India has announced a cap on trade margins for 137 cancer medicines in a move aimed at reducing treatment costs and improving access to essential drugs for patients. The revised prices are scheduled to come into effect on November 9, following concerns over excessive mark-ups by hospitals, distributors and pharmacies that have made several life-saving medicines unaffordable.
Under the new measure, the government has limited trade margins on the identified non-scheduled anti-cancer drugs to 30 per cent. The National Pharmaceutical Pricing Authority (NPPA), under the Department of Pharmaceuticals, expects the intervention to reduce the maximum retail prices of the medicines by up to 70 per cent, depending on their existing price structures. The move is also projected to save patients around Rs 2,500 crore annually.
The decision follows scrutiny by the Supreme Court of the substantial difference between the prices at which cancer medicines are purchased and the amounts charged to patients. During hearings in September, the court raised concerns over the high mark-ups applied at different stages of the medicine supply chain, prompting renewed attention to the financial burden faced by cancer patients and their families.
The scale of the disparity became evident during the proceedings when the court was informed that a medicine purchased by a hospital for Rs 2,700 could be sold for as much as Rs 27,000. Data analysed by the NPPA indicated that trade mark-ups on certain non-scheduled cancer medicines averaged approximately 170 per cent, with some exceeding 700 per cent.
The latest intervention expands an earlier initiative introduced in 2019, when the government imposed a 30 per cent trade-margin ceiling on 42 anti-cancer medicines. That exercise led to price reductions across hundreds of medicine brands, demonstrating the potential impact of regulating margins in the distribution and retail chain.
The newly covered list includes medicines used in immunotherapy and targeted cancer treatment, including pembrolizumab, durvalumab and osimertinib. Other drugs covered by the measure include denosumab, used in the treatment of certain breast and prostate cancer patients, pegfilgrastim, which helps prevent a potentially serious reduction in white blood cells during cancer treatment, and bevacizumab, prescribed for certain cancers, including colorectal, ovarian and cervical cancers.
For many patients, the cost of newer cancer medicines represents a substantial share of their overall treatment expenses. Targeted therapies and immunotherapy can be prohibitively expensive, forcing families to exhaust their savings, borrow money or discontinue treatment. Doctors have also reported instances of patients beginning chemotherapy or radiation but failing to return for subsequent sessions because they cannot sustain the financial burden.
The consequences extend beyond the immediate cost of medicines. Healthcare expenditure pushes an estimated 55 million Indians below the poverty line every year, according to studies by the Public Health Foundation of India. Although the government’s Ayushman Bharat scheme provides financial coverage for eligible families, its annual limit of Rs 5 lakh may be insufficient for patients requiring expensive cancer drugs over several treatment cycles.
The challenge is particularly acute for medicines that remain outside the scheduled drug-price control system. While certain medicines are already subject to government price regulation, many newer and high-cost therapies have continued to carry substantial trade margins. The revised policy seeks to address this gap while allowing manufacturers a reasonable margin and requiring them to maintain supplies.
However, experts have cautioned that reducing medicine prices alone may not resolve the wider affordability crisis in cancer care. Greater transparency in the pharmaceutical supply chain, effective monitoring of revised prices and stronger safeguards against possible circumvention of the rules will be essential to ensure that patients receive the intended benefits.
The Supreme Court has also sought the government’s response on whether similar controls should be extended beyond cancer medicines to other non-patented drugs. The broader question is whether price regulation can be strengthened across the healthcare system without compromising the availability of essential medicines.
India records approximately 1.56 million new cancer cases annually, making access to affordable diagnosis and treatment a major public health concern. The latest price-control measure is expected to provide financial relief to patients, although its long-term impact will depend on effective implementation, continued drug availability and wider efforts to make cancer care accessible to all sections of society.
