Feb 26, 2017

Monitor stent quality under CGHS: Pricing regulator to government

The National Pharmaceutical Pricing Authority (NPPA), while fixing the price cap on stents on February 13, also decided to request the Union health ministry to monitor the quality of stents that are being supplied under the Central Government Health Scheme (CGHS).

“The Authority also decided to request the Ministry of Health and Family Welfare to be vigilant about the quality of coronary stents under CGHS, in view of the fact that the manufacturers, hospitals and few other stakeholders did accept that the quality of stents supplied under CGHS rate contract was very ‘basic’,” the NPPA said in a detailed note attached with the minutes of the February 13 meeting where the stent price cap was decided.
The CGHS was started under the Union health ministry in 1954 with the objective of providing cheaper and comprehensive medical care facilities to central government employees, pensioners and their dependents residing in 25 CGHS-covered cities.

“If the perception is wrong, the same should be dispelled by random inspections and clinical trials and issue of necessary clarifications to restore the faith of CGHS patients. This monitoring exercise needs to be made regular and stringent, keeping public interest in mind,” the NPPA added in its request.

A stent is a tiny expandable metal scaffold to open up narrowed or blocked arteries. The ceiling price of bare metal stents (BMS) has been fixed at Rs 7,260 per piece and that of drug-eluting stents (DES) and biodegradable stents has been fixed at Rs 29,600 per piece.

While discussions were on with various stakeholders on how to decide the price cap, stent importers and manufacturers “were opposed to taking CGHS price or cost of production or even landed cost as benchmark, since as per their arguments, those prices neither reflected the actual market conditions, nor was such an option provided for, under DPCO, 2013”.

The NPPA noted: “They (stent importers and manufacturers) unanimously mentioned that stents being provided to CGHS were among the lowest category of DES and many patients had to pay out-of-pocket, if they went for ‘higher quality’ stents. This practice, as per their view, had been officially provisioned for by CGHS and was known practice by all hospitals availing CGHS rate contract.”

On the other hand, civil society representatives held the view that CGHS rates or the cost of production data could be taken as benchmark for price fixation on which a reasonable margin to distributors and hospitals could be provided for. However, the NPPA decided otherwise.

“The Authority also decided that the CGHS-based pricing method should not be taken as a benchmark because CGHS prices are based on open tenders and based on supply of bulk quantities where the manufacturers normally quote at the bottom level. CGHS-based prices do not provide scope for margins for future R&D, innovation and growth and may not be good from the public health policy perspective in the long term. Moreover, CGHS prices are meant for reimbursement and may not reflect real price…” the NPPA stated.

The NPPA also decided that the option of Price to Hospitals (PTH) should not be considered during price cap calculations, as hospitals are not legal entities as retailers and the margins at the level of PTH are too exorbitant to defeat the basic objective of price capping.

“Thus, for the final price calculations, the Authority considered the options of Price to Distributor (PTD), the landed cost (LC) and the cost of production (COP) data and excluded CGHS and PTH for the reasons discussed earlier,” the NPPA noted.
Source : http://indianexpress.com/

Feb 25, 2017

Option -1 for Pre-2016 Pensioners Rejected - Confederation

OPTION-I FOR PRE-2016 PENSIONERS REJECTED: In the meeting held on 30-06-2016, with Group of Ministers by JCM staff side, the Finance Minister had also clarified that Government has taken the decision to implement the recommendation of 7th CPC to bring about parity between past and present pensioners. (Vide NJCA Statement issued on 06-07-2016). Finance Minister categorically assured the NJCA leaders on 30-06-2016 that the Government has accepted the recommendation in to and Pension department has only been asked to sort out the difficulties in implementation of Option-I, if any.

NJCA wrote to Finance Minister on 16-07-2016, as follows: "The issue of acceptance of Option-I and II was discussed with your goodself at the residence of Hon’ble Home Minister (Govt. of India) wherein Hon'ble Minister for Railways and Hon'ble MoS Railways were present. You had categorically agreed our demand that no dilution would be made in the options given to the Pensioners by the 7th CPC. It is unfortunate that a rider "subject to feasibility" has been imposed on Option-I. Sir, this is very unfair and we will appreciate, if you kindly get the sentence "subject to feasibility" removed from that order, to keep your promise also".

But, Finance Minister had gone back from his assurance to JCM Staff side leaders and he refused to withdraw the condition “subject to feasibility". In the letter dated 17-10-2016, addressed to Chairman of the “Pension Option-I Committee”, the Secretary, JCM staff side requested as follows:

"The attempt therefore must be to explore the ways and means of implementing the said recommendation which is beneficial to a large number of pensioners, especially those retired prior to 1996. In view of this, the staff side is of the firm view that the Government issue orders for implementation of Option-I as there is no room for stating that the recommendation is impossible to be implemented for those who are benefitted by the said option".

Finally NJCA wrote a letter to Hon'ble Home Minister Shri. Rajnath Singh on 17-01-2017, requesting intervention. The letter reads as follows:

"The Central Government Pensioners numbering presently more than the working employees are aggrieved of the fact that the one and the only recommendation of the 7th CPC which was in their favour ie; Option-I have been recommended to be rejected by the Pension Department to the Government".

Inspite of all these, the proposal is submitted to cabinet to reject Option-I. This underlines the fact that unless NJCA revive its deferred indefinite strike, the Government will not allow Option-I to pensioners, as assured by Finance Minister.

Source: http://confederationhq.blogspot.in/


While deferring the indefinite strike from 11th July 2016, as per the assurance given by the Group of Ministers, the NJCA in its statement dated 06-07-2016, stated as follows:

"The committee set up to look into the matter of minimum wage and fitment formula is expected to submit their report to the Government in the given time frame of not more than four months".

Finance Ministry's press statement issued on 06-07-2016 also stated as follows: “The Ministers assured the Union leaders that the issues raised by them would be considered by a High Level Committee".
After one month, the NJCA wrote letters on 28-07-2016 to Hon'ble Home Minister, Finance Minister, Railway Minister and Cabinet Secretary in which it conveyed the following:

"It is a matter of concern that, despite elapsing of a pretty long time, nothing has been heard in this regard from the Government of India, which is leading to serious resentment amongst the Central Government employees."

Again after two months the JCM staff side, Secretary, wrote a letter on 12-08-2016, to Shri. Arun Jaitely, Finance Minister – "We are expecting a quick action on the part of the Government to operationalise the assurance of setting up a High Level Committee to go into the Minimum Wage, Multiplication factor etc. However, we are disappointed that even after a lapse of more than a month, no orders have been issued by the Government in this regard ………. we therefore appeal to you that the concerned authorities may be asked to expedite the issuance of orders setting up the committee and finalisation of the report within the available time of remaining three months."

A group of Senior Officers invited the JCM staff side on 30-08-2016 to discuss the grievances arising out of the recommendations related to 7th CPC. No High Level Committee was constituted and no terms of reference was notified. The second meeting with Group of seniors was held on 24-10-2016.

Eventhough the group of senior officers held two round of discussion with JCM staff side, surprisingly they had not come prepared to discuss increase in minimum wage and fitment formula. They made a mockery of the meeting by disclosing in the first meeting that they are not fully aware of the details of the issues to be discussed and in the second meeting they told that they came for discussing allowances (though another committee under the chairmanship of Finance Secretary is constituted for allowances) and not minimum wage and fitment formulas. The JCM staffside leaders felt humiliated.

After that meeting, the JCM staffside wrote the following letter on 26-10-2016, to Hon’ble Finance Minister…..

"We (staff side) interacted with the said committee headed by Shri. P. K. Das, Addl. Secretary (Expenditure) on 24-10-2016. It would be quite appropriate to bring to your kind notice that, we have felt, during the course of meeting, that the proceedings of the committee are extremely disappointing and are left with the impression that committee is dilly-dallying the issue…………….. we are, therefore, left with no option, but to address this communication with the fervent hope that, your goodself will direct the said committee to interact with the staff side in a fruitful manner and arrive at a mutually agreeable proposal on the issue of minimum pay and fitment formula…. We have full trust and believe that, the Government would honour the decision taken in the meeting held on 30-06- 2016 in your benign presence and suitable direction will be given to the committee to complete the assigned task within the stipulated time frame in a satisfactory manner…. It would be the most unfortunate development, we regret to state, if we are constrained to tread the path of struggle once again in the event of the committee not coming up with a satisfactory settlement."
Inspite of all these, after that (ie after 24-10-2016) no meeting of the group of senior officers was held and no discussion on minimum wage and fitment formula took place. The four months time fixed for the High Level Committee (which is yet to constituted) expired on 30-10-2016. Government has gone back from the most important assurance given to the NJCA leaders on 30-06-2016 by the Group of Cabinet Ministers. NJCA decided to defer the strike mainly because of this assurance of the Govt. that the Minimum pay and fitment formula will be enhanced. Now that Govt. has gone back and betrayed the entire Central Govt. employees and pensioners. NJCA has no other option but to revive the indefinite strike.

Source: http://confederationhq.blogspot.in/


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