India caps cancer drug markups

The Indian government will extend a 30 percent margin cap to 137 cancer medicines starting next month. This move follows a Supreme Court order that labeled hospital and retailer markups on these drugs as "carnage" and "extortion." The policy aims to reduce the out-of-pocket burden for patients who often abandon treatment due to high costs.

The legal battle was initiated by Sarojam Radhakrishnan, a retired bank clerk from Kerala diagnosed with breast cancer in 2021. Her prescribed targeted treatments cost more than 63,000 rupees, or roughly 500 pounds, per month. In 2022, she petitioned the Kerala high court to force the government to lower prices. The case eventually reached the nation's highest court, where justices Vikram Nath and Sandeep Mehta reviewed the pricing structure.

During a hearing on 29 September, the justices cited specific examples of excessive pricing. They noted that one cancer drug supplied to hospitals for 2,700 rupees was sold to patients for 27,000 rupees. The court found that distributors, chemists, and hospitals were capturing large portions of the final price through trade margins. This finding triggered the government's move to expand existing regulations.

The National Pharmaceutical Pricing Authority conducted an analysis showing that trade markups on certain cancer drugs averaged 170 percent, with some cases exceeding 700 percent. A 30 percent cap had already applied to 42 drugs for several years, but many others remained outside the list. The Department of Pharmaceuticals stated that extending the cap to 137 additional drugs is expected to reduce medicine prices by up to 70 percent. The department estimated this change would help cancer patients save 2,500 crore rupees, approximately 199 million pounds, annually.

The financial strain on families is well documented in medical literature. Krishan Kalra, a former council member of the Rajiv Gandhi Cancer Institute and Research Centre, noted that many people avoid free diagnosis camps in Gurgaon. He explained that patients fear finding out they have cancer because they lack the funds for treatment. Cancer drug prices currently range from 38,000 to 380,000 rupees, causing many families to leave consulting rooms after hearing cost estimates. Studies by the Public Health Foundation of India indicate that healthcare spending pushes about 55 million Indians below the poverty line each year.

Existing insurance coverage offers limited protection against these costs. The government's Ayushman Bharat scheme provides 500,000 rupees of annual cover per family for some cancers. This amount equals the cost of one dose of Kadcyla, a breast cancer drug for which patients may require up to 14 doses. Dr. Ravi Kannan, a surgical oncologist at Cachar cancer hospital in Silchar, Assam, said the decision is a "welcome step" because it may help more patients access necessary drugs. He noted that many families begin treatment but cannot sustain it financially over time.

India records about 1.56 million new cancer cases annually, an increase from 1.39 million in 2020. Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, called for a "total overhaul" of healthcare with greater transparency across the supply chain. She warned that hospitals might offset lower drug prices by raising other charges. The Supreme Court has asked government lawyers why the cap should not apply to all non-patented medicines and set a deadline of 27 October for a response. Radhakrishnan died in September 2022 while her case was still pending.