NPPA’s new price table cuts some cancer medicines by up to 93 per cent. However, medicines sold by a single company, which activists describe as patented, stay at the same price
In less than a fortnight, some cancer medicines in India will cost a fraction of what they do today. One brand of palbociclib capsules, now priced at Rs 40,421, will sell for Rs 2,720. A thiotepa injection priced at Rs 80,072 will cost Rs 7,150.
However, for the newer medicines that many patients now depend on, the price list brings almost no relief. Sample this: A pack of 30 osimertinib tablets, used in lung cancer, costs Rs 4.16 lakh today and will cost the same after November 9.
This is what a reading of the data published by the country’s drug price watchdog, National Pharmaceutical Pricing Authority (NPPA) shows. The table lists the old and the revised maximum retail price (MRP) of 543 brand and pack entries, based on information given by companies up to October 27.
What The Government Has Done
On October 17, NPPA, the government body that controls medicine prices, capped the “trade margin” on 137 cancer medicines at 30 per cent of the MRP, excluding GST. These are medicines whose prices were not already under direct government control. The move is called trade margin rationalisation, or TMR.
Trade margin is the gap between the price at which a company sells a medicine to the stockist or distributor, known as the price to stockist (PTS), and the MRP the patient pays. NPPA’s 30 per cent cap on the MRP works out to a mark-up of 42.86 per cent over the PTS. The order covers patented medicines too. The new prices start on November 9, and the government has said prices can fall by up to 70 per cent.
In NPPA’s table, 397 of the 543 entries show a lower price, and 146 show no change. A total of 97 entries, nearly one in five, fall by 70 per cent or more. Fifty drugs fall by 80 per cent or more, and five fall by more than 90 per cent. So, in some cases, the cut is bigger than the government’s “up to 70 per cent”.
The steepest cuts are on medicines that many companies sell under different brand names. For instance: A pack of 60 dasatinib tablets (70 mg, Dyronib), used in blood cancer, falls from Rs 17,811 to Rs 1,808. A pack of 120 abiraterone tablets (250 mg, Abirat), used in prostate cancer, falls from Rs 36,089 to Rs 4,064. A 400 mg bevacizumab injection (Bevacizab) falls from Rs 65,205 to Rs 8,957.
Malini Aisola, co-convenor of the All India Drug Action Network (AIDAN), said the size of the cuts shows what patients were paying. “The price reductions of certain brands have been drastic or substantial. This indicates the looting and exploitation that has been taking place.”
Aisola added, “Many of the major Indian companies making generic versions of the cancer drugs have been providing huge margins and exploiting patients.”
Dr Pragya Shukla, head of the department of clinical oncology at Delhi Cancer Institute, pointed to the discounts that can lie behind such margins. “Conversely, parts of the generic and biosimilar market can utilise deep trade discounts and schemes—such as ‘100+50’—that materially increase effective trade margins well above 50 per cent.”
Where Prices Stay The Same
NPPA’s table also lists newer, high-cost medicines for which it shows no price change. Experts describe many of these as “patented medicines”. They include osimertinib, alectinib, tremelimumab, dostarlimab, ivosidenib, selumetinib and pembrolizumab. For each of them, the old and the revised MRP are the same.
Osimertinib—brand name Tagrisso—stays at Rs 4.16 lakh. Similarly, Alectinib—brand name Alecensa—stays at Rs 4.31 lakh. Tremelimumab (Imjudo, 300 mg injection) stays at Rs 4.18 lakh, and dostarlimab (Jemperli, 500 mg injection) at Rs 3.91 lakh. Ivosidenib (Tibsovo, 250 mg, 60 tablets) stays at Rs 6.58 lakh, and selumetinib (Koselugo, 25 mg, 60 capsules) at Rs 10.22 lakh. A single 100 mg vial of pembrolizumab (Keytruda) stays at Rs 2.17 lakh.
KM Gopakumar, co-convener of the Working Group on Access to Medicines and Treatments, said: “The NPPA list shows that there is no change in the MRP of nearly 37 patented medicines, consisting of 65 formulations, even after the fixation of the trade margin. Therefore, measures to bring competition for those life-saving medicines, like compulsory licensing or government use, are urgent.”
Also, Aisola said TMR was never meant to make cancer treatment affordable. “The prices of several patented medicines have not reduced. TMR was never about ensuring affordability of cancer treatments. Yet even marginal price reductions in the price of exorbitantly priced patented medicines have been scuttled by the conscious exclusion of volumes provided free under Patient Assistance Programs under the TMR.”
Patient Assistance Programmes, or PAPs, are company schemes that provide certain medicines free of charge to patients. The NPPA sheet table does not say why the prices of these medicines have not changed.
What Does This Mean For Families?
A single pack of these medicines can cost more than Rs 4 lakh. Cancer treatment can go on for months, and for many families the cost cannot be met from savings alone. Dr Suresh Kumar Patel, a cancer physician at MOC Cancer Care in Mumbai, said even small cuts matter.
“In cancer treatment, even a reduction of a few thousand rupees can matter when the expense recurs every month. Lower medicine prices can help families sustain treatment with less financial strain. But affordability also means ensuring that the right medicine remains consistently available to the patient,” he said.
