NPPA Caps Margins On 137 Cancer Drugs, Experts Stress Effective Implementation

Welcoming the National Pharmaceutical Pricing Authority’s (NPPA) decision to cap trade margins at 30% on 137 non-scheduled anti-cancer drugs, experts have said the move could make cancer treatment more affordable, with maximum retail prices (MRPs) expected to fall by up to 70%, depending on existing price structures.

However, they stressed that strict implementation, transparent pricing and uninterrupted availability of quality medicines would be crucial to ensure that the price reductions translate into actual savings for patients.

The revised prices will take effect from November 9, following a Gazette notification issued on October 17. The decision comes amid growing Supreme Court scrutiny of medicine markups and concerns over the financial burden of cancer care.

On September 29, the Apex Court questioned how a drug purchased by retailers for Rs 2,700 could carry an MRP of Rs 27,000, describing the disparity as “broad daylight dacoity” and “carnage”. The court also asked why curbs on excessive trade margins should be limited to cancer medicines.

Suresh Prabhu, former Cabinet Minister and social activist, welcomed the decision but stressed that lower prices must translate into tangible savings for patients.

“The decision to cap trade margins on 137 anti-cancer medicines at 30% is a welcome step; the MRP of some drugs is expected to fall by up to 70%. Cancer treatment is a heavy burden on any family; lower prices will bring real relief, but the benefit must reach the patient."

“Manufacturers and the trade must follow the order in the letter and spirit. The medicines must also be available in hospitals and pharmacies, including in small towns and villages. Affordable medicines and good quality care must go together. Only then can we call healthcare accessible to all,” Prabhu posted on X.

Nikhil Jha, an insurance expert, also welcomed the move, stating on the social media platform X that it could provide relief to middle-class families struggling with rising healthcare expenses.

“For years, we have fought against irrational healthcare pricing. Finally, we are seeing some action! At every meeting with insurers and IRDAI, we have consistently raised the issue of unreasonable hospital pricing… This could bring massive relief to middle-class families struggling with the rising cost of cancer treatment.”

Dr Shuchin Bajaj, Founder Director, Cygnus Uajala Healthcare Services, described the decision as an important step towards improving affordability but cautioned that medicine prices were only one component of the overall cost of cancer care.

“The NPPA’s decision to rationalise trade margins on 137 anti-cancer medicines is a welcome and important step towards making cancer treatment more affordable for Indian patients."

“Cancer is not just a medical diagnosis; for millions of Indian families, it is also a financial crisis. No patient should have to abandon potentially life-saving treatment because medicines are unaffordable."

“However, affordability must be addressed across the entire pharmaceutical value chain. The objective should be to ensure that the benefits of lower prices actually reach patients, while preserving the availability of quality medicines and the sustainability of cancer care delivery."

“We must also recognise that the cost of cancer treatment extends beyond medicines to diagnostics, surgery, radiation, hospitalisation and supportive care. A comprehensive approach involving rational drug pricing, stronger insurance coverage, early detection and decentralised cancer services is essential,” said Dr Bajaj.

Dr Abhishek Shankar, Assistant Professor, Radiation Oncology, AIIMS Delhi, too welcomed the move, saying that it could help reduce the financial strain on families as many of them struggle to afford medicines even when they are essential for treatment.

“Nearly 70 per cent of cancer treatment expenditure goes towards medicines, placing an enormous financial burden on patients and their families. Many families want to do everything possible to save their loved ones, but the high cost of medicines often forces them to compromise on treatment or leaves them struggling to meet these expenses."

“The cap on trade margins on cancer medicines can help ease this burden and improve access to essential drugs. However, the real measure of its success will be whether patients actually experience a reduction in their out-of-pocket expenditure. The revised prices must translate into lower bills at pharmacies and hospitals, rather than remaining limited to an announcement."

“For this, effective implementation, transparent pricing, regular monitoring and an uninterrupted supply of quality medicines will be essential. The benefits must reach patients uniformly, irrespective of whether they receive treatment at private or government hospitals."

“Equally important, a patient's treatment should be guided by clinical needs and the nature and stage of the disease, not by their ability to pay. Financial constraints should not determine whether a patient can access the medicines required for appropriate treatment."

Dr Shankar noted that no doubt Ayushman Bharat has already helped expand access to healthcare and reduce financial barriers for many patients, while day-care cancer centres have brought cancer services closer to people's homes.

“The latest decision can further strengthen these efforts. If implemented effectively, it could ease the financial distress faced by cancer patients and their families and make treatment more accessible to those who need it most.”

Estimates from the Union Health Ministry and the Indian Council of Medical Research’s National Cancer Registry Programme put the annual number of new cancer cases at around 15.3 lakh to 15.6 lakh.

The NPPA revised list includes widely used drugs such as pembrolizumab, durvalumab and osimertinib, along with immunotherapies used to treat more than 20 types of cancer. It also covers denosumab, used by some breast and prostate cancer patients; pegfilgrastim, which helps prevent neutropenia in cancer patients; and bevacizumab, used to treat cancers including those of the colon, ovary and cervix.

The NPPA has invoked Paragraph 19 of the Drugs (Prices Control) Order, 2013, to impose the cap. The decision builds on a 2019 pilot exercise, when trade margins on 42 anti-cancer drugs were capped at 30%. That intervention reduced the MRPs of 526 brands of non-scheduled cancer medicines by up to 90%.

The Department of Pharmaceuticals has estimated that the measure could save patients around Rs 2,500 crore annually. Hospitals and medical institutions, which account for a substantial share of anti-cancer drug purchases, will have to implement the revised prices from the effective date.

According to the DoP, India's anti-cancer drug market comprises nearly 225 drugs and 500 formulations, with an annual turnover of around Rs 12,500 crore. Scheduled cancer drugs already subject to price controls account for about Rs 2,250 crore, while the remaining market falls under the non-scheduled category.