India caps trade margins on 137 cancer drugs

Overview

Updated 1 hour ago

Sarojam Radhakrishnan was diagnosed with breast cancer in 2021. The targeted drugs her doctors prescribed cost more than 63,000 rupees a month, so the retired Kerala bank clerk petitioned the high court. The case reached India's Supreme Court, which examined what hospitals and retailers added to drug prices.

On October 17, India's drug price regulator capped trade margins on 137 anti-cancer medicines at 30% of their maximum retail price, excluding tax. The limit takes effect November 9. It targets distributors, stockists and hospitals, not the manufacturers' own price, so about 56 single-source medicines may stay expensive.

Why it matters

The cap limits what middlemen add to cancer drug prices, not what manufacturers charge, so some of India's costliest treatments may stay out of reach.

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Key Indicators

137

Cancer drugs covered

Non-scheduled anti-cancer medicines brought under the trade margin cap.

30%

Cap on trade margin as share of MRP

Total margin allowed to distributors, stockists and retailers, excluding GST.

70%

Maximum expected price cut

The government's upper estimate for how far maximum retail prices could fall.

$260M

Estimated annual patient savings

Government estimate of roughly 2,500 crore rupees a year.

709%

Markup found on Cizumab before the cap

A 400 mg bevacizumab injection whose price fell 82% under the new order.

Voices

Curated perspectives — historical figures and your fellow readers.

People Involved

Sarojam Radhakrishnan

Petitioner; retired bank clerk in Kerala

Her petition led to the Supreme Court review behind the 2026 cap

K.M. Gopakumar

Co-convenor, Working Group on Access to Medicines and Treatments

Public critic of the cap's limited reach

Organizations Involved

National Pharmaceutical Pricing Authority

Drug price regulator

Issued the October 17 trade margin order

India's drug price regulator, which sets ceiling prices for scheduled medicines and can intervene in non-scheduled drugs in the public interest.

Supreme Court of India

Highest court of appeal

Reviewed hospital and retailer markups; its criticism preceded the order

India's highest court, which heard Radhakrishnan's petition and criticised markups on cancer medicines.

Working Group on Access to Medicines and Treatments

Advocacy network

Analysed the 137-drug list and questioned the cap's reach

A network of patients and activists campaigning for lower medicine prices in India.

All India Drug Action Network

Patient advocacy group

Documented margin rebound after the 2019 pilot

An advocacy group that tracks whether drug price interventions hold over time.

Timeline

2019 November 2026

6 events Latest: October 17th, 2026 · 3 weeks ago

Tap a bar to jump to that date

November 2026
Revised cancer drug prices take effect
Upcoming Regulation

The government expects maximum retail prices to fall by up to 70%.
In 3 days
The Lancet reports India's cancer drug cap
Upcoming Publication

A World Report describes the Supreme Court-driven margin limit.
Tomorrow
October 2026
NPPA notifies 30% margin cap on 137 drugs
Latest Regulation

The order covers 643 brand-strength-pack entries and takes effect November 9.
October 17th, 2026
2022
Radhakrishnan petitions Kerala High Court
Legal

She asked the court to order government action on cancer drug prices.
2022
2021
Kerala patient diagnosed with breast cancer
Background

Sarojam Radhakrishnan faced monthly targeted-treatment bills above 63,000 rupees.
2021
2019
India tests trade-margin caps on 42 cancer drugs
Regulation

The NPPA capped margins at 30%, cutting prices on 526 brands by up to 90%.
2019

Scenarios

Most of the 137 drugs get cheaper

Likely Resolves by Q2 2027

Discussed by: The NPPA and the government, which project price cuts of up to 70% and annual patient savings of about 2,500 crore rupees

The order takes effect November 9 and applies to 643 brand-strength-pack entries. A Third World Network analysis found nearly three-fourths of listed entries will see reductions. If manufacturers hold their selling prices steady, the margin cap flows through to patients and the government's savings estimate holds.

Margins rebound as they did after 2019

Possible Resolves by End of 2028

Discussed by: The All India Drug Action Network, which found markups returned after the 2019 pilot

AIDAN found that 38 of 50 drugs covered in both rounds rose in price after 2019, and that 45 of the 50 carried markups above the 42.8% threshold before the new cap. It argues the government runs one-time interventions rather than continuous regulation, and that companies are not required to hold the margin when they later revise prices. Non-scheduled drug prices can rise up to 10% a year.

High-cost patented drugs stay out of reach

Likely Resolves by Q2 2027

Discussed by: K.M. Gopakumar and the Working Group on Access to Medicines and Treatments, which identified about 56 single-source medicines

The cap limits what intermediaries add, not what manufacturers charge stockists. For single-source and patented drugs, there is little competitive pressure to lower that starting price. A Third World Network analysis found nearly a quarter of listed entries saw no reduction, and another third fell 10% or less. Koselugo remains above 10 lakh rupees, Tagrisso above 4 lakh and Keytruda at 2.16 lakh.

Historical Context

2 moments from history that rhyme with this story — and how they unfolded.

2019

India's cancer drug margin pilot (2019)

The government capped trade margins on 42 anti-cancer drugs at 30%, allowing a maximum markup of 42.8% over the price to the stockist. Maximum retail prices fell on 526 brands, with some cuts reaching 90%.

Then

Prices dropped sharply for the covered brands.

Now

An AIDAN review found prices of 38 of 50 overlapping drugs rose afterward, and markups above the threshold returned before the 2026 order.

Why this matters now

The 2026 cap is the second round of the same policy, and the 2019 experience is the main evidence that margin caps can erode.

2013

Drugs (Prices Control) Order (2013)

India set a ceiling-price formula for scheduled medicines, using market data and a 16% retail margin. Non-scheduled drugs were left outside that system, with annual price increases generally limited to 10%.

Then

Scheduled medicines got fixed ceiling prices; others did not.

Now

The NPPA retained paragraph 19, a public-interest power it can use to intervene on non-scheduled and patented drugs.

Why this matters now

The 137 cancer drugs are non-scheduled, which is why the government used margin caps rather than the ceiling-price formula.