Lowering cancer drug prices alone cannot ensure access. Discuss the role of pricing, fiscal and supply-side measures in reducing out-of-pocket expenditure on cancer care.
New · District CollectorCan you hold the district for 72 hours?Floods, a heatwave, an outbreak, a grievance queue. Take the decisions, see the consequences.Play →On 17 October 2026, NPPA capped trade margins on 137 non-scheduled anti-cancer drugs at 30% of MRP. This is expected to cut MRPs by up to 70% [1]. Yet a lower printed price reduces out-of-pocket expenditure (OOPE) only when pricing, fiscal and supply-side measures work together.
Pricing measures
- Trade Margin Rationalisation (TMR) under Para 19, DPCO 2013 limits distribution and retail mark-ups while protecting legitimate manufacturer revenue [1].
- The 2019 pilot on 42 drugs cut MRPs of 526 brands by about 50% on average, saving patients about ₹984 crore a year [2].
- Transparency: manufacturers and hospitals must publish revised prices, and patients can check them on the Pharma Sahi Daam app [1].
Fiscal measures
- Customs duty was cut to nil and GST from 12% to 5% on Trastuzumab Deruxtecan, Osimertinib and Durvalumab. NPPA directed firms to pass this on through lower MRPs [3].
- Budget 2025-26 fully exempted 36 lifesaving drugs from Basic Customs Duty [4]. Budget 2026-27 exempted 17 more, particularly for cancer patients [5].
Supply-side measures
- Firms must maintain current production and supply, so cheaper drugs do not disappear from shelves [1].
- Much of the supply goes directly to hospitals, which must charge the revised prices. State Drug Controllers enforce the order, which tests cooperative federalism [1].
Why price cuts alone fall short
- Launch-price loophole: non-scheduled drugs make up about 82% of the market and can be launched at arbitrary prices. TMR does not touch the manufacturer's price [6].
- Weak recovery: ₹8,526 crore (85%) of NPPA's overcharging demands remained unrecovered as of 2025, mostly stuck in litigation [6].
- Ad hoc tool: TMR still relies on emergency Para 19 powers, with no timeline for a permanent framework in DPCO [6].
Pricing caps lower the bill, fiscal relief lowers the base cost, and supply safeguards keep the drug available. The way forward is to act on the Standing Committee's call to make TMR permanent, review drug classification and fast-track overcharging disputes [6], and to monitor availability after each price cut. Together, these would turn price notifications into real access. That would fulfil the Article 47 duty to improve public health and SDG 3.8 on affordable essential medicines.
Sources
- 1Trade Margin Rationalisation on 137 Anti-Cancer Drugs — PIB, 17 Oct 202630% margin cap, up to 70% MRP cut, Para 19 basis, price display, Pharma Sahi Daam, supply obligation, hospital and State Drug Controller enforcement *(the release page could not be opened or found in search, so this links the PIB site root)*
- 2NPPA caps trade margin of 42 non-scheduled anti-cancer medicines under TMR; up to 90% MRP reduction of 526 brands — PIB2019 pilot results, ~50% average cut, ~₹984 crore annual savings
- 3Customs duty on Trastuzumab Deruxtecan, Osimertinib and Durvalumab reduced to nil; GST cut from 12% to 5% — PIBduty and GST relief, NPPA direction to cut MRPs
- 4PIB Summary, Union Budget 2025-26BCD exemption on 36 lifesaving drugs
- 5PIB Summary, Union Budget 2026-27BCD exemption on 17 drugs, particularly for cancer patients
- 6Standing Committee Report Summary: Review of Role, Functions and Duties of NPPA — PRS Legislative Researchlaunch-price loophole (82% non-scheduled), ₹8,526 crore unrecovered, no permanent TMR timeline, recommendations