KATHMANDU, March 25: How fair is the pricing mechanism for our life-saving medicines? The pharmacies and drug companies are fleecing patients, if the rates for medicines at the dispensary run by the Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC), located within the premises of Tribuvan University Teaching Hospital (TUTH), are anything to go by.
While patients have to pay the maximum retail price (MRP) for medicines even at drug stores inside the premises of public hospitals, the MCVTC dispensary is selling them at prices less than half the printed MRP. If you are denied justice go to Gorkha, has long been a common saying. If you need to buy medicines go to Manmohan, can be a modern-day parallel to that paean to King Ram Shah.
The dispensary run by MCVTC at its premises–hardly a kilometer from the prime minister’s official residence–has been silently providing medicines at significantly lower rates even as the much-hyped Fair Price Shops proposed by Prime Minister Dr Baburam Bhattarai have fizzled out.
And the most surprising thing about all this is that the institute is not providing a penny in subsidy for the medicines. Dr Bhagawan Koirala, acting director of the institute, claims that Manmohan, instead, is making a profit of 15 percent even from its unbelievably low drug prices. “The drug manufacturers provide a very huge profit margin to drug retailers. We give that margin to the buyers,” Dr Koirala said matter-of-factly.
He added that manufacturers even provide free medicines to the stores. “But since they don’t have to provide free medicines to us as bonus, they can afford to supply them to us at a substantially lower rate,” he explained. All this shows that the real price of medicines is much lower than the rates at which they are being sold, he states.
Dr Koirala claims that patients are even harder done by when it comes to surgical tools and devices—such as valves and pacemakers in the case of heart patients—which are very expensive and don’t have the prices printed on them. “A public hospital has to run its own dispensary to provide medicines and every tool to patients at a just price,” he opines.
Bir Hospital—which is known as the hospital of the poor—generates up to a million rupees in monthly rent from a dispensary inside its premises but poor patients have to pay twice as much on average for every medicine than what one pays at the Manmohan dispensary. “I’ll concede that the drug stores are not being fair and are fleecing poor patients,” acknowledges Director of Bir, Dr Bulanda Thapa.
“I know that the exorbitant rent that the drug stores pay us ultimately hits poor patients from far-flung villages who come to us in the hope of getting a quality service at reasonable cost and we have even proposed to run our own pharmacy, but the health ministry has not been serious over the issue,” Dr Thapa claims.
Chief Drug Administrator at the Ministry of Health and Population (MOHP) Bhupendra Bahadur Thapa also concedes that the drugs market is not fair and opines that every hospital should have its own pharmacy to ensure fair prices and quality control.
The MoPH had brought in an interim Act in 2006 to check unfair practices at pharmacies but it is yet to be implemented. The Act has directed that zonal, sub-regional, regional and central hospitals must have their own pharmacies. “We are discussing how we can help Bir run its own dispensary,” Chief Drug Administrator Thapa discloses.
Dr Arun Sayami, dean of the Institute of Medicine (IOM), which runs TUTH and to which MCVTC is also affiliated, has seen how Manmohan has developed as a model institution even as the 400-bed TUTH teeters on the brink. “We have to improve many things at TUTH including the dispensaries,” Dr Sayami states.
However, MOHP Chief Drug Administrator Thapa warns that the drugs market is driven by profit and multiple problems will arise if a public hospital runs its own dispensary. And Manmohan also is already mulling not sell medicines at more than a 15 percent lower price than the MRP.
“We feel that companies are quoting unreasonably lower prices to enter our institute and fear our dispensary may not be sustainable in the long run if we continue to sell at the existing rates,” explains Dr Koirala, who also spoke of how he faced pressure from all sorts of places while starting the dispensary.
He, however, assures that medicines will continue to be cheaper at Manmohan even if the new guidelines are followed.byARJUN POUDEL/PREM DHAKAL from Republica