India Slashes Prices of 137 Cancer Drugs After Supreme Court Calls Excessive Mark-Ups ‘Extortion’
The Indian government has moved to make cancer treatment more affordable by imposing a 30 per cent cap on trade margins for 137 additional anti-cancer medicines, following strong criticism from the Supreme Court over excessive mark-ups in the pharmaceutical supply chain. The revised prices are expected to take effect from November 9, 2026, with some medicines projected to become cheaper by as much as 70 per cent.
The decision follows a series of hearings in which the Supreme Court questioned the substantial difference between the prices at which cancer medicines are supplied to retailers and the maximum retail prices charged to patients. During a hearing in September, a bench of Justices Vikram Nath and Sandeep Mehta expressed outrage after being informed that a cancer drug available to retailers for approximately ₹2,700 carried a maximum retail price of ₹27,000.
Questioning the tenfold difference, the judges described the practice as “extortion” and raised concerns about the financial burden imposed on patients who depend on life-saving medicines. The court also questioned why regulatory authorities had failed to adequately address such steep mark-ups and whether similar controls should apply to a wider range of medicines.
Under the new measure, the National Pharmaceutical Pricing Authority (NPPA) has extended trade-margin rationalisation to 137 additional anti-cancer medicines. The policy covers branded and generic drugs, including medicines manufactured domestically and those imported from abroad. It also includes patented medicines that fall outside the existing scheduled price-control framework.
The government expects the intervention to reduce the prices of affected medicines by approximately 20 to 70 per cent, depending on their existing prices and trade margins. Officials have estimated that the measure could generate annual savings of around ₹2,500 crore for cancer patients and their families.
The move builds on an earlier initiative introduced in 2019, when trade margins on 42 anti-cancer medicines were capped at 30 per cent. The expanded framework seeks to address medicines that remained outside that initial list, where substantial differences between procurement costs and retail prices continued to affect affordability.
The Supreme Court’s scrutiny gained momentum through a petition filed by Sarojam Radhakrishnan, a retired bank employee from Kerala who was diagnosed with breast cancer in 2021. Her prescribed treatment reportedly cost more than ₹63,000 per month, placing an enormous financial burden on her family. She approached the Kerala High Court in 2022 seeking government intervention to make essential cancer medicines more affordable.
The matter eventually reached the Supreme Court, where the wider issue of drug pricing and excessive trade margins came under examination. Radhakrishnan died in September 2022 while her case was still pending, but the questions raised through her petition have contributed to renewed scrutiny of medicine affordability.
According to findings discussed during the proceedings, the National Pharmaceutical Pricing Authority identified substantial mark-ups across parts of the cancer-drug supply chain. Some medicines reportedly carried average trade mark-ups of approximately 170 per cent, while certain examples exceeded 700 per cent. Such differences can significantly increase the amount patients pay, particularly when hospitals require medicines to be purchased through their own pharmacies.
The issue is especially serious in India, where many families pay a substantial portion of their healthcare expenses out of pocket. Cancer treatment can involve repeated chemotherapy sessions, specialised medicines, diagnostic procedures and prolonged hospital care. When the cost of medicines becomes unaffordable, some patients delay treatment, discontinue therapy or avoid seeking a diagnosis altogether.
Government-backed health insurance provides financial assistance to eligible families, but coverage limits can be insufficient for expensive cancer treatments. For certain patients, the cost of a single dose of a targeted therapy can consume a large share of the annual insurance benefit, leaving subsequent doses and other medical expenses difficult to finance.
Health experts have welcomed the price-control measure as a step towards improving access to essential medicines. However, they have also stressed that the actual benefit will depend on whether revised prices are reflected in patient bills, whether hospitals and pharmacies comply with the rules, and whether supplies remain uninterrupted.
The policy does not directly reduce the prices charged by manufacturers before medicines enter the distribution chain. Instead, it restricts the trade margin that can be added along the supply chain for the medicines covered by the measure. Consequently, the extent of the reduction will differ from one drug to another, and medicines whose existing margins are already within the prescribed limit may not become cheaper.
The Supreme Court has also questioned why tighter controls should be limited to cancer medicines rather than being considered for other essential drugs. The Centre has been asked to respond to broader concerns regarding medicine pricing, while the court continues examining petitions seeking stronger regulation of pharmaceutical costs.
The expanded price cap marks a significant intervention in India’s efforts to curb excessive medicine mark-ups and reduce the financial pressure on cancer patients. Its long-term impact will depend on effective enforcement, transparent pricing throughout the supply chain and continued availability of the medicines patients need to sustain treatment.
