India cuts prices on 397 of 543 cancer drug brand entries, effective 9 November

The National Pharmaceutical Pricing Authority released revised maximum retail prices for 543 cancer drug brands and pack sizes on 28 October, the Ministry of Chemicals and Fertilizers said in a release issued through the Press Information Bureau. The new rates take effect on 9 November.

What the list shows

Not every entry moved. Prices fell in 397 of the 543 listed brand, strength and pack-size entries, or nearly three-fourths, according to the revised list as reported by The Indian Practitioner. The average reduction among the affected entries was about 50%, and more than 200 formulations recorded cuts of 50% or more. Some individual brands fell by more than 90%.

How the cuts work

The mechanism is narrower than the headline count suggests. On 17 October NPPA capped trade margins at 30% of MRP for 137 non-scheduled anti-cancer medicines, a far smaller set than the 543 entries in the list. The order invoked Paragraph 19 of the Drugs (Prices Control) Order, 2013, which lets the government regulate prices in the public interest. Those medicines sit outside the National List of Essential Medicines, so they are not subject to direct price fixation under the standard framework.

The Supreme Court had questioned the gap between wholesale and retail prices. A bench of Justices Vikram Nath and Sandeep Mehta examined instances where drugs supplied to distributors for Rs 2,700 were sold to patients for Rs 27,000, and described the markups as "broad daylight dacoity", according to a Gujarat Samachar report.

What got cheaper

The deepest cuts hit generics and biosimilars. One brand and pack size of palbociclib, used in some breast cancers, fell from Rs 40,421 to Rs 2,270, NENow and News9live reported. Palbopro, a brand of palbociclib 125 mg, fell from Rs 40,421.33 to Rs 2,720, a reduction of 93.3%, India Today reported; PTC News gave the earlier price as Rs 40,421.

Thiotepa, a chemotherapy drug made by Samarth Life Sciences, fell from Rs 80,072 to Rs 7,150 for a 100 mg vial, a saving of nearly Rs 72,922 a vial. A strip of 10 Anarzole tablets, anastrozole 1 mg from RPG Life Sciences, went from Rs 695.76 to Rs 73.00, a reduction of nearly 90%. Fulvestrant 50 mg injection from the same manufacturer fell by over 78%, from Rs 26,072.16 to Rs 5,491. Dr Reddy's Laboratories' azacitidine 100 mg injection fell from Rs 6,337 to Rs 1,495.04. Abbott Healthcare's bevacizumab 100 mg/4 ml injection went from Rs 21,767.70 to Rs 5,930.13, and Natco Pharma's dasatinib 20 mg pack of 60 tablets from Rs 2,812.50 to Rs 1,085.93.

Savings vary by brand within the same molecule. The PALENO brand of palbociclib 100 mg moved only slightly, from Rs 5,717.81 to Rs 5,624.10. PTC News reported the cuts are much deeper than the 70% reduction the government had earlier indicated. Indranil Ghosh, a consultant medical oncologist at Manipal Hospitals, told The Times of India that Bevaceril 400, an anti-angiogenic drug used in colon, ovarian and brain tumours, dropped from Rs 75,718 to Rs 12,668.

What did not change

Keytruda, MSD Pharma's pembrolizumab, used for more than 21 types of cancer, stays at Rs 2,16,500. Ribociclib, sold as Kryxana, remains at Rs 24,435. Originator brands Tagrisso, Tecentriq, Darzalex and Imfinzi also show no change.

A 30% cap on trade margin hits hardest where the supply chain was adding large markups; on very expensive patented drugs the effect is much smaller, PTC News reported. S Srinivasan, co-convenor of the All India Drug Action Network, said high-cost medicines remain unaffordable even after the revisions. He argued that ceiling prices under DPCO 2013 use a simple average formula that can justify high costs, and called for cost-based pricing under the DPCO 1995 instead.

Ghosh said patented drugs from multinationals such as pembrolizumab, durvalumab and enfortumab are likely to be unaffected and remain extremely costly.

Why it matters

Oncologists in Kolkata told The Times of India that out-of-pocket expenses for advanced cancer care run upwards of Rs 3.3 lakh a year, and that the city and state have one of the largest numbers of patients who drop out of treatment. Sanjoy Roy, an oncologist at Ruby General Hospital, said "a significant number of patients drop out after the first chemotherapy cycle".

What happens next

NPPA has said it will update the list as manufacturers submit revised prices for non-scheduled anti-cancer medicines.

The larger question sits with the Supreme Court. It has been examining medicine costs and margins in the cancer treatment chain, and is considering whether to cap trade margins on all non-scheduled drugs in the country. It has reserved its order. Until that is settled, the relief runs brand by brand: 397 of 543 entries cheaper, and the costliest therapies untouched.