A cancer diagnosis in an Indian household has long arrived with two verdicts. The first is medical, and it is frightening enough on its own. The second is financial, and for countless families it has proved just as devastating.
The Modi Government has now taken aim at that second verdict. The National Pharmaceutical Pricing Authority (NPPA), under the Department of Pharmaceuticals, has rationalised trade margins on 137 non-scheduled anti-cancer drugs. Retail prices are expected to fall by as much as 70 per cent, and the revised rates take effect from November 9, 2026.
The list includes immunotherapy medicines used against more than 20 types of cancer, along with Denosumab for breast and prostate cancer patients and Pegfilgrastim, which protects patients from neutropenia during chemotherapy. Bevacizumab, prescribed for colon, ovarian and cervical malignancies, is also covered, as are Pembrolizumab, Durvalumab and Osimertinib.
A burden that keeps growing
The scale of the intervention matches the scale of the crisis. According to ICMR National Cancer Registry Programme, India’s estimated cancer incidence for 2025 stood at 15,69,793 cases, a figure the International Agency for Research on Cancer expects to climb to 22,18,694 by 2040. Behind each number stands a family facing months, often years, of expensive treatment.
The risk is widely shared. ICMR estimates that one in nine Indians is likely to develop cancer during their lifetime, with lung and breast cancers leading among men and women respectively. No region, class or community is spared.
What makes the disease so punishing is not merely its spread but the price of fighting it. Advanced biologics and targeted therapies can cost lakhs per cycle, and treatment rarely ends with one cycle. For a middle-class family, a single diagnosis can wipe out decades of savings and push a household into debt.
Where the money actually went
Much of that cost had little to do with research, manufacturing or innovation. It came from the distribution chain, where markups between the manufacturer’s gate and the patient’s bedside often ran far beyond any reasonable level. The patient paid an inflated MRP, while intermediaries pocketed the difference.
The NPPA has now drawn a firm line. Under Paragraph 19 of the Drugs (Prices Control) Order, 2013, trade margins on the notified medicines are capped at 30 per cent of the MRP. The intervention targets the excess, not the enterprise.
The measure is designed to protect legitimate manufacturer revenue while curbing what the distribution and retail channel had been extracting. Companies must also maintain current production and supply levels, which guards against any artificial shortage engineered to resist the reform.
Building on a proven trust and enforcement
It extends a pilot the Modi government ran in 2019, when the NPPA invoked extraordinary powers in the public interest under Para 19 of the DPCO to bring 42 non-scheduled anti-cancer drugs under price control through trade margin rationalisation. Following that exercise, the MRP of 526 brands came down by as much as 90 per cent.
First, the inflated prices were never a law of nature; they were a feature of an unchecked supply chain. Second, the industry adjusted without the collapse in availability that sceptics had predicted.
Seven years later, the same model now covers more than three times as many medicines. The list was not drawn up in a ministry corridor either. An Expert Committee under the Directorate General of Health Services, bringing together leading oncologists, specialists from hospitals nationwide and government officers, recommended the 137 drugs, and the list will be revised periodically.
Good intentions on paper have often died at the pharmacy counter in India. This notification anticipates that problem with an unusually detailed enforcement framework. Manufacturers must report revised prices to the NPPA within seven days of the Gazette notification and publish their price lists online.
The responsibility then moves down the chain. Retailers and hospitals must charge the reduced rates from November 9 and display them in their pharmacies. Hospitals must also post the revised prices prominently on their websites.
Hospitals were a particular blind spot and the order addresses that directly. Since a substantial share of anti-cancer drugs is supplied straight to hospitals and medical institutions, those institutions are now accountable for passing on the benefit. State Drug Controllers have been tasked with ensuring compliance across manufacturers, dealers, retailers and hospitals alike.
The Pharma Sahi Daam app and the NPPA website allow any patient or caregiver to verify the correct price of a medicine. Transparency of this kind turns every buyer into a watchdog.
One piece of a larger design
In the Union Budget for 2024-25, the government had cut customs duty on three cancer medicines, Trastuzumab Deruxtecan, Osimertinib and Durvalumab, from 10 per cent to nil. Two of those, Osimertinib and Durvalumab, now feature in the trade margin list as well. The relief on these medicines has thus come at the border and again at the retail counter.
The 2025-26 Budget went further. Finance Minister Nirmala Sitharaman added 36 lifesaving drugs and medicines, chiefly for cancer, rare diseases and severe chronic conditions, to the list fully exempted from basic customs duty. The same Budget committed to setting up daycare cancer centres in all district hospitals over three years, with 200 to be established in 2025-26 itself.
Taxation reform added another layer. At its 56th meeting, the GST Council brought GST on 33 life-saving drugs down from 12 per cent to nil and on three more medicines for cancer, rare diseases and severe chronic conditions from 5 per cent to nil. These changes took effect from September 22, 2025.
Customs duty, GST, trade margins and physical infrastructure have each been addressed in turn. This is what a coordinated policy on cancer looks like, as opposed to the scattered announcements of earlier eras.
Antyodaya in practice
There is a philosophy underpinning these decisions. The idea of Antyodaya, serving the last person in the queue first, has shaped this government’s welfare architecture, from Ayushman Bharat’s health cover for poor families to the Jan Aushadhi Kendras offering quality generics at a fraction of branded prices. Rationalising cancer drug margins extends that principle into one of medicine’s most expensive domains.
For decades, governments spoke of healthcare as a right while leaving its cost to the market’s mercy. Patients from small towns travelled to metropolitan hospitals, sold land, borrowed from moneylenders and still often abandoned treatment midway. The present approach confronts that reality rather than reciting slogans around it.
Critics who habitually accuse this government of favouring industry would do well to study this notification. It openly curbs the margins of a powerful commercial lobby in favour of patients. Welfare and enterprise can coexist, but when they collide, the citizen’s life comes first.
The real test lies in implementation across thousands of pharmacies and hospitals, many in districts where oversight has historically been thin. State Drug Controllers must act swiftly against violators, and patients must be encouraged to check and report.
Hospitals in particular need close scrutiny. Packaged treatment billing can easily hide medicine costs, and the benefit must not be absorbed into other charges. Regular audits and public disclosure of prices will be essential.
Oncology is advancing rapidly and newer therapies will keep entering the market at steep prices. The Expert Committee’s mandate to revise the list must be exercised regularly and with urgency.
Supply vigilance cannot be relaxed either. The directive to maintain current production levels must be monitored closely. Any attempt to create scarcity and force the reform’s reversal should invite firm action.
A measure of compassion
Policy is often judged by numbers, and those here are impressive enough: 137 drugs, margins capped at 30 per cent, prices down by up to 70 per cent. Yet the true measure will be found in hospital wards and pharmacy queues across the land.
It will show up when a farmer from Bundelkhand completes his immunotherapy without selling his fields. It will show up in a daughter in Varanasi buying her mother’s chemotherapy support drugs without borrowing from relatives. These are the quiet victories that rarely make headlines but define a government’s character.
Bharat has earned global standing as the pharmacy of the world, supplying affordable medicines across continents. It is only fitting that Indian patients should benefit from fair pricing at home. With this decision, the government has made that commitment tangible.
