Karnataka Food Safety and Drug Administration commissioner K Srinivas has raised concerns over the pricing of medicines, medical devices and consumables supplied to hospitals at discounted institutional prices but billed to in-patients at the printed maximum retail price (MR, P) or close to it. In some cases, the difference between the landing cost and MRP is as high as 52 times. The commissioner has flagged critical-care medicines, oncology medicine, high-value injectables, implants and surgical supplies, besides diagnostic-linked consumables and disposable devices as particularly vulnerable to this pricing discrepancy.

In a letter to the National Pharmaceutical Pricing Authority (NPPA) and Department of Pharmaceuticals, Srinivas has highlighted examples where the difference between the landing cost and MRP is substantial. For instance, Gufipol, manufactured by Criticare, has a landing cost of Rs 86 and an MRP of Rs 4,528, a difference of 5,165.1% or 52.6 times the landing cost. Similarly, Guficycline-50 injection, manufactured by GUFI, has a landing cost of Rs 160 and an MRP of Rs 7,110, a 4,343.7% difference or 44.4 times the landing cost. Terlitis has a landing cost of Rs 118 against an MRP of Rs 4,416, a 3,642.4% difference or 37.4 times.

The commissioner described the issue as an 'information-asymmetry and captive-patient problem', noting that patients generally do not know the institutional acquisition cost and do not have an effective choice at the point of use. The letter argues that MRP-only regulation is insufficient, as MRP operates as a ceiling on retail sale to a consumer but does not ensure that the MRP is a fair patient-facing price in an institutional setting.

Srinivas proposed mandatory disclosure of institutional transaction prices, a patient-facing price ceiling linked to acquisition cost, anti-evasion provisions, MRP rationalisation and an enforceable reporting and penalty framework. The letter also seeks quarterly electronic reporting, risk-based audits, a grievance channel and refunds with interest where overcharging is established. The commissioner has sought an expert working group and amendments to the Drugs (Prices Control) Order, 2013, and asked that the matter be treated as 'urgent' with a reasoned action taken report communicated.

The issue remains unresolved, with the potential for significant financial burden on patients. Further investigation is needed to determine the extent of the problem and the effectiveness of proposed regulatory measures.