Author: YK Gupta
The RBI’s decision to raise the repo rate to 5.50 per cent signals a shift towards tighter monetary policy amid rising oil prices, currency pressures and weather-related risks. The challenge is to contain inflation without undermining India’s economic growth
India is making remarkable strides in cancer diagnosis and treatment. Yet, for too many families, access to life-saving medicines remains constrained not by medical expertise, but by the ability to pay. When a family must choose between continuing treatment and protecting its financial survival, cancer becomes an economic catastrophe as well as a medical crisis. No patient should have to make that choice.
The National Pharmaceutical Pricing Authority’s (NPPA) decision to bring 137 non-scheduled anti-cancer drugs under Trade Margin Rationalisation (TMR) deserves strong support. By capping trade margins at 30 per cent, it seeks to curb excessive mark-ups. The revised prices take effect on November 9, 2026, with government estimates indicating MRP reductions of up to 70 per cent and annual savings of approximately Rs 2,500 crore.
India’s growing cancer burden demands urgent action
India recorded an estimated 14.61 lakh new cancer cases and 8.09 lakh cancer-related deaths in 2022, according to the ICMR’s National Cancer Registry Programme. Treatment often means prolonged therapy and expensive medicines; families exhaust savings, borrow money or sell assets.
Out-of-pocket expenditure accounted for 43.4 per cent of India’s total health expenditure in 2022-23, according to National Health Accounts estimates, underscoring the continuing financial vulnerability of households. A medicine that exists but remains beyond a patient’s means cannot deliver its intended benefit.
Why NPPA’s intervention matters
Substantial mark-ups across the distribution chain widen the gap between the price at which a medicine enters distribution and the price the patient pays. TMR limits those margins. The 30 per cent cap is not a 30 per cent cut in manufacturers’ prices or a 70 per cent cut in the MRP of every medicine; the actual reduction will depend on each product’s existing price structure. Even so, it targets excessive margins and improves affordability without relying exclusively on broader price controls.
What lower margins could mean for high-cost drugs
The impact of TMR will be felt most for medicines that are both widely used and among the costliest per dose. Immunotherapies such as pembrolizumab and nivolumab (lung, head and neck and several other cancers), bevacizumab (colorectal, lung and ovarian cancers), and pertuzumab with trastuzumab (HER2-positive breast cancer) are typical examples. To see what is at stake, consider a reduction of 30 per cent to 70 per cent (the upper end being the government’s own estimate) applied to current per-dose prices:
1. Pembrolizumab: About Rs 2.06 lakh could fall to roughly Rs 0.62-1.44 lakh.
2. Nivolumab: The highest-priced brand, about Rs 1.04 lakh, could fall to roughly Rs 0.31-0.73 lakh.
3. Bevacizumab: The highest-priced brand, about Rs 1.18 lakh, could fall to roughly Rs 0.35-0.82 lakh.
4. Pertuzumab with trastuzumab: From about Rs 2.45 lakh to roughly Rs 0.73-1.71 lakh.
These figures are illustrative, not forecasts; the actual reduction will depend on each product’s existing price structure, and the largest falls are likely where mark-ups are greatest. Even so, because such drugs are given in repeated cycles, every reduction compounds across treatment and can decide whether a patient completes therapy or abandons it.
Building on India’s earlier experience
In 2019, the NPPA introduced TMR for 42 non-scheduled anti-cancer drugs; government reports documented price reductions across 526 brands and annual savings of approximately `984 crore. Carefully designed price regulation can deliver meaningful relief, and this experience provides a valuable foundation for the current expansion. The next step is to ensure the benefits extend to more patients and are sustained over time. The success of the present intervention must be judged not by the number of medicines covered or the reductions announced, but by the savings patients actually realise.
From policy announcement to patient benefit
Revised prices must be displayed prominently in pharmacies and hospitals and made accessible through the NPPA website and the Pharma Sahi Daam application, with overcharging complaints addressed promptly. The NPPA should publish periodic data on price reductions, compliance and realised savings, and independent assessments should test whether lower MRPs mean lower expenditure for patients in public and private settings. A price reduction announced by the government must be a price reduction experienced by the patient.
Affordability must go hand in hand with availability
Lower prices deliver little if patients cannot obtain medicines when needed, and interrupted treatment can have serious consequences, particularly for patients receiving time-sensitive therapies. Price regulation must be accompanied by continuous monitoring of production, distribution and retail supplies, with shortages identified early and addressed through coordination among regulators, manufacturers and healthcare providers.
Patient welfare and pharmaceutical innovation must coexist
Developing new cancer therapies demands substantial investment, and responsible pricing must recognise innovation, quality manufacturing and reliable supply. But this cannot justify excessive or opaque mark-ups. TMR should remain transparent, evidence-based and subject to periodic review, protecting patients while preserving the incentives needed to sustain a dependable pharmaceutical sector.
A more equitable future for cancer care
The ultimate test is not whether prices fall on paper, but whether patients can continue treatment without avoidable financial distress and obtain the medicines they need reliably. As India strengthens its cancer-care infrastructure, affordability must remain integral to the national response. Access to treatment must be considered alongside advances in diagnosis and therapeutics. India’s fight against cancer requires scientific progress, compassionate care and policies that place patients at the centre of decision-making. Cancer is already a formidable adversary. The price of treatment should not become another adversary that patients and their families are forced to fight alone.
As India strengthens its cancer-care infrastructure, affordability must remain integral to the national response. Access to treatment must be considered alongside advances in diagnosis and therapeutics. India’s fight against cancer requires scientific progress, compassionate care and policies that place patients at the centre of decision-making. Cancer is already a formidable adversary
The writer is the President of AIIMS Kalyani and former Head of the Department of Pharmacology and Dean of AIIMS, New Delhi; Views presented are personal.