Out-of-pocket expenditure on cancer care remains a major cause of medical impoverishment in India. Evaluate the role of drug-pricing regulation in addressing it.

The Parliamentary Standing Committee on Health notes that 70–80% of cancer treatment cost in India is paid out of pocket, at an average of about ₹7.5 lakh per patient [1]. Drug-pricing regulation is a necessary but partial answer to this.

Role of pricing regulation: gains

• Trade Margin Rationalisation (TMR): NPPA has capped trade margins at 30% on 137 non-scheduled anti-cancer drugs. This is expected to save ₹3,502.31 crore a year, and 600 formulations are now more than 50% cheaper [2].
• Newer therapies covered: the cap includes immunotherapies and biologics such as Bevacizumab [3].
• Innovation-friendly: the manufacturer's own price is untouched, so supply incentives stay in place. Drugs not yet launched are covered in advance [2].
• Transparency: revised MRPs must be displayed, and consumers can report violations on Pharma Sahi Daam [2].

Limitations

• Partial cost coverage: medicines are the biggest part of catastrophic spending, but surgery, radiation and travel remain unaddressed [1].
• Patented drugs stay costly: in biologics, most of the price is the manufacturer's price, and TMR does not touch it [2].
• Margins still high: retail margins on anti-cancer drugs are still 50–60% [1]. Drugs outside the list only face a 10% annual increase limit, so a price that is already high stays high [4].
• Weak legal base: TMR still runs through ad hoc notifications. There is no timeframe for building it permanently into DPCO 2013 [4].
• Poor enforcement: ₹8,526 crore (85%) of overcharging demands remained unrecovered as of 2025, mostly because of litigation [4].
• Flat rate: a 30% cap still leaves the largest rupee margins on the costliest drugs.

Way forward

• Make TMR permanent within DPCO, with lower margin slabs for costlier drugs.
• Regulate mark-ups and publish prices across the supply chain, as WHO's 2020 guideline advises [5].
• Set up fast-track dispute resolution to recover overcharged amounts [4].
• Pair price caps with insurance (PM-JAY) for risk pooling [1].

Overall, pricing regulation has clearly lowered medicine bills and removed inflated MRPs. But it addresses only one part of cancer-related impoverishment. A permanent TMR framework, combined with insurance and stronger public oncology services, can advance SDG 3.8 (Universal Health Coverage) and the Article 21 right to health.