Out-of-pocket expenditure remains the main barrier to cancer care in India. Evaluate how price regulation and insurance schemes such as AB-PMJAY together address this.

Medicines make up the largest share of India's out-of-pocket expenditure (OOPE) on health, about 52% by older estimates [1]. Cancer treatment runs long and costs a lot, so this burden is heavier for cancer patients. Price regulation and AB-PMJAY target different cost heads. Together they reduce this barrier but do not remove it.

Price regulation: cheaper medicines

• Ceiling prices: NLEM 2022 lists 63 anti-cancer drugs. These are scheduled under DPCO 2013 and have fixed ceiling prices [2].
• Trade Margin Rationalisation (TMR): NPPA used Paragraph 19 to cap trade margins at 30% of MRP on 137 non-scheduled anti-cancer drugs, including patented ones. MRPs fall by up to 70% from 9 November 2026 [3].
• Proven model: The 2019 pilot covered 42 drugs and cut the MRPs of 526 brands by up to 90% [4].
• Safeguards: Companies must give 6 months' notice before stopping a drug and must refund overcharges with interest. Patients can check prices on the Pharma Sahi Daam app [2].

AB-PMJAY: protection against hospital costs

• It gives Rs 5 lakh per family per year of cashless cover, including oncology [2]. This covers surgery and hospital stays, which price caps cannot touch.
• Cheaper drugs make this fixed cover last longer, so the two tools work together.

Gaps that remain

• Weak enforcement: As of 2025, Rs 8,526 crore (85%) of overcharging dues had not been recovered. About 70% of that is stuck in court cases [5].
• Drug-by-drug coverage: Paragraph 19 orders are issued one drug at a time. Retail margins on anti-cancer drugs are still 50–60% [6]. Drugs not on the list can still raise their MRP by 10% a year under Paragraph 20 [2].
• Manufacturer's price untouched: TMR caps only the markup, so patented drugs stay expensive. GST is also added on top of the capped price [2].
• Insurance gaps: The scheme does not fully cover newer therapies and diagnostics [7].

Way forward

• Write a permanent TMR framework into law, covering all anti-cancer molecules [5][6].
• Set up a fast-track system to recover overcharges, with a dedicated legal cell in NPPA [5].
• Expand National Cancer Grid pooled buying, cut the Paragraph 20 yearly increase to 5%, and add diagnostics to insurance cover [7].

Price regulation lowers what medicines cost, and AB-PMJAY protects families from large hospital bills. Together they are a credible but still partial answer to OOPE. Making TMR permanent, enforcing it better and widening insurance cover would turn this into lasting financial protection. That would advance the right to health under Article 21 and SDG 3.8 on universal health coverage.