Agra: At Sarojini Naidu Medical College and Hospital, Agra, the price of medicines supplied under the ‘Asadhya Rog Nidhi’ (ARN) scheme has gone up by 150%, making them costlier than their branded counterparts, even after a 55% discount.

The scheme was instituted to provide free treatment for cancer, liver, kidney and heart diseases.

The Wire accessed the rate of the supplied medicines at the medical college and found that their prices had increased by 150%. For example, the cost of granisetron, an injection manufactured by MMG Healthcare to treat nausea and vomiting following chemotherapy, supplied under the ARN scheme rose from Rs 80 in 2016 to Rs 200 in 2017. This injection is prescribed to almost every cancer patient at the medical college; its supply varies from 5,000 to 10,000 units in a year. Interestingly, a Cipla Ltd. product called Granicip, used for the same purpose, costs Rs 60.

The agreement between the government and the supplier was to provide a 55% discount on the maximum retail price (MRP) of supplied medicines. Since the suppliers are free to pick any brand, they tend to go for the priciest medicine to increase their profit.

However, the medical college didn’t accept that the MRP of the supplied medicines had increased drastically in the last year.

“It is not so easy to change the MRP of a medicine. Everything is in the public domain; if one thinks that somebody is doing wrong then they should complain about that particular product,” Shailendra Choudhary, the medical superintendent and officer on special duty to the principal at Sarojini Naidu Medical College, told The Wire.

While the inflated prices are not meant to be paid by patients seeking treatment under the ARN scheme, the annual budget has been increasing with each passing year.

“On average, patients get medicines under the scheme for six months,” Choudhary said. “In the past three years, the Asadhya Rog Nidhi funds stood at Rs 40 lakh, Rs 50 lakh and Rs 70 lakh, respectively.”

Medicines supplied differ from prescription

Patients also have alleged that the supplier hands over different medicines than those prescribed by the doctors.

“Instead of giving the multivitamin capsule and syrup that was mentioned in my mother’s drug requisition slip, they gave us something else,” Anuj, son of Shakuntala, who is seeking free cancer treatment under the ARN scheme at the college, told The Wire. “Once, the doctor prescribed her Tablet PMG Plus [a branded drug for cancer] but the vendor refused to give it, saying that the medicine wasn’t available.

“However, he didn’t cut it from the slip. I have worked in this field, that’s why I understand the problems. Many patients are not even aware of what’s happening.”

Ashok Kumar Arya, a professor and head of the radiotherapy department at Sarojini Naidu Medical College, agreed that according to the scheme’s norms, the vendors are free to provide what medicines they will according to their bottomline.

“We face problems when we have to prescribe a combination of medicines to the patients as it’s very difficult to write a combination of generic drugs,” Arya said. “Under the Asadhya Rog scheme, there is a limitation on the type of medicines that can be prescribed. Any deviation from the limited stock means funds are being misused. So, if we are free to prescribe any medicine to the Asadhya Rog patients, then even the vendors are free to give any medicine.”

Further, a common vendor, Garg Surgical Point, has been supplying medicines for the last three years to the medical college at a constant discount: 55%. The medical superintendent at the college also confirmed that this wasn’t the vendor authorised by the office of the director general, medical and health, Uttar Pradesh government.

“In December 2015, at the DG level, a firm called Peetambara Pharmacy was authorised to supply medicines at 22.01% discount rate under the Asadhya Rog Nidhi funds in all the medical colleges of Uttar Pradesh for three years but it didn’t appear until May 2017,” the superintendent said. “Even [then], the firm had not been capable of handling the supply. Calling fresh tenders would have meant [overriding] the order of our higher authorities. So we had no option other than to continue the supply from our existing vendor.”

However, Peetambara Pharmacy said that the medical college never placed an order with them to supply medicines under the scheme.

“The government ordered us to run a retail shop 24×7 within the campus of the medical colleges and provide medicines at 22.01% discount,” Sujit Babeley, chief operations officer at Peetambara Pharmacy, told The Wire. “In clause 31 of the agreement, we were also authorised to supply medicines for Asadhya Rog patients in all medical colleges of Uttar Pradesh except Lucknow.

“Our manager is in touch with the principal of S.N, Medical College but she never ordered us to supply medicines. We are already supplying medicines under the scheme in Jhansi and Allahabad,” he added.

When The Wire contacted Saroj Singh, the principal of S.N. Medical College and Hospital, she refused to speak on the matter.

Fuss over discount rate

While the medical college in Agra has been purchasing medicines at 55% discount instead of 22.01%, as authorised by the government, vendors in the city have raised more questions.

“For generic medicines, discount up to 90% is given, and for branded medicines, maximum discount is 25%. But the supplier at S.N. Medical College is providing generic medicines at 55%, which is a total misuse of government funds,” a vendor in the city, who didn’t wish to be named, told The Wire. “It seems that the supplier has a deal with MMG Healthcare to increase the MRP of supplied medicines.”

When asked why the discount rate had been modified by the medical college, the medical superintendent said, “We are taking medicines [branded and generic] at 55% discount instead of 22.01%. How it can be wrong? If the entire state is ‘misusing’ the funds then we are ‘misusing’ it judiciously.”

However, patients say that the medicines supplied have been mostly generic. “Every time there is a branded drug in the prescription, the vendor says it isn’t available or gives a generic medicine in its place,” said Anuj.

Discount on net rate v. MRP

Thanks to orders given by the office of the director general, medical and health, Uttar Pradesh, to purchase medicines under the ARN scheme at 22.01% discount on the MRP and not on the net rate, the supplier goes for the highest MRP medicine available in the market to hike profits.

Despite there having been a continuous spike in the MRPs of medicines supplied under the scheme, the administration believes that a discount on the net rate instead of the MRP will not be effective in utilising the funds.

“Net rate can be constant only for a year. For net rate, the vendor will give us only a document but it can’t be used as a proof,” Choudhary said. “Everything is purchased at MRP and it isn’t at all arbitrary. The whole state has the procedure to seek discount on MRPs, not the net rate.”

Shruti Jain is a freelance journalist.