A margin cap extended to 137 more drugs

The move follows years in which a 30% trade margin cap applied to only 42 cancer drugs; the government has now imposed the same cap on 137 other medicines, which will cost less from next month [F2, F9].

The Department of Pharmaceuticals expects the measure to reduce medicine prices by up to 70% and help cancer patients save 2,500 crore rupees (£199m) annually.

• •42 drugs already carried the 30% trade margin cap
• •137 additional drugs join the cap from next month
• •Prices may fall by up to 70%
• •Expected patient savings: 2,500 crore rupees (£199m) a year

'Extortion' before the court

The policy change began with a retired bank clerk. Sarojam Radhakrishnan, a former bank employee in Kerala, was diagnosed with breast cancer in 2021 and found the prescribed targeted treatments cost more than 63,000 rupees (£500) a month, far beyond her family's means [F4, F5]. She petitioned the Kerala high court in 2022 demanding government intervention to lower the costs, but died in September 2022 while the case was still pending [F6, F23].

At a hearing on 29 September, justices Vikram Nath and Sandeep Mehta noted that a life-saving drug supplied to hospitals at 2,700 rupees carried a marked-up price of 27,000 rupees. National Pharmaceutical Pricing Authority analysis found trade mark-ups on some cancer drugs averaging 170%, with extreme examples stretching beyond 700%. The judges called the situation 'carnage' and 'extortion'.

The cost patients cannot carry

The ruling landed against a backdrop of severe financial strain. With cancer drugs ranging in price from 38,000 to 380,000 rupees, many families quietly walk out of the doctor's room on hearing the estimated cost of treatment.

• •Public Health Foundation of India studies show healthcare spending pushes about 55 million Indians a year below the poverty line
• •Ayushman Bharat provides 500,000 rupees of annual family cover - the cost of just one dose of Kadcyla, and patients may need up to 14 doses
• •India records about 1.56 million new cancer cases annually, up from 1.39 million in 2020

Krishan Kalra, a former council member of the Rajiv Gandhi Cancer Institute and Research Centre, urges local drivers, maids, cooks and tailors to attend the free diagnosis camps the Indian Cancer Society holds in Gurgaon, where he lives - but few come. When he asks why, people tell him they are too scared to be tested, because if something serious like cancer is detected, they have no money to pay for treatment.

Welcome, but is it enough?

Dr Ravi Kannan, director of the Cachar cancer hospital in Silchar, Assam, said some families start treatment hoping to manage the cost, but never come back for chemotherapy or radiation because they cannot sustain the payments. Of the price cap, he said: "The decision is a welcome step if the outcome is that more patients can access the drugs they need."

Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, said a "total overhaul" of the healthcare system was needed. She argued that the entire supply chain, from the cost of manufacturing a drug to the point of sale, must be made transparent and regulated for medicines to reach those who need them. She also warned that companies and hospitals may seek legal loopholes, possibly offsetting a lower drug price by raising charges on other items.

The supreme court has now asked why the cap should not apply to all non-patented drugs and given the government until 27 October to respond.