India extends price caps to 137 cancer drugs after Supreme Court ruling

The Indian government will lower the price of 137 cancer medicines starting next month following a directive from the Supreme Court.

The decision responds to a legal challenge initiated by Sarojam Radhakrishnan, a former bank clerk from Kerala who was diagnosed with breast cancer in 2021. Her doctors prescribed targeted treatments that cost over 63,000 rupees monthly, a sum her family could not sustain. Radhakrishnan petitioned the Kerala high court in 2022 to intervene on pricing issues.

The case reached the Supreme Court, where justices Vikram Nath and Sandeep Mehta reviewed the pricing structures used by hospitals and retailers. During a hearing on 29 September, the judges described the high mark-ups as "carnage" and "extortion." They cited a specific example of a drug supplied to hospitals for 2,700 rupees but sold for 27,000 rupees. The National Pharmaceutical Pricing Authority analysis indicated that trade mark-ups on certain cancer drugs averaged 170%, with some instances exceeding 700%. While a 30% margin cap already applied to 42 drugs, the government has now expanded this limit to the additional 137 medicines.

The Department of Pharmaceuticals stated that the new measures should reduce medicine prices by up to 70%. The department projected that cancer patients would save 2,500 crore rupees annually. This financial relief aims to address the burden on families who often sell land or incur debt to pay for treatment. Krishan Kalra, a former council member of the Rajiv Gandhi Cancer Institute and Research Centre, noted that many people avoid free diagnosis camps because they fear they cannot afford the treatment if cancer is detected. Cancer drugs in India currently range from 38,000 to 380,000 rupees. Studies from the Public Health Foundation of India indicate that healthcare costs push approximately 55 million Indians below the poverty line each year.

Insurance coverage remains limited for many patients. The government’s Ayushman Bharat scheme provides 500,000 rupees in annual coverage per family, which equals the cost of one dose of the breast cancer drug Kadcyla. Patients may require up to 14 doses of that medication. Dr Ravi Kannan, director of Cachar Cancer Hospital and Research Centre in Assam, called the new pricing decision a "welcome step" that could help more patients access necessary drugs. He noted that some families currently begin treatment but cannot sustain the costs.

India records approximately 1.56 million new cancer cases annually, an increase from 1.39 million in 2020. Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, argued that the healthcare system requires a "total overhaul" with greater transparency across the supply chain. She warned that hospitals might offset lower drug prices by increasing other charges. The Supreme Court has asked government lawyers to explain why the price cap applies only to cancer drugs and not all non-patented medicines. The government has until 27 October to respond to that question. Radhakrishnan died in September 2022 while her case was still pending in Kerala.