NEW DELHI: Cancer treatment in India is set to become significantly more affordable after the National Pharmaceutical Pricing Authority (NPPA) capped the trade margins on 137 non-scheduled anti-cancer drugs at 30 per cent of the maximum retail price, a move expected to bring down the prices patients pay for these critical medicines by up to 70 per cent.
The Gazette notification was issued on October 17, 2026, and the revised prices will come into effect from November 9, 2026. The intervention, known as Trade Margin Rationalisation, has been carried out in the public interest under Paragraph 19 of the Drugs (Prices Control) Order, 2013, which empowers the pricing authority to fix or revise the prices of drugs in extraordinary circumstances.
Trade margin is the amount earned by intermediaries such as distributors, stockists and retailers between the manufacturer and the patient. Under the new order, traders will be allowed a margin of up to 30 per cent of the MRP, excluding Goods and Services Tax. This corresponds to a mark-up of 42.86 per cent on the price at which a manufacturer sells the drug to a stockist or distributor, known as the Price to Stockist or Price to Distributor.
The cap will apply to 137 anti-cancer drugs identified by an expert committee constituted under the Directorate General of Health Services. The committee, comprising leading oncologists, medical specialists, hospital experts and government officers, deliberated on the drugs used in cancer treatment and recommended the 137 medicines for inclusion. The list, which covers both patented and non-patented drugs, will be updated periodically.
The drugs covered by the order include widely used oncology medicines such as bevacizumab, pembrolizumab, nivolumab, osimertinib, palbociclib, atezolizumab, trastuzumab, olaparib, denosumab and topotecan. The cap applies to all strengths, dosage forms and routes of administration, including combination formulations. However, quantities supplied under Patient Assistance Programmes run by drug manufacturers for individual patients have been kept out of the purview of the order.
Manufacturers have been directed to inform the NPPA of their revised prices within seven days of the publication of the Gazette notification. They are also required to display the revised price lists on their websites and disseminate them widely among retailers and hospitals. Retailers, dealers, hospitals and medical institutions have been asked to prominently display the revised price lists, and hospitals must also showcase them on their websites.
Consumers will be able to verify the revised prices using the Pharma Sahi Daam app and the NPPA website.
Non-compliant manufacturers will face action. The NPPA has said that companies that do not follow the order will be liable to deposit the overcharged amounts, along with interest, under the Drugs Prices Control (Amendment) Order, 2013 and the Essential Commodities Act, 1955. State drug controllers have been asked to monitor the implementation of the order.
The pricing authority said that excessive mark-ups between the manufacturer's sale price and the MRP paid by the consumer were imposing catastrophic out-of-pocket costs on cancer patients and their families. Most of these medicines are classified as non-scheduled drugs, which means they are not covered by the government's regular price controls.
This had given companies and traders greater freedom to set prices, which the regulator said had resulted in high and sometimes unreasonable mark-ups.
The current intervention builds on the success of a pilot exercise carried out by the NPPA in 2019, when trade margins on 42 anti-cancer drugs were capped at 30 per cent. That effort reduced the MRP of 526 brands of non-scheduled anti-cancer medicines by up to 90 per cent and generated estimated annual savings of 984 crore rupees. Officials expect the latest and much larger intervention to yield annual savings of about 2,500 crore rupees.
The move also follows a significant development in the Supreme Court. On October 12, the Union government informed the apex court that it had decided to regulate trade margins on anti-cancer medicines by capping them at 30 per cent of the MRP. The court, while taking note of the assurance, called for a broader review of medicine pricing across the pharmaceutical sector.
Cancer is among the leading causes of death in the country, and the cost of treatment is one of the biggest barriers to care. A large share of cancer drugs in India are imported or manufactured under patent, and their prices have long been a matter of public concern.
Patient groups and oncologists have repeatedly flagged that the difference between the price at which a drug leaves the manufacturer and the price printed on the pack is often enormous, with the margin being absorbed by intermediaries rather than reaching the patient in the form of lower prices.
By capping the trade margin at 30 per cent of the MRP, the NPPA has sought to retain what it describes as a reasonable trade margin while preventing excessive mark-ups. The minutes of the 284th meeting of the NPPA, held on October 16, record the authority's view that the cap was necessary to ensure that the benefits of rationalised margins flow to patients.
The pharmaceutical industry will now have to rework the prices of a large number of oncology brands within a short window. Companies must submit their revised price details to the NPPA and to the State Drug Controller within seven days of the notification, even in cases where there is no change in the price. Products that are already priced below the ceiling will retain their existing MRP.
For patients and hospitals, the change will mean lower bills for chemotherapy and targeted therapy from November 9. Hospitals, which often add their own margins to the medicines they dispense, will also have to comply with the revised prices and display them. The NPPA has said that the list of drugs under the cap will be reviewed from time to time, depending on market conditions and public health needs.
The order is the latest in a series of steps by the government to bring down the cost of essential and life-saving medicines. Price regulation in India has traditionally focused on scheduled drugs under the National List of Essential Medicines, but the use of Paragraph 19 of the DPCO has allowed the regulator to act on non-scheduled drugs as well when the public interest demands it.
As the November 9 deadline approaches, all eyes will be on the implementation. State drug controllers, retailers and hospitals have been asked to ensure that the revised prices are charged from the effective date, and patients have been advised to verify prices through the official app and website. If implemented effectively, the trade margin rationalisation could bring meaningful relief to lakhs of cancer patients and their families across the country.
(Reporting based on Business Today and The Hindu BusinessLine.)