The National Pharmaceutical Pricing Authority (NPPA) has released a list of 543 non-scheduled anti-cancer drugs with revised maximum retail prices (MRP) based on its recent Trade Margin Rationalisation (TMR) announcement. However, experts from Civil Society Organisations (CSOs) have pointed out several flaws in the margin rationalisation methodology.
The revised prices, based on data received from companies until October 27, 2026, show reductions of up to 93.27% in some cases. Many drugs have seen declines of around 80-90% in MRP. Despite these reductions, the prices of many latest and patented drugs with high MRP remain unchanged. This has raised concerns about the effectiveness of the TMR in ensuring affordability for patients, particularly for critical treatments.
High-Priced Drugs Remain Unaffected
The Working Group on Access to Medicines and Treatments, a network of patients, activists, and professionals, has highlighted that the effort has left almost 65 formulations of 36 high-priced medicines with their prices intact. For example, the price of the cancer immunotherapy drug pembrolizumab (brand name Keytruda) remains at Rs. 216,500 per vial of 100 mg injection. Similarly, a combination of pertuzumab and trastuzumab 1,200 mg vial, branded as Phesgo and marketed by Roche Pharma, will remain at a price of Rs. 493,266 per vial. K M Gopakumar, co-convenor of the Working Group, stated that the measures to make cancer drugs affordable are inadequate, as they fail to address the prices of the latest and most critical treatments.
Flawed Methodology and Exclusion of PAP Quantities
The NPPA’s price-fixing methodology for TMR determines the Price to Stockist (PTS) or Price to Distributor (PTD) based on the manufacturer’s net sales realization during March 2026. However, Patient Assistance Programme (PAP) quantities were excluded from the calculation, which has led to the conscious exclusion of volumes provided free under PAP. This exclusion has been criticized for undermining the potential for greater price reductions, particularly for patented medicines.
Malini Aisola, co-convenor of the All India Drug Action Network (AIDAN), emphasized that the high markup legitimizes profiteering, especially given the limited supply chain for cancer medicines. She further noted that if the markup had been limited to 16%, as under the DPCO for scheduled formulations, the public benefit would have been significantly greater.
Drastic Price Reductions and Exploitative Practices
The price reductions for certain brands have been substantial. For instance, the price of a strip of palbociclib 125 mg capsules under the brand Palbopro has declined by 93.27% from Rs. 40,421.33 to Rs. 2,720. Another palbociclib drug, Isogen 125 mg, has seen its MRP drop from Rs. 27,540 to Rs. 2,362.53 per strip, a 91.4% reduction.
Additionally, the price of Thiotepa 100 mg injection (Samtepa) per vial has seen a 91.07% price drop from Rs. 80,071.86 to Rs. 7,150.33. Aisola alleged that these reductions indicate the exploitation that has been taking place, with many major Indian companies providing huge margins and exploiting patients. She emphasized the need for permanent margin caps and consistent monitoring by the NPPA to ensure affordability and prevent profiteering.
The latest list shows that many of the formulations, for which the TMR were fixed in 2019, underwent a TMR once again. NPPA has abdicated its responsibilities towards gathering and maintaining the price data at various points in the supply chain and diverse distribution channels. The paucity of critical data has led to a situation where companies have been asked to calculate their MRPs and self report, and implement the prices, without any verification, she opined.
