The recent revision of maximum retail prices (MRPs) for cancer medications in India has led to substantial reductions, with some prices decreasing by over 90 per cent. The National Pharmaceutical Pricing Authority (NPPA) announced the changes affecting 543 cancer drug brands and pack sizes, signalling a significant shift in the cost landscape for many treatments. For instance, the price of palbociclib, a drug used for specific breast cancers, has been slashed from Rs 40,421 to Rs 2,720 for one brand and pack size.

Another notable reduction is in the price of thiotepa, a chemotherapy agent, which has fallen from approximately Rs 80,072 to Rs 7,150 per vial. Additional drugs such as dasatinib, lenvatinib, abiraterone, and olaparib have also seen steep price cuts, marking a positive development for patients in need of these treatments.

However, the price of Keytruda, an immunotherapy drug indicated for over 21 types of cancer, remains unchanged at Rs 2,16,500. Similarly, ribociclib (Kryxana) retains its price at Rs 24,435, along with other originator brands like Tagrisso, Tecentriq, Darzalex, and Imfinzi, which have not experienced any price adjustments.

Implementation and Regulatory Context

The revised pricing structure will come into effect on November 9, following the NPPA’s decision to limit trade margins to 30 per cent of MRP for 137 non-scheduled anti-cancer drugs. This move is part of a broader effort to address the escalating costs of cancer treatment in India, which has attracted scrutiny from the Supreme Court. The Court has raised questions regarding the government’s approach to high medicine prices and the profit margins within the cancer treatment supply chain.

The Supreme Court is contemplating a more extensive intervention that could involve capping trade margins on all non-scheduled drugs nationwide. The outcome of this consideration remains uncertain, as the Court has reserved its order on the matter.

This ongoing debate is particularly significant given India’s increasing cancer burden and the financial challenges faced by patients. The comprehensive costs of cancer care, which include medications, surgeries, radiation, diagnostics, and hospitalisation, can place a heavy financial strain on families, often leading to difficult decisions regarding treatment options.

Challenges in Accessing Affordable Cancer Treatment

K M Gopakumar, a legal researcher with Third World Network, highlighted the implications of the revised price list, suggesting it reveals the extent of exploitation within the healthcare system. He emphasised the need for immediate benefits to be passed on to patients and pointed out the limitations of the current intervention, noting that the prices of critical medications like Keytruda and ribociclib remain unchanged.

Gopakumar proposed that the government should consider measures such as compulsory licensing, which would allow for the production of generic versions of patented medicines to enhance access to essential treatments. This approach could potentially alleviate some of the financial burdens faced by patients requiring life-saving drugs.

The NPPA’s recent price cuts are more substantial than earlier projections, which suggested reductions of up to 70 per cent. For example, the price of palbopro, a brand of palbociclib 125 mg, has decreased by 93.3 per cent, from Rs 40,421.33 to Rs 2,720. Another brand of palbociclib has seen a reduction of 91.6 per cent for its 100 mg pack.

Despite these reductions, disparities remain among brands containing the same active ingredients, raising questions about the relationship between manufacturing costs and pricing strategies. The impact of these price changes on individual patients will depend on the specific brands prescribed and the overall treatment costs, highlighting the complexity of the issue.

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