If you aren’t a government employee – and the overwhelming majority obviously aren’t – an angioplasty could cost you five to six times what the government pays for those covered under schemes like the central government health scheme (CGHS), the Indian railways health directorate or various state health schemes.The dealer price or the landed cost (total cost of an imported item as recorded by customs, which includes original cost of the item, brokerage and logistics fees, shipping costs, customs duties, tariffs, taxes, handling fees etc) in India for a drug eluting stent (DES) is not more than Rs 40,000, often just Rs 20,000. But patients are charged anything from Rs 55,000 to Rs 1.2 lakh for a DES.The rate fixed by the Maharashtra health ministry under the Rajiv Gandhi health scheme for the poor in February 2014 and by the Centre for the CGHS in April last year was Rs 23,625. Many stent manufacturers, including MNCs, have agreed to supply at this rate for the various government schemes. But such schemes cover only a fraction of the patients who might require stenting. An estimated six lakh patients undergo angioplasty every year. While not all of them need stents, there are also many cases where doctors advise two or three stents for one patient. Hence the market for stents in India is huge, and steadily increasing with the rising incidence of cardiovascular diseases.A recent comparison of the price of DES of top stent companies including Abott, Medtronics, Johnson & Johnson’s, Cordis and Boston Scientific in the US, UK and India showed that while the Indian price seems lower, this could be a misleading comparison. The price of DES in the UK ranges between the equivalents of Rs 1.2 and Rs 1.4 lakh. In the US, the range is from Rs 50,000 to Rs 2 lakh. The Indian range of Rs 55,000 to Rs 1.2 lakh might seem reasonable in this context. However, if we take the difference in income levels into consideration, the picture changes dramatically. The comparison showed that in the UK or UK, even at the top end, the price of a DES would be no more than 6% of GDP per capita (which mirrors average incomes). In India, on the other hand, it ranges between 27% and 130% of GDP per capita. Thus, it is between 5 and 22 times harder for the average Indian to afford a DES than it is for someone in the UK or US.It has also been found that not only company dealers but also hospitals which might get the stent cheap, charge patients ‘handling charges’ on every stent, often pushing up the price to two or even three times the original cost of the stent. The Maharashtra Food and Drug Administration (FDA) had sent a report to the National Pharmaceutical Pricing Authority (NPPA) laying bare the way patients were being overcharged on stents. The FDA report gave several examples of drug eluting stents being imported by manufacturers for about Rs 40,000 but with the MRP shown as approximately Rs 1.5 lakh, a mark-up of more than 250%.The FDA report had sought control on prices of devices like stents and orthopaedic implants under the Drugs and Cosmetics Act, 1940. The NPPA recently asked device companies to submit details of price revisions in the last two years for each type of device.