Experts red-flag cancer drug price cuts as patented therapies see zero relief, markups exceed benchmark

Experts said there should be comprehensive, cost-based price controls covering all oncology therapies, permanent statutory margin caps across distribution channels and full scrutiny of company assistance programmes.

New Delhi: India’s healthcare industry and public health experts have warned that price cuts of non-scheduled cancer medicines effective 9 November under the National Pharmaceutical Pricing Authority’s trade margin rationalization exercise are structurally flawed, legitimize profiteering and completely bypass high-cost patented drugs.

One-off, self-reported price revisions without independent verification will fail to deliver lasting relief, health groups said, demanding comprehensive, cost-based price controls covering all oncology therapies, permanent statutory margin caps across distribution channels and full scrutiny of company assistance programmes.

They also urged the government to mandate supply-chain data audits and expand public cancer care infrastructure to ensure access is determined by medical need rather than commercial pricing.

“We welcome the government’s move to cap trade margins on 137 anti-cancer drugs. However, the real test is whether patients benefit, without loopholes undermining the intended relief,” said Jyotsna Govil, chairperson of the Indian Cancer Society in New Delhi.

According to public health network Jan Swasthya Abhiyan India, the government's policy formula legitimizes an excessive 42.8% markup over the stockist price in supply chains involving direct hospital sales. This is much higher than the 16% retail margin under the Drug Price Control Order.

Jan Swasthya Abhiyan India noted that while prices of generic brands fell sharply—such as Palbociclib (Palbopro 125 mg) crashing from ₹40,421 to ₹2,720 and Thiotepa (Samtepa 100 mg) plunging from ₹80,072 to ₹7,150—the policy formula legitimizes high distributor markups instead of mandating cost-based price control.

“The dramatic collapse in cancer drug prices exposes the staggering exploitation of patients over the years by pharmaceutical companies, including major Indian generic manufacturers that offered inflated trade margins while families faced unaffordable treatment costs,” said Amulya Nidhi, national co-convenor of Jan Swasthya Abhiyan India. “Controlling trade margins alone is insufficient. Life-saving treatment must be affordable and based on medical need, not a patient’s ability to pay.”

Prices unchanged

An evaluation of the 24-page NPPA compliance notification and document shows that high-cost patented therapies and imported innovator brands remained completely untouched because medicines supplied free under patient assistance programmes were excluded from calculations.

Consequently, there was no price reduction for several exorbitantly priced patented therapies. Prices remained unchanged for AstraZeneca’s lung cancer therapy Osimertinib and Selumetinib, MSD’s Pembrolizumab, Roche’s breast cancer combo Phesgo, Alecensa and Avastin, Janssen’s Daratumumab, Astellas’s Gilteritinib and Padcev, Johnson & Johnson’s Rybrevant, Takeda’s Alunbrig, GSK’s Jemperli, Pfizer’s Lorbriqua and AbbVie’s Imbruvica.

“While a detailed examination is required, the prices of many original manufacturers appear to have remained unchanged. My only worry remains that the low-cost, life-saving drug should remain viable to manufacture and sell. In the past we have seen that getting affected because of price control,” said Dr. Sandeep Nayak, chairman of oncology, MACS-Renova Oncology Institute, KIMS Hospital in Bengaluru. “The primary impact is likely to be on drugs that have traditionally been marketed with very high profit margins. Overall, the move appears reasonable, with its long-term impact depending on how effectively it is implemented.”

Medical professionals stressed that access to newer therapies remains critical.

“We need to ensure that newer therapies and innovative medicines are also accessible, alongside transparent pricing and effective implementation. Ultimately, no patient should have to compromise on treatment because of cost,” said Dr. Aashish Chaudhry, managing director of Aakash Healthcare.

The pricing directive comes against the backdrop of the Supreme Court, responding to public interest litigations challenging exorbitant markups, criticizing the vast gap between wholesale procurement rates and printed retail prices. It cited instances where an injection procured at ₹11,000 was billed to hospital patients at ₹1.3 lakh. The court asked why margin caps were selectively applied to non-scheduled cancer medicines rather than across all essential drugs.

Cancer drug market

India's anti-cancer market comprises roughly 225 drugs and 500 formulations, generating an annual turnover of ₹12,500 crore. Scheduled medicines covering 63 drugs under the National List of Essential Medicines 2022 accounted for about ₹2,250 crore under statutory ceiling prices, leaving over ₹10,250 crore non-scheduled, where uncurbed margins drive up out-of-pocket spending.

According to Govil of the Indian Cancer Society, the government’s projected annual savings are encouraging, but these must translate into measurable reductions in patients’ out-of-pocket expenditure.

“Too often, such initiatives lose their effectiveness due to inadequate monitoring and weak implementation. Regular compliance reviews, accessible grievance redressal and transparent reporting are essential,” Govil said. “Patients and patient support groups must be consulted on policy design and implementation. Affordable cancer care must also strengthen organizations providing financial, emotional and practical support to patients.”

Queries sent to the spokesperson of the NPPA and ministry of health and family welfare remained unanswered till publishing time.

Govil also called for vigilance against evergreening of patents, where minor modifications or extensions of patents could delay the entry of affordable generic alternatives.

“Strong safeguards are essential to ensure that patent protections do not become a barrier to access to life-saving cancer medicines,” Govil said.

About the Author

Priyanka Sharma is a journalist at Mint, where she covers the Union Ministry of Health and the pharmaceutical industry. Her work focuses on explaining government policies and how they impact healthcare and the medicine market in India. With 12 years of experience in journalism, she has built a reputation for providing clear and honest news on important health topics that affect the entire country.<br><br>Her educational background includes a journalism degree from the prestigious Indian Institute of Mass Communication (IIMC) and specialized training in public health from the Public Health Foundation of India. Before her current role at Mint, Priyanka worked with India Today, The Pioneer, and ANI. She also served as a lead consultant for the National Health Authority, which gave her firsthand knowledge of how the government manages large-scale health programmes.<br><br>Priyanka is based in New Delhi and is an avid traveller who loves visiting the mountains. She has a great interest in regional flavours, particularly South Indian food.