India caps margins on 137 cancer drugs, with prices set to fall by up to 70%

Key Facts

India’s National Pharmaceutical Pricing Authority has capped trade margins on 137 non-scheduled anti-cancer drugs, invoking paragraph 19 of the Drug Price Control Order, 2013. The Ministry of Chemicals and Fertilizers said the move could cut maximum retail prices by up to 70%, depending on each drug’s current price structure. The revised prices are due to take effect on November 9, 2026. Minutes of the authority’s meetings, as reported by The Indian Express, estimated that the overall reduction could range from 20% to 70%. The authority’s experts also estimated annual patient savings at about 2,500 crore rupees.

The decision targets drugs that were not included on the list of medicines subject to specified price ceilings. The government said the products were selected on the recommendation of an expert committee under the Directorate General of Health Services. The committee recommended including 137 drugs, with the list to be updated from time to time. They include immunotherapy drugs used to treat more than 20 types of cancer, as well as denosumab, pegfilgrastim and bevacizumab. The government also cited pembrolizumab, durvalumab and osimertinib among the drugs covered by the decision. The list includes treatments for various uses, including preventing neutropenia and treating patients with breast and prostate cancer.

The intervention followed an estimate by experts at an authority meeting that trade markups on non-scheduled anti-cancer drugs averaged about 170% and reached 700% in some cases. The estimates point to a wide gap between a drug’s price before it passes through sales channels and the retail price paid by patients, which the new margin limits are intended to address. The authority estimated that its recalibration could reduce maximum retail prices within a broader range than the government’s stated maximum: between 20% and 70%. The size of the decline will depend on each drug’s price structure, so the decision does not imply a uniform reduction across all products. The government said the revised prices would reflect implementation of the measure for the drugs specified in the notification.

Market figures put the decision in the context of a cancer-drug market with annual sales estimated at about 12,500 crore rupees, according to The Indian Express. Of that total, listed drugs subject to price regulation account for about 2,250 crore rupees, leaving a large share of sales outside the previous ceilings. The government had said prices for 131 anti-cancer drugs were subject to ceilings in force through March 9, 2026. Those ceilings helped reduce prices by about 21% compared with levels under the 2015 National List of Essential Medicines, with estimated annual patient savings of about 294 crore rupees. The new decision expands the intervention to cover 137 non-scheduled drugs.

Capping trade margins means the decision will affect distribution and sales channels, while production and supply requirements remain in place. The government has required drug companies to maintain current production and supply levels for the covered formulations. The Indian Express also reported that companies selling a drug below the maximum price calculated after the margin recalibration must keep their current price. Annual price-increase rules remain part of the regulatory framework: the government said in an earlier statement that manufacturers may not raise the maximum retail price of non-scheduled drugs by more than 10% over the preceding twelve months. Business Standard noted that applying a margin cap does not necessarily remove the possibility of the permitted annual increase.

Doctors and activists cited by Business Standard do not expect all patients to benefit to the same extent, as the impact may be smaller for those enrolled in patient assistance programs that provide some treatments free or at steep discounts. An oncologist said a margin cap “is unlikely to lower costs for patients enrolled in patient assistance programs, because their medicines are already provided free or at heavily discounted prices.” The report said such programs may cut expenses for some high-cost immunotherapy and targeted treatments by between 30% and 60%. Doctors and activists said patients buying medicines through hospitals or pharmacies may benefit more. Hospitals account for about 70% of cancer-drug sales, according to industry estimates cited in the report.

The new coverage remains limited compared with some of the best-selling drugs in the retail channel: six of the 10 best-selling drugs were already subject to National List of Essential Medicines price ceilings, while the new decision covers three of those 10 drugs. The figures show that broader price controls do not automatically align with the list of products that sell the most in pharmacies. The move follows an earlier intervention in 2019 that cut prices for 390 anti-cancer drugs, or 91% of the brands reported by manufacturers at the time. The government then estimated that 22 lakh patients would benefit, with annual savings of about 800 crore rupees. That earlier step provides context for the repeated use of pricing tools in the oncology drug market.

Companies must notify the authority of their revised prices within 7 days of publication of the official notification, while state drug regulators will verify that companies, distributors and hospitals comply with the new prices. The government said consumers can check prices through the Pharma Sahi Daam app or the National Pharmaceutical Pricing Authority’s website. The revised prices take effect on November 9, 2026, while the requirement to maintain production and supply levels remains in place. The next phase will focus on announcing the revised prices and monitoring their implementation across sales channels. The actual reduction will continue to depend on each drug’s current price and structure.