India Extends 30% Trade Margin Cap to 137 Additional Cancer Medicines

The Indian government will apply a 30% ceiling on trade margins for 137 additional cancer medicines starting next month, extending an existing price control that previously covered only 42 drugs. The measure follows a Supreme Court proceeding concerning a retired bank clerk who could not afford her treatment.

The Department of Pharmaceuticals said in a statement that the change "is expected to reduce medicine prices by up to 70% and help cancer patients save 2,500 crore rupees [£199m] annually," reducing out-of-pocket spending for patients.

The National Pharmaceutical Pricing Authority found that trade mark-ups on some cancer drugs averaged 170%, with extreme cases exceeding 700%. At a 29 September hearing, justices Vikram Nath and Sandeep Mehta cited a cancer drug supplied to hospitals at 2,700 rupees that carried a price of 27,000 rupees. The court determined that hospitals, distributors and chemists held large margins on medicines.

The case originated with Sarojam Radhakrishnan, a former bank employee in Kerala diagnosed with breast cancer in 2021. Her prescribed targeted treatments cost more than 63,000 rupees (£500) monthly, a figure her family could not meet. She petitioned the Kerala High Court in 2022 seeking government intervention to lower costs. When the matter reached the Supreme Court, justices described the mark-up situation as "carnage" and "extortion." Radhakrishnan died in September 2022 while her case remained pending in Kerala.

The cost burden has limited access to treatment for many families. Krishan Kalra, a former council member of the Rajiv Gandhi Cancer Institute and Research Centre, said few people attend free diagnosis camps run by the Indian Cancer Society in Gurgaon because "they're too scared" that a cancer finding would leave them without money for care. Cancer drugs range from 38,000 to 380,000 rupees, and many families leave the consulting room after hearing the estimate. Studies by the Public Health Foundation of India indicate that healthcare spending pushes about 55 million Indians below the poverty line each year.

Insurance provides limited coverage. The government's Ayushman Bharat scheme covers certain cancers but offers 500,000 rupees of annual cover per family, equal to the cost of one dose of Kadcyla, a breast cancer drug for which patients may receive up to 14 doses. Dr Ravi Kannan, a surgical oncologist and director of Cachar Cancer Hospital and Research Centre in Silchar, Assam, said some families begin treatment but cannot sustain it, calling the decision "a welcome step" if more patients gain access to necessary drugs.

Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, said a "total overhaul" of healthcare was required, with transparency and regulation across the entire supply chain. She noted that companies and hospitals may pursue legal loopholes, and that hospitals could offset lower drug prices by raising other charges.

The Supreme Court has asked government lawyers why the cap should apply only to cancer drugs rather than all non-patented medicines, giving the government until 27 October to respond. India records about 1.56m new cancer cases a year, up from 1.39m in 2020.