Srinagar: The Pradhan Mantri Jan Arogya Yojana (PMJAY) SEHAT Scheme, aimed at providing healthcare coverage to all families in J&K, has proven effective in mitigating catastrophic treatment costs for various health conditions. However, for cancer treatment, the current SEHAT Scheme’s Golden Card falls short, leaving patients burdened with financial constraints and offering limited treatment options, thereby posing challenges to oncologists as well.
While the SEHAT Scheme assures a promising insurance cover of Rs 5 lakh for every family, its provisions for cancer treatment reveal certain inadequacies. Cancer patients face significant challenges due to the capped number of chemotherapy packages. This cap limits patients’ access to potentially life-saving treatment, restricting the availability of packages for certain chemotherapy regimens and leading to unforeseen issues and difficulties for the patients.
A senior oncologist, in a conversation with Greater Kashmir, highlighted that cancer patients in metastatic or advanced stages require chemotherapy over an extended period, sometimes indefinitely.
“Unfortunately, the current SEHAT Scheme restricts the availability of packages for certain chemotherapy products. For instance, a patient undergoing urinary cancer treatment may only receive half the necessary packages during the initial treatment cycle. Once these packages are exhausted, the patient is deprived of the crucial chemotherapy regimen they require, regardless of potential benefits or the oncologist’s recommendation,” he said.
In the past too, doctors treating cancer across J&K have also raised concerns about the SEHAT Scheme’s limitations in regards to newer oncology drugs, immunotherapy, and targeted therapies.
Several recent and advanced treatment options are not included in the Transactions Management System (TMS) packages, thereby restricting cancer patients’ access to cutting-edge therapies.
The exclusion of immunotherapy, targeted oncology therapies, and various newer chemotherapeutic regimens from the scheme’s coverage imposes a substantial financial burden on patients who may greatly benefit from these treatments to enhance their quality of life.
Last year, a medical expert committee constituted by the State Health Agency (SHA) had recommended several modifications to the SEHAT Scheme protocols.
The medical expert committee’s recommendations offer valuable insights into addressing these issues and ensuring equitable access to cancer treatments for all beneficiaries. One of the key recommendations was the elimination of capping on packages.
“Removing the cap on chemotherapy packages will enable oncologists to customise treatment plans based on individual patient needs, ensuring continuity of care and maximizing the likelihood of successful outcomes,” the oncologist said.
Additionally, introducing packages that cover newer targeted therapies, immunotherapy for cancer treatment, and advanced chemotherapy regimens will grant cancer patients access to state-of-the-art treatments without encountering financial hardships. Oncology experts have also advocated granting the authority to sanction treatment amounts based on individual cases, ensuring that patients receive the most appropriate and effective therapies while adhering to budgetary constraints.
Managing Director of the State Health Agency, Sanjiv M Gadkar told Greater Kashmir that J&K was currently adhering to the package rates set by the National Health Authority (NHA).
“As of now, there is no proposal from our side to increase the package rates,” he said.