NEW DELHI, Oct. 28: The Central Government has revised the maximum retail prices (MRPs) of 543 cancer medicine brands and pack sizes, reducing prices by as much as 93 per cent in some cases. However, several expensive cancer treatments, including widely used immunotherapy medicines, have seen no reduction, raising questions about the effectiveness of the latest price-control measures.
The National Pharmaceutical Pricing Authority (NPPA), India's drug price regulator, has introduced the reductions under its trade-margin rationalisation framework, which seeks to limit the margins charged within the pharmaceutical distribution chain.
The revised prices represent a significant reduction for several generic and biosimilar cancer medicines, potentially easing the financial burden on patients who require prolonged and repeated treatment.
Among the largest reductions is Palbopro, a brand of the cancer medicine palbociclib marketed by RPG Life Sciences. Its MRP has fallen from ₹40,421.33 to ₹2,720 per unit, a reduction of approximately 93.3 per cent.
Another palbociclib brand, ISOGEN, has recorded a price reduction of 91.6 per cent for its 100 mg pack.
The reductions are substantially greater than the government's earlier estimate that the pricing intervention could lower medicine prices by up to 70 per cent.
Palbociclib is a targeted cancer therapy used in certain forms of breast cancer. Because treatment may involve repeated cycles, changes in medicine prices can significantly affect the overall cost borne by patients and their families.
However, the financial benefit will vary depending on the medicine prescribed, the duration of treatment and whether hospitals and other suppliers pass on the revised prices.
While several generic and biosimilar medicines have become considerably cheaper, the prices of some widely prescribed original-brand medicines remain unchanged.
Avastin, a cancer medicine containing bevacizumab and marketed by Swiss pharmaceutical company Roche, continues to carry an MRP of approximately ₹1.23 lakh for a 400 mg vial.
By comparison, biosimilar versions of bevacizumab have recorded substantial reductions. Abbott's Bevacimab has seen its price fall by 86 per cent, while Torrent Pharma's Bevakalp has registered a reduction of 69 per cent.
The difference highlights the uneven impact of the government's intervention across medicines containing the same active ingredient.
Similarly, the MRPs of nivolumab products marketed by Bristol Myers Squibb India and Dr Reddy's Laboratories have remained unchanged.
Bevacizumab and nivolumab rank among the highest-selling anti-cancer medicines in India's retail market, making their pricing particularly important for patients and healthcare providers.
Keytruda, the immunotherapy medicine containing pembrolizumab, has also remained unaffected by the revisions. Its listed price continues to be approximately ₹2.16 lakh.
The medicine is used for a range of cancers, with indications covering more than 21 cancer types.
The absence of price reductions for these high-cost therapies has prompted concerns that the latest measures may provide only partial relief to patients facing the highest treatment expenses.
Officials familiar with the pricing exercise indicated that the differences may arise because the regulator targeted medicines and product categories where unusually high trade margins had been identified.
Under this approach, medicines whose prices were not primarily driven by excessive distribution margins may not experience comparable reductions.
The government's intervention comes amid growing scrutiny of cancer medicine pricing in India.
The Supreme Court has recently questioned the high costs of cancer treatment and the margins charged by hospitals and other participants in the medicine supply chain.
The issue has drawn attention to the difference between the price at which a manufacturer supplies a medicine and the amount ultimately charged to a patient.
Patient advocacy groups have welcomed the prospect of lower prices but questioned whether the regulatory framework adequately addresses the underlying cost of cancer treatment.
Malini Aisola, co-convener of the All India Drug Action Network (AIDAN), argued that trade-margin rationalisation was not designed to ensure comprehensive affordability of cancer medicines.
She raised concerns about the treatment of medicines supplied through Patient Assistance Programmes (PAPs), under which pharmaceutical companies provide eligible patients with free or discounted doses.
According to Aisola, excluding quantities supplied through such programmes from pricing calculations can understate the effective margins involved and reduce the scale of price cuts.
Patient assistance arrangements sometimes involve discounts or offers under which patients purchase a specified number of doses and receive additional doses without charge.
Advocacy groups argue that these arrangements need closer examination when regulators assess actual treatment costs and commercial margins.
Questions have also been raised about the permissible margins under the revised framework.
The NPPA's methodology allows a trade margin equivalent to 30 per cent of the MRP, excluding goods and services tax. This translates into a markup of approximately 42.86 per cent over the price charged to a stockist or distributor.
Patient representatives argue that such margins remain high for expensive cancer medicines, particularly when the distribution chain involves only a small number of intermediaries or direct sales to hospitals.
The criticism is especially relevant for high-value injectable cancer therapies, where even a relatively small percentage margin can translate into a substantial amount of money.
Another concern relates to the data used to calculate the revised prices.
The NPPA's updated list is based on pricing information reported by pharmaceutical companies, and the regulator has indicated that the list will be revised periodically.
AIDAN has questioned the adequacy of independent verification and the availability of reliable pricing data across different stages of pharmaceutical distribution.
The organisation argues that stronger oversight is necessary to ensure that the declared prices accurately reflect commercial transactions and that the intended reductions reach patients.
The revised MRPs nevertheless represent a major intervention in the pricing of cancer medicines, particularly for patients using generic and biosimilar treatments.
For some medicines, reductions exceeding 90 per cent could substantially change the affordability of individual treatment regimens.
However, the continued high prices of several original-brand therapies demonstrate that controlling distribution margins alone may not address every factor contributing to cancer treatment costs.
The effectiveness of the government's measures will depend on enforcement of the revised prices, transparency in pharmaceutical distribution and the extent to which hospitals and other providers pass on the reductions.
For patients, the immediate priority will be ensuring that lower listed prices translate into lower treatment bills, while broader questions concerning the affordability of expensive cancer therapies remain unresolved.
