India Cuts Prices of 137 Cancer Drugs After Supreme Court Calls Mark-Ups 'Extortion'

The Indian government has moved to lower the price of cancer drugs after a retired bank clerk brought her case before the country's highest court. From next month, 137 cancer medicines will become cheaper, as authorities try to address the plight of poorer patients who skip treatment, sell land or fall into debt to pay for them.

The case began with Sarojam Radhakrishnan, a former bank employee in Kerala who was diagnosed with breast cancer in 2021. Her doctors prescribed life-saving targeted treatments, but the monthly cost of more than 63,000 rupees (£500) was far beyond what her family could afford. In 2022 she petitioned the Kerala high court, asking the government to step in and bring costs down.

When the matter reached the supreme court, judges examined the mark-ups applied by hospitals and retailers and described the situation as "carnage" and "extortion". At a hearing on 29 September, justices Vikram Nath and Sandeep Mehta pointed to one cancer drug supplied to hospitals at 2,700 rupees that carried a price of 27,000 rupees. The court found that hospitals, distributors and chemists enjoyed large margins on medicines.

Analysis by the National Pharmaceutical Pricing Authority showed trade mark-ups on some cancer drugs averaging 170%, with extreme cases above 700%. A 30% cap on trade margins has applied to 42 drugs for some years, but many others sat outside that list. The government has now extended the cap to 137 further drugs.

In a statement, the Department of Pharmaceuticals said the measure "is expected to reduce medicine prices by up to 70% and help cancer patients save 2,500 crore rupees [£199m] annually", cutting what patients pay out of pocket.

The financial burden is well documented. Krishan Kalra, a former council member of the Rajiv Gandhi Cancer Institute and Research Centre, said that few people attend free diagnosis camps run by the Indian Cancer Society in Gurgaon. "They're too scared", he said, because if cancer is found they have no money for treatment. Cancer drugs range from 38,000 to 380,000 rupees, and many families leave the consulting room on hearing the estimate. Studies by the Public Health Foundation of India show healthcare spending pushes about 55 million Indians below the poverty line each year.

Insurance offers limited relief. The government's Ayushman Bharat scheme covers some cancers but provides only 500,000 rupees of annual cover per family, equal to the cost of one dose of Kadcyla, a breast cancer drug of which patients may need up to 14 doses. Dr Ravi Kannan, a surgical oncologist and director of Cachar cancer hospital and research centre in Silchar, Assam, said some families begin treatment but cannot sustain it. He called the decision "a welcome step" if more patients can access the drugs they need.

India records about 1.56m new cancer cases a year, up from 1.39m in 2020. Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, said a "total overhaul" of healthcare was needed, with transparency and regulation across the whole supply chain. She warned that companies and hospitals may look for legal loopholes, and that hospitals might offset lower drug prices by raising charges elsewhere.

The supreme court has also asked government lawyers why the cap should apply only to cancer drugs and not to all non-patented medicines, and has given the government until 27 October to respond. The ruling came too late for Radhakrishnan, who died in September 2022 while her case was still pending in Kerala.