Kerala woman's death sparks new cap on 137 Indian cancer medicines

The Department of Pharmaceuticals in New Delhi announced on Thursday that trade margins on 137 cancer medicines will be capped at 30 percent starting next month. This regulatory action directly implements findings from the Supreme Court of India, which recently scrutinized pricing structures for oncology treatments. The new cap joins 42 drugs already subject to similar pricing constraints, significantly expanding the list of regulated medicines.

The legal impetus for this change originated with Sarojam Radhakrishnan, a retired bank clerk from Kerala. Diagnosed with breast cancer in 2021, she faced monthly treatment costs exceeding 63,000 rupees, a sum her family could not sustain. In 2022, she petitioned the Kerala High Court, which eventually escalated the matter to the nation's highest tribunal. Radhakrishnan passed away in September 2022 while the case remained under review, but her petition triggered the judicial inquiry into drug pricing.

Justices Vikram Nath and Sandeep Mehta reviewed evidence regarding the supply chain for cancer medications. During a hearing on September 29, the bench identified instances where a single drug supplied to hospitals for 2,700 rupees was sold to patients for 27,000 rupees. The court described these markups as a form of carnage and extortion, noting that hospitals, distributors, and retail chemists were capturing excessive profits from life-saving therapies.

Data from the National Pharmaceutical Pricing Authority supported the court's observations. The analysis revealed that average trade markups on certain cancer drugs reached 170 percent, with some extreme cases exceeding 700 percent. By extending the 30 percent margin cap to 137 additional drugs, the government aims to standardize pricing across a wider range of treatments. The Department of Pharmaceuticals stated that this measure is expected to reduce medicine prices by up to 70 percent.

Financial officials estimate that patients will save approximately 2,500 crore rupees, or 199 million pounds, annually under the new rules. This reduction targets the out-of-pocket expenses that frequently push households into debt. Krishan Kalra, a former council member of the Rajiv Gandhi Cancer Institute, noted that many potential patients avoid free diagnosis camps in Gurgaon due to fear of unaffordable treatment costs. He observed that families often leave consulting rooms upon hearing price estimates, which range from 38,000 to 380,000 rupees for various drugs.

The financial strain extends beyond immediate treatment costs. Studies by the Public Health Foundation of India indicate that healthcare spending contributes to pushing 55 million Indians below the poverty line each year. Existing insurance mechanisms offer limited protection; the government's Ayushman Bharat scheme provides 500,000 rupees in annual cover per family. Dr. Ravi Kannan, a surgical oncologist in Assam, pointed out that this amount covers only one dose of Kadcyla, a breast cancer drug for which patients may require up to 14 doses.

India currently records approximately 1.56 million new cancer cases annually, an increase from 1.39 million in 2020. Jyotsna Singh, co-convener of the Working Group on Access to Medicines, argued that the margin cap requires a total overhaul of healthcare transparency. She warned that hospitals might attempt to offset lower drug prices by increasing other service charges. The Supreme Court has also questioned why the cap applies only to cancer drugs rather than all non-patented medicines, giving government lawyers until October 27 to respond.