Cheaper cancer drugs on paper are only half the job. From Monday the price cut must reach the patient

On Monday, every pharmacy and hospital in India that sells a cancer medicine on the government’s list must start charging a lower price. The National Pharmaceutical Pricing Authority (NPPA) ordered on October 17 that trade margins on 137 anti-cancer drugs be capped at 30% of the maximum retail price. The Centre expects prices to fall by as much as 70%, and says patients will save about ₹2,500 crore a year.

This is a good order, and it came after pressure. In October the Centre told the Supreme Court that margins on these medicines ran from 170% to more than 700%. Some of the first revised prices show what that meant: one breast cancer drug, palbociclib, falls about 93%, from ₹40,421 to ₹2,720 for a pack of 21 capsules.

A price list is not a price

A cap is only as good as the counter at which it is checked. Manufacturers had seven days from the gazette notification to report new prices. State drug controllers are meant to monitor compliance, and any firm that does not comply can be made to repay the overcharge with interest.

That is a lot of process, and none of it is visible to a patient standing at a chemist’s counter with a prescription. The NPPA already publishes revised price lists. It should now also publish, every week for the first three months, how many brands have reported new prices, how many have not, how many overcharging complaints it has received and how many recoveries it has started. A number reported weekly is a number someone must answer for.

The brands that did not move

On the latest list, with data up to October 28, three well-known medicines show no change. Keytruda (pembrolizumab) stays at ₹2,16,500 for 100 mg, Tagrisso at ₹4,16,492 and Imfinzi at ₹1,71,324. All three were named when the government announced the step. They are expensive immunotherapy and targeted drugs, the very ones families struggle most to afford.

There may be a good reason. A company may have priced the drug below the cap already, or may yet file a revised price. But the list is updated as manufacturers report, and patients cannot tell which explanation applies. The NPPA should say, brand by brand, whether a price is unchanged because it is already compliant or because the company has not yet reported.

The fair objection

The industry will argue that thinner margins can mean thinner supply, and that distributors may stop stocking a drug that earns them less. The order anticipates this: manufacturers must keep production at current levels and give six months’ notice before discontinuing a formulation. One pharma analyst quoted since the announcement expects the effect on drug companies to be minimal. If so, the risk to supply is small, and the NPPA can afford to publish any shortage the moment it appears.

There is also a limit that no order can remove. A lower MRP does not lower a hospital bill that adds its own procedure, room and pharmacy charges. Hospitals must display the new prices on their websites. They should also show them on the itemised bill.

The question the court asked

The Supreme Court bench of Justices Vikram Nath and Sandeep Mehta asked the right thing on October 12: why does the cap stop at cancer medicines? It cited a cardiac stent supplied for about ₹5,000 and sold at an MRP of ₹25,000. Cancer is not the only illness that bankrupts a family.

The Centre should go back to the court with a dated plan for the other medicines and devices where mark-ups run this high, starting with those on the essential list. It has shown, with 137 drugs, that the method works. The next step is to show that it does not need a court to prompt it each time.

The reporting behind this view

• 137non-scheduled anti-cancer drugs under the NPPA's October 17, 2026, margin cap
• 30%cap on trade margin as a share of MRP, in force from November 9
• 643revised brand entries on the NPPA's latest list, with data up to October 28