Private hospitals have raised concerns with the Union Health Ministry over a reimbursement policy under the Central Government Health Scheme (CGHS), warning that it could severely affect treatment for advanced cancer patients dependent on costly immunotherapy drugs.
The issue revolves around a CGHS policy that reimburses hospitals only up to 70% of the Maximum Retail Price (MRP) for certain high-cost oncology medicines. Hospitals say the reduced reimbursement is creating financial pressure and may restrict patient access to critical cancer treatments.
The Association of Healthcare Providers (India) (AHPI), which represents more than 20,000 private healthcare institutions, has written to the health minister highlighting nine expensive cancer drugs that hospitals say are becoming difficult to provide under the current policy. These include Keytruda, Imfinzi, Enhertu, Imjudo, Adcetris, Tagrisso, and Zoladex.
In its letter, AHPI Director General Dr. Girdhar Gyani said the issue is particularly challenging because these are patented medicines with no alternative substitutes available. The association has requested the government to allow reimbursement at the full MRP for this limited set of drugs instead of the existing 70% cap.
Currently, CGHS offers hospitals three methods for claiming reimbursements. Patients may procure medicines through the CGHS system, hospitals may bill CGHS directly while receiving only 70% reimbursement of the MRP, or the medicines may be supplied through the CGHS procurement network.
Hospitals argue that all three options come with serious practical and legal concerns. Many healthcare providers procure patented drugs through confidential agreements with multinational pharmaceutical companies that prohibit disclosure of negotiated purchase prices. Sharing invoices with CGHS, hospitals warn, could breach these contracts and potentially disrupt future supplies.
Hospitals also said asking patients to arrange these medicines themselves is risky because the drugs require strict cold-chain handling and transport conditions. Doctors are often reluctant to administer medicines if storage and transportation standards cannot be verified.
The third option procurement through the CGHS supply system has reportedly faced delays and shortages, leading to interruptions in treatment schedules and concerns over patient outcomes.
As a result, hospitals say they are left with little choice but to procure the medicines themselves and bill CGHS at MRP. However, since these patented drugs offer limited profit margins of around 10-15%, hospitals claim they are absorbing substantial financial losses on every treatment cycle, making the arrangement difficult to sustain.
