical Technologies, Meril Life Sciences and Translumina Therapeutics. Similarly, various vaccines essential to the Centre’s Universal Immunization Programme — including those for DPT, hepatitis B, polio and measles — are all under price control.
Most of these pricing interventions so far have been carried out by the National Pharmaceutical Pricing Authority (NPPA) through one of several processes.
However, as per a regulatory expert, the NPPA would have limited role to play in regulating the prices of Covid-19 vaccines, which means that it was up to the Centre to intervene in ensuring affordability and access here. “These vaccines were new vaccines. There was no earlier market data on pricing, so NPPA would not have been able to fix any prices for them. Secondly, since these vaccines were not mandated as essential, it would have been beyond its jurisdiction,” said the expert on condition of anonymity.
The ideal scenario, which the government did follow in the earlier phases of vaccination, was to negotiate with the vaccine makers to fix a price, according to the expert. “This is one of the universally adopted methods of price fixation,” the person added. Queries sent to NPPA Chairperson Shubhra Singh,
Department of Pharmaceuticals Secretary S Aparna and Health Secretary Rajesh Bhushan remained unanswered by press time.
Yet, where Covid-19 vaccines are concerned, the Centre has allowed the manufacturers to call the shots on pricing. The earlier rates of Covishield and Covaxin — the only two vaccines available at the moment…