India's 30% Trade-Margin Cap on Cancer Drugs May Spare Few Patients, Experts Warn

Starting November 9, India will enforce a 30% ceiling on trade margins for 137 anti-cancer drugs, a move projected to cut maximum retail prices by up to 70% and save roughly ₹2,500 crore annually. However, experts caution that the policy leaves manufacturer-run patient-assistance programmes (PAPs) out of the price formula, meaning patients already receiving free or heavily discounted medicines will see no benefit. Tanvi Singh of MOC Cancer Care says only those purchasing drugs through hospitals or pharmacies stand to gain, while Malini Aisola of the All India Drug Action Network warns that excluding PAP volumes skews margin calculations and weakens intended price drops.

The NPPA requires detailed reporting and permits audits, but the Centre admitted it lacks data on hospital-level mark-ups, which can exceed 700%. Mandeep Singh Malhotra of CK Birla Hospital suggests independent verification and periodic audits to ensure the exemption does not mask commercial sales. Only three of the top-selling cancer drugs—bevacizumab, nivolumab and abiraterone acetate—are covered, and hospitals still capture about 70% of cancer-drug sales, raising concerns that they may offset reduced pharmaceutical margins with higher treatment charges.