Stent price caps chasing manufacturers from the market

Global pharmaceutical companies are trying to withdraw from the Indian coronary stent market following a price cap introduced by the National Pharmaceutical Pricing Authority (NPPA). The price cap of stents has proven an unpopular move amongst international investors and pharmaceutical manufacturers.

Some international pharmaceutical companies, such as Abbott and Medtronic have already submitted withdrawal requests to the NPPA to take some of their stents off the market. These requests were refused by the NPPA, though there is speculation that repeated withdrawal requests will be submitted as the companies have maintained a hostile outlook due to the price caps.

Abbott joins other international groups such as Boston Scientific and Johnson & Johnson in announcing that in May the group of companies intends to discuss with Indian officials the future of their relationship with the country. In this discussion, the companies are to establish that any further price control measures put in place by the Indian government could seriously endanger any future investments, or new products marketed in India.

Prime Minister Narendra Modi has reportedly mentioned that the wellbeing of Indians in need of medical care is more important than “unhappy companies”. While this statement likely to win the support of many voters, it may be short sighted. India is, at the present time, reliant on a number of these companies for the supply of medical devices. To strain relations with these companies could potentially — as in the case with Abbott and Medtronic — see more attempts to withdraw products from the Indian market.

Some view the situation more optimistically. The Times of India has noted a shift in the overall market share in India, with domestic companies shifting from 30 percent of the market share to 40 percent following the price cap on stents. This indicates that, as international companies threaten to withdraw from the market, domestic companies are more than happy to fill the void. Some caution that Chinese imports may also flood the market.

This presents a potential beneficial situation to both the Indian pharmaceutical manufacturing companies, as well as the patients themselves. With an increased market share, profits will rise. Simultaneously the Indian stent market will be dominated by domestic stents selling 30 percent cheaper than their imported equivalents, increasing access to the poor.

There are however disadvantages in terms of potential technological advancements in regards to stent development. By putting both drug eluting stents, and the more advanced biodegradable stents under the same price cap, the likelihood of more advanced stents entering the market is massively reduced. Biodegradable stents — of which Abbott is the only manufacturer in India — previously sold for around Rs 2 lakh (200,000).  As they are now limited to Rs 30,000, there is no longer an incentive for similarly advanced stents to be marketed in India.

The tough stance presented by companies such as Abbott may however amount to little real world effect. Cardiologists have claimed that the attempted withdrawal of “Absorb BVS”, the company’s biodegradable stent is an attempt to save face over allegations of safety concerns with the product. Though the company states the withdrawal is due to the price capping making the stent commercially inviable. Cardiologists, as well the FDA note that the stent has been shown to increase the risk of death by cardiac arrest.

Some domestic stents producers remain optimistic over the situation. Manish Doshi, founder-president of Envison Scientific Private Limited — himself owning 16 patents on stents — believes the domestic share of the market could see a further increase of 50 percent in the coming years.