More Pain For Patients: Cancer, HIV Medicines To Cost More As Govt Withdraws Customs Exemption

Source: Catch News | Author: Vishakh Unnikrishnan | Image Courtesy: nevadadui

The move

• The Union Finance Ministry has withdrawn customs duty exemptions from 74 drugs.

• This is means that drugs that are imported or made in SEZs will get about 10% dearer.

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The pain

• Many of these drugs are used to treat diseases like cancer and HIV/AIDS.

• For some cancer patients, treatment costs may increase by up to Rs 3 lakh.

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More in the story

• Why has the government taken such a decision?

• Is there any silver lining?

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The Union Finance Ministry has withdrawn customs duty exemptions from many drugs, including those used in the treatment of HIV/AIDS and cancer.

In other words, life-saving drugs are now set to get more expensive.

How expensive? On some drugs, there used to be a 5% duty, which will now go up to 10%. But on others, which were totally exempt, there will be a bigger jump due to the application of a 10% duty.

Patients and healthcare professionals alike are irate at this move.

Govt has withdrawn customs duty exemptions from nearly 75 medicines, most of them essential drugs!

Since many cancer drugs, for example, are used in high dosage amounts, experts say the treatment cost in some cases could increase by as much as Rs 2-3 lakh a year.

For patients reliant on a particular drug without viable substitutes, the move could very well prove detrimental.

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The notification

The Central Board of Excise and Customs (CBEC), in its notification, has removed around 74 life-saving drugs, among many others, from customs duty exemptions.

According to the notification, the specified drugs – whether imported or manufactured in special economic zones, will now be taxed.

Just last month, the government had also increased basic customs duty on medical devices, in a bid to help boost domestically manufactured products.

At the time, it had said that the changes are expected to provide support to the domestic medical devices sector and help the Make in India campaign generate employment.

But the present move has put critics at the end of their tether, since many essential and life-saving drugs, some of which do not even have a good quality substitute, are to be taxed.

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The affected medicines

Some of the medicines from whom exemptions are to be lifted are part of the National List of Essential Medicines (NLEM), a list compiled after several consultations with various stakeholders.

The government itself states that the medicines mentioned in the list should be available at affordable prices and meet a certain quality standard at all times.

These include essential cancer drugs such as Mitomycin, used in chemotherapy for breast cancer and gastro-intestinal cancers; Imatinib Mesylate, used as the first line of treatment in Leukemia; Ifosfamide, used for the treatment of cervical and lung cancer; and Ritonavir, used for antiretroviral treatment in HIV/AIDS.

Many of the medicines are also part of the World Health Organisation’s list of essential medicines, a list the WHO describes as ‘basic medications’ in any healthcare system.

Other medicines that will get dearer are those used in the treatment of kidney stones, cancer radiotherapy, heart-rhythm disorders, diabetes, Parkinson’s disease, arthritis, bone diseases and antibiotics used to treat infections.

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‘Poor decision’

Ranjana Smetacek of the Organisation of Pharmaceutical Producers of India (OPPI), which represents research-based pharma companies in India, said the government had made ‘a poor decision’.

Kiran Mazumdar Shaw, CMD of Biocon, a biotechnology company based in Bangalore, has also publicly resonated a similar view.

In a series of tweets, Shaw said: “The move will make these drugs more expensive for the patients. There are over 75 drugs in this list. This will also impact the indigenous drugs being manufactured in SEZs, thus adversely impacting the Govt’s agenda of making healthcare affordable and accessible to the patients in India.”

Special Economic Zones are deemed foreign territory for the purposes of trade operations and duties and tariffs, according to the Directorate General of Foreign Trade.

Because of this, supplies produced in SEZs are considered as imports as well, and will therefore fall under the ambit of the government’s decision.

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Good for generic drugs

A few experts, however, have hailed the move as a step in the right direction with respect to promoting indigenously manufactured drugs.

Industry representatives agree the move is intended to provide protection to the domestic manufacturing industry, and support to the Make in India initiative.

Some medical experts also agree that there are better generic alternatives, although their availability will be a cause of concern.

“While I’m not an expert on all the drugs in the list, the ones used for cancer and HIV/AIDS are substitutable. For HIV/AIDS, a generic variant is available for almost all the drugs listed. The WHO has stopped recommending drugs like Saquinavir and Stavudine,” says Leena Menghaney, lawyer and activist working for access to affordable drugs.

“People attached to a brand would be willing to pay for it, but from a public health perspective, what is needed is a quality alternative available locally, and if there is one, then there shouldn’t be a dependence on imports.”

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Setback for haemophiliacs

The one disease that Menghaney mentions as a cause for worry, and for which the drug is largely imported, is haemophilia, a rare hereditary genetic disorder that impairs the body’s ability to control blood clotting.

“Drugs used by Haemophilia patients are mostly imported, and for them, the move could be a cause of serious concern with an increase in price,” she says.

Haemophilia occurs in two forms. ‘Haemophilia A’, the most common form of the disorder, occurs when there is a lack of an essential blood-clotting protein called Factor VIII, while ‘Haemophilia B’ is caused due to a deficiency of the Factor IX protein.

Two drugs listed in the notification, anti-haemophilic factor concentrates (VIII & IX) are both heavily imported, as locally available supplements are both of low quality and, more often than not, out of stock.

The concentrates are injected into the body of the patient in high quantities to treat or prevent bleeding.

“‘Haemophilia drugs cost about Rs 15-20 per unit on an average. The removal of the exemption would mean an increase in about Rs 4 to 5. A patient uses around 40,000-50,000 units in a year. This means, on an average, a patient would have to spend around Rs 2 lakh more for treatment every year for the rest of their lives,” says Rupal Panchal, founder of the Mumbai-based Haemophilia Society