India Caps Cancer Drug Markups to Enhance Affordability for Patients

The Indian government is prioritizing access to affordable and high-quality cancer treatment for all families. On October 17, 2026, the National Pharmaceutical Pricing Authority (NPPA) set a cap on the trade margin for 137 non-scheduled anti-cancer drugs, including patented medicines, limiting it to 30% of the maximum retail price (MRP). These revised prices will take effect on November 9, 2026. By November 4, 2026, 70 companies reported adjusted MRPs for 120 drugs, reflecting reductions of up to 96.45% and an estimated savings of around 33.57 billion rupees. The average price reduction ranges from 20% to 70%.

This reduction in cancer medication prices potentially lowers costs by 20% to 70%.

To make cancer treatment in India more affordable, the government has imposed stringent limits on markups across the drug supply chain, which includes retail and hospital pharmacies.

As of November 4, 2026, companies have reported an average MRP decrease between 20% and 70%, with the most significant drop recorded at 96.45%.

These revisions in MRPs are expected to yield an estimated savings of 33.57 billion rupees, reflecting the price differences based on quantities sold from April 2025 to March 2026.

The trade margin cap addresses concerns raised by state officials, patients, and citizens regarding the discrepancy between the maximum retail price (MRP) of anti-cancer medications and their actual procurement costs.

Consumers can confirm prices through both the NPPA website and the official ‘Pharma Sahi Daam’ mobile application.

The new pricing will be established based on distributor prices as of March 2026.

The trade margin refers to the difference between the price charged by the distributor (stockist) and the maximum price that patients pay (MRP), exclusive of the Goods and Services Tax (GST). Excessive trade margins can inflate costs in the supply chain, making cancer drugs significantly pricier compared to the prices set by manufacturers.

Under this new order, the revised maximum retail price for each drug will be determined based on the average distributor price from March 2026 and must not exceed a 30% trade margin, to which GST will be added.

Regulating Drug Prices

To enhance affordability for lifesaving essential medicines, the government regulates drug prices under the Drug Price Control Order (DPCO), 2013.

This regulation is rooted in the Essential Commodities Act, which aims to control drug prices, prevent profiteering, and ensure that essential treatments remain accessible.

According to DPCO, 2013, drugs are categorized into two groups: scheduled drugs, which are included in the first schedule of DPCO 2013, known as the National List of Essential Medicines (NLEM), 2022, for which the government sets a maximum price. The NLEM 2022 lists 388 medicines, including 63 anti-cancer medications.

Non-scheduled drugs are those not included in the first schedule of DPCO 2013. Unlike scheduled drugs with fixed maximum prices, these are regulated through price monitoring: manufacturers cannot increase the MRP by more than 10% within a twelve-month period, and any increase exceeding 10% must be rectified by reverting back to the 10% level for the next twelve months.

To address high prices for these essential and other medications, in 2019, the government piloted a Trade Margin Rationalization (TMR) intervention covering 42 non-scheduled anti-cancer drugs, which successfully reduced costs for patients.

On similar grounds, and based on market data that indicated significant differences between retail and hospital prices, the government exercised its extraordinary powers in public interest under Article 19 of DPCO 2013. Following a recommendation from a specialized committee formed under the Directorate General of Health Services, the authority brought 137 non-scheduled anti-cancer drugs (including patented medications) under the trade margin rationalization through the order issued on October 17, 2026.

What is the National List of Essential Medicines?

The National List of Essential Medicines (NLEM) is an authoritative compilation of critical, high-priority medications for India. Its latest version, NLEM 2022, was released by Union Health Minister Dr. Mansukh Mandaviya on September 13, 2022, under the government’s policy of “medicines for all, affordable medicines.” This list was first established in 1996 and has since been updated in 2003, 2011, 2015, and 2022. It was compiled by a specialist panel known as the Standing National Committee on Medicines (SNCM), which consulted doctors, scientists, and industry experts while reviewing WHO standards. The significance of this list includes:

- Cost reduction: Helps in reducing healthcare expenses for families.

- Enhanced healthcare: Ensures the safety, efficacy, and high quality of medications.

- Improved planning: Provides guidance for government procurement, hospital budgets, health insurance, and training of medical students.

Legal Authority Behind the Order

The legal basis for this order lies in paragraph 19 of DPCO 2013.

This grants the government special powers to take action in public interest beyond the standard regulations in extraordinary circumstances.

Price-setting or changes: The government holds the authority to determine maximum sealing prices or retail prices for any medication as deemed necessary.

Adjustments to previously set prices: If a price has already been established, the government can modify it directly without waiting for the general annual revisions tied to the wholesale price index.

How the New Rules Limit Trade Margins on Cancer Drugs

The trade margin is capped at 30% of the maximum retail price: The margin (the difference between the amount charged by the distributor from the manufacturer and the amount paid by the patient) cannot exceed 30%.

Applies to all forms: This regulation is applicable to all listed anti-cancer drugs regardless of their dosage form or whether they are sold independently or in combination.

Based on March 2026 pricing: The initial value for these calculations must be based on distributor prices as of March 2026.

Calculation of New Maximum Retail Prices (MRPs)

This order specifies the formula for calculating the maximum retail price payable by patients:

Details of anti-cancer drugs covered under this order

Index: Drug Name: Index: Drug Name

7: Amivantamab: 76: Mirvetuximab Soravtansine

15: Belantamab Mafodotin: 84: Niraparib

18: Brentuximab Vedotin: 87: Ofatumumab

21: Cabazitaxel: 90: Palbociclib

22: Cabozantinib (S)-Malate: 91: Panitumumab (Vectibix)

23: Capmatinib: 92: Pazopanib (as Hydrochloride)

24: Carfilzomib: 93: Pegaspargase

25: Carmustine: 94: Pegfilgrastim

26: Ceritinib: 95: Pegylated Interferon Alpha 2b

27: Cetuximab: 96: Pembrolizumab

30: Crizotinib: 99: Pertuzumab + Trastuzumab

32: Dabrafenib: 101: Polatuzumab Vedotin

37: Datopotamab Deruxtecan: 106: Ribociclib

44: Enfortumab Vedotin: 113: Sunitinib

46: Enzalutamide: 115: Teclistamab

47: Epirubicin: 116: Tegafur + Uracil

48: Erdafitinib: 117: Tegafur, Gimeracil, and Oteracil

49: Eribulin Mesylate: 118: Temsirolimus

56: Gilteritinib: 125: Trabectedin

57: Goserelin Acetate: 126: Trametinib

60: Idelalisib: 129: Trifluridine + Tipiracil

61: Ifosfamide and Mesna: 130: Triptorelin

62: Nivolumab and Relatlimab: 131: Tucatinib

63: Pegylated Liposomal Irinotecan: 132: Vemurafenib

64: Inotuzumab Ozogamicin: 133: Venetoclax

65: Interferon Alpha 2b: 134: Vinorelbine Tartrate

Source: Ministry of Chemicals and Fertilizers, NPPA Order S.O. 5690(E) dated October 17, 2026

What Changes Will Affect Patients and Companies?

Manufacturers will be required to recalculate their maximum retail prices based on their average distributor prices starting March 2026. Free medicines provided under patient assistance programs and those sold directly by the government will not be included in this calculation.

The new lower prices will be implemented starting November 9, 2026. Drugs that are already priced below the new limits cannot be raised further.

Companies must inform the NPPA of their revised prices. They are required to announce price reductions in newspapers, display them on their websites, and share them with all retailers and hospitals.

The NPPA has made the revised prices for these medications available on its website, which will be updated as companies submit their revised prices.

As of November 4, 2026, 70 companies reported revised MRPs for 120 drugs across 1,136 stock keeping units (SKUs).

Companies are not allowed to reduce drug production without permission, and they must give a six-month notice before completely halting production of any drug.

Hospitals and pharmacies must clearly display the new prices. Any company that fails to lower prices must refund the excess amount charged along with interest.

The government is running several health programs to provide affordable cancer treatments, diagnostics, and medications.

AB-PMJAY: Cashless hospital services include cancer treatment

The Government of India, through the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), offers financial support of up to 500,000 rupees per family annually to the poorest 40% of families and all senior citizens aged 70 and above.

As of June 30, 2026, this scheme has permitted 12.69 crore hospital admissions at a cost of approximately 1.92 lakh crore rupees.

Cashless treatment is available for 1,961 procedures across 27 medical specialties at listed government and private hospitals, including medical oncology, surgical oncology, and radiation oncology.

Under this scheme, 1.95 million admissions for medical oncology have been approved, costing nearly 29.26 billion rupees (as of November 4, 2026).

NP-NCD: Comprehensive care from cancer screening to treatment

The government enhances infrastructure, human resource development, screening, early diagnosis, referral, treatment, and health promotion for non-communicable diseases, including cancer, through the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), part of the National Health Mission.

Under NP-NCD, 770 district NCD clinics have been established for cancer patients, along with 6,410 NCD clinics in community health centers and 524 day-care cancer centers.