Hospitals Raise Concerns Over CGHS Reimbursement Cap Impacting Cancer Treatment
Hospitals warn Central Government Health Scheme reimbursement cap may hurt cancer treatment
The Economic Times
Image: The Economic Times
A coalition of private hospitals in India has alerted the health ministry about the detrimental effects of the Central Government Health Scheme's reimbursement cap on cancer treatment. The cap limits reimbursements to 70% of the Maximum Retail Price for essential immunotherapy drugs, jeopardizing patient access and hospital finances.
- 01The Central Government Health Scheme (CGHS) limits reimbursements for cancer drugs to 70% of Maximum Retail Price (MRP).
- 02Hospitals report that this policy threatens patient access to life-saving immunotherapy treatments.
- 03Nine critical oncology drugs are identified as being out of reach for patients due to the reimbursement cap.
- 04Hospitals face financial strain as they are left to cover the costs of expensive patented drugs.
- 05The CGHS supply system has proven unreliable, leading to treatment delays and poor patient outcomes.
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The Association of Healthcare Providers (India) (AHPI), representing over 20,000 private healthcare companies, has expressed serious concerns to the Indian health ministry regarding the Central Government Health Scheme (CGHS) reimbursement policy for cancer treatments. Currently, the CGHS caps reimbursements for high-cost oncology medicines at 70% of the Maximum Retail Price (MRP), which hospitals argue is unsustainable and detrimental to patient care. The AHPI has identified nine essential immunotherapy drugs, including Keytruda and Imfinzi, that are becoming increasingly inaccessible to patients due to this policy. Hospitals are left with limited options to procure these drugs, often under strict contracts with pharmaceutical companies that prevent them from disclosing negotiated prices. This situation risks exposing them to legal repercussions while also compromising patient safety, as patients are unable to verify the integrity of self-sourced medications. Furthermore, the CGHS supply system has been unreliable, causing treatment delays and suboptimal patient outcomes. The AHPI urges the health ministry to reconsider the reimbursement policy to ensure hospitals can provide necessary treatments without incurring unsustainable costs.
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The reimbursement cap could lead to reduced access to life-saving cancer treatments for patients covered under the CGHS, potentially resulting in worsened health outcomes.
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