No. 2-2/2014/CGHS(HQ)/PPTY/CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Nirman Bhawan, New Delhi
Dated: the 13th March, 2015

OFFICE MEMORANDUM

Subject: Clarification regarding issue of Medicine under CGHS

With reference to the above mentioned subject the under signed is directed to state that the situation arising out of issue of office memorandum NO 2-2/2014/CGHS(HQ)/PPTY/CGHS(P) dated the 25th August, 2014 has been engaging the attention of government for quite some time. Although the guidelines were modified subsequently vide Office Memorandum of even number date 01.10.2014 and 23.12.2014, this Ministry is in receipt of representations seeking clarifications. The matter has been reviewed and it has now been decided to withdraw the OM of even no. dated 25.08.2014.

(Sunil Kumar)
Under Secretary to the Govt. of India

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File953.pdf

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BANGALORE: Heart patients availing benefits under the Central Government Health Scheme (CGHS) will have to dig deeper into their pockets for treatment.

The Union ministry of health and family welfare has cut the aid by nearly 50% to various coronary drug-eluting stents to Rs 25,000 effective February 21. This is irrespective of the standard of stent used.

The CGHS beneficiaries who undergo angioplasty will be reimbursed for stents as per the new rates  a maximum of Rs 25,000 for drug-eluting stents and Rs 12,000 for the bare-metal coronary stents.

Till February 20, the CGHS rates were Rs 65,000 for drug-eluting stents approved by Drug Controller General of India and FDA; Rs 50,000 for sents approved by CE, Europe; and Rs 40,000 for those manufactured indigenously.

The move has not gone down well with the patients and the hospitals, who fear quality stents would be unaffordable.

Drug-eluting stents prevent narrowing of coronary artery after . They are coated with medicine that prevents scar tissue from growing into the artery.

There are about 40,000 CGHS card holders in Karnataka and about 1 lakh beneficiaries under this scheme. However, the exact number of persons with cardiovascular diseases in the CGHS scheme is not known.

Ravi Kant, undersecretary, government of India, has stated on the CGHS website: “Reimbursement to the beneficiaries/empanelled hospitals shall be allowed subject to the ceiling rates or actual, whichever are lower.”

The decision will affect the CGHS beneficiaries as the market rate for high-end drug-eluting stents is between Rs 1 lakh and Rs 2 lakh. “With this decision, patients will have to pay from their pocket if they want FDA-approved stents,” said a senior cardiologist from Bangalore.

“I came to know about this sudden change only after my wife was operated last week at a private hospital empanelled with CGHS. As we already had fixed the date of surgery around February 18, we could not back out. I had to withdraw a bank fixed deposit to settle the difference in the cost of stent as I was left with no option,” said Murugesh Shetty (name changed), a retired central government employee.

“Not just poor and retired employees from central government jobs, but even affluent and high-ranked government officials will be affected by the Centre’s move as they go to government hospitals for treatment. A patient will either have to shell out a huge amount or will have to compromise on the quality of stent,” said Dr C N Manjunath, senior cardiologist and director, Sri Jayadeva Institute of Cardiovascular Sciences and Research.

“This decision has come as a rude shock for pensioners. You can’t afford to pay such a huge difference if you depend on pension nor can you compromise on quality of stent as it is a matter of your life. Hospitals too will be hit as they don’t stock stents at wholesale rate. Older versions of stents, which are comparatively cheap, are not as much beneficial as the high-end stents,” said Dr Ranganath Nayak, interventional cardiologist, Vikram Hospital.

Source: TOI

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