India Caps Trade Margins on 137 Cancer Drugs, With Lower Prices From November 9

A price reset aimed at a costly gap

India's National Pharmaceutical Pricing Authority (NPPA) has capped trade margins on 137 non-scheduled cancer medicines at 30% of their maximum retail price excluding tax, with revised prices taking effect on November 9, 2026. The intervention is expected to cut maximum retail prices by roughly 20% to 70%, depending on existing margins, and generate estimated annual savings of ₹2,500 crore for patients and families.

The order, issued through Gazette notification S.O. 5690(E) on October 17, 2026, covers medicines including pembrolizumab, nivolumab, durvalumab, osimertinib, ribociclib and abemaciclib. Patented medicines are included unless they have an approved exemption under Paragraph 32 of the Drugs (Prices Control) Order, 2013.

NPPA's market analysis found average trade markups of about 170%, reaching 700% in some cases. These markups describe the increase between the price charged at the manufacturer's first sale and the amount charged further along the supply chain. The new rules target that gap, including when manufacturers sell directly to hospitals.

Manufacturers must report their revised prices within seven days of the Gazette notification. Retailers and hospitals must apply and display the new prices from November 9, and the revised prices remain in force until further orders.

For families paying for repeated injections or months of tablets, the potential relief is substantial. The amount saved on an individual medicine will depend on its current price structure. Products already carrying a lower maximum retail price must keep that lower price.

How the 30% cap actually works

The 30% limit is a share of the final maximum retail price (MRP) before Goods and Services Tax (GST). A medicine supplied to a stockist for ₹70 can therefore have an MRP of up to ₹100 before GST: the ₹30 difference is 30% of ₹100.

Measured against the stockist's ₹70 purchase price, that same ₹30 difference is a markup of 42.86%. This explains why the order refers both to a 30% trade margin and a 42.86% markup. They describe the same permitted gap using different starting amounts.

The formula is the price to stockist or distributor multiplied by 100 divided by 70, with applicable GST added afterward. GST may be added only where it has actually been paid or is payable to the government.

The notification gives an example of a medicine with an existing MRP of ₹300 before GST and a stockist price of ₹70. Its revised maximum would be ₹100 before GST, a reduction of about two thirds. A medicine already priced below the calculated maximum must retain its existing lower MRP.

Which medicines and uses are covered?

The 137 medicines were recommended by an expert committee under the Directorate General of Health Services. The committee included oncologists, medical specialists, hospital experts and government officers. NPPA says the list will be updated periodically in response to market developments and public health needs.

Coverage extends to non-scheduled formulations containing the listed medicines alone or in combinations, across all strengths, dosage forms and routes of administration. The rules also apply when those formulations are prescribed for conditions other than cancer.

The list includes immunotherapies, which help the immune system fight cancer, and targeted therapies, which act on particular features of cancer cells. It also includes supportive medicines such as pegfilgrastim, used to prevent neutropenia, a shortage of white blood cells that can leave patients vulnerable to infection.

Other medicines named include denosumab, used in the care of patients with breast and prostate cancers, and bevacizumab, used to treat cancers including those of the colon, ovaries and cervix. Olaparib, palbociclib, atezolizumab and topotecan are also covered.

Why the regulator used extraordinary powers

NPPA issued the order under Paragraph 19 of the Drugs (Prices Control) Order, 2013. That provision permits price intervention in extraordinary circumstances and in the public interest. The government is using an existing power rather than waiting for an amendment to the pricing rules.

Scheduled medicines have regulated ceiling prices. Non-scheduled medicines ordinarily operate under a different rule: manufacturers may raise their MRPs by no more than 10% over a rolling period of 12 months. That annual limit controls price increases, while the new order directly restricts the gap between the first sale price and the MRP.

Market figures cited in NPPA deliberations put annual cancer medicine turnover at about ₹12,500 crore, covering roughly 225 drugs and 500 formulations. Scheduled oncology medicines account for approximately ₹2,250 crore, leaving about ₹10,250 crore in the non-scheduled segment.

Those figures put the non-scheduled share at about 82% of cancer medicine turnover: ₹10,250 crore out of ₹12,500 crore. The National List of Essential Medicines, 2022, contains 63 cancer medicines among its 388 listed drugs, illustrating how much oncology spending sits beyond conventional ceiling prices.

The decisions and deadlines

NPPA's October decisions followed scrutiny of medicine pricing by the Supreme Court and expanded an approach first used for cancer medicines in 2019. The sequence sets out both the policy's development and the next obligations for companies.

• February 2019: NPPA introduced a 30% trade margin cap for 42 non-scheduled cancer medicines.
• October 8, 2026: NPPA considered excessive oncology markups at its 283rd overall meeting, also numbered its 151st meeting under the 2013 pricing order.
• October 12, 2026: Solicitor General Tushar Mehta told the Supreme Court that the government would notify a list of cancer medicines covered by the cap.
• October 16 and 17, 2026: NPPA considered the expert committee's recommendations at its 284th overall meeting.
• October 17, 2026: The Gazette notification covering 137 medicines was issued, starting the reporting period of seven days.
• October 27, 2026: The Supreme Court scheduled a further hearing on medicine pricing.
• November 9, 2026: Revised maximum retail prices take effect.

The two numbering systems for NPPA meetings refer to its overall meetings and those held under the 2013 pricing order. The October 8 and October 16–17 discussions were successive stages of the intervention.

How companies must calculate their prices

Manufacturers must establish the price to stockist or distributor using their net sales realisation for March 2026 divided by the quantity sold that month. Government sales are excluded. If there were no March sales, companies must use sales from April 2025 through March 2026.

Formulations launched after March 31, 2026, use their prevailing stockist or distributor price. Where manufacturers supply hospitals directly, the hospital is treated as the stockist or distributor, with the manufacturer's invoices forming the calculation base.

Companies must submit the required price information to NPPA and State Drug Controllers within seven days, including where an existing MRP does not change. Price lists in Form V must be filed through the Integrated Pharmaceutical Database Management System, known as IPDMS.

Manufacturers must publish revised lists on their websites and distribute them to retailers and hospitals. Retail outlets and hospital pharmacies must display the prices, while hospitals must also publish them on their websites. Consumers can check prices through the Pharma Sahi Daam app and the NPPA website.

Free medicine programmes draw scrutiny

Free medicines supplied through manufacturers' Patient Assistance Programmes can be excluded from the quantities used to calculate the stockist or distributor price. Companies must provide undertakings and maintain patient records, including identity, treatment, dosage and medicine supply details.

NPPA may request more information, conduct audits or inspections, and arrange independent checks. Supplies can lose their exclusion if companies fail to meet the conditions.

K M Gopakumar, co-convenor of the Working Group on Access to Medicines and Treatments, has raised concerns about the calculation. Excluding free quantities means dividing sales revenue by fewer units, producing a higher calculated price than if all supplied units were counted. His example concerns pembrolizumab programmes that combine paid vials with substantial free supplies.

The practical limits of assistance programmes are illustrated by Surekha Panicker, a pseudonym used for a retired professional aged 65 from Kerala. Her treatment plan included Roche's Phesgo under an arrangement alternating paid and free cycles. After a severe bacterial infection interrupted treatment, the free offer lapsed. Her spending on medicines, surgery, infection treatment and other hospital charges exceeded ₹35 lakh.

Panicker described the strain on her savings and her uncertainty about further treatment:

I spent my savings on immunotherapy in the hope that it would buy me at least 10 years. I don't know how I will manage if I need to continue the treatment,

How much relief can patients expect?

The projected annual saving of ₹2,500 crore equals 20% of the cited ₹12,500 crore cancer medicine market. An earlier estimate during policy discussions put potential savings at ₹2,500 crore to ₹3,500 crore. The figure accompanying the final cap is approximately ₹2,500 crore.

The 2019 exercise provides a practical comparison. Its cap on 42 medicines reduced MRPs across 526 brands by up to about 90% and generated estimated annual savings of ₹984 crore. The latest projected saving is roughly two and a half times that earlier amount.

Patients already receiving discounts from printed MRPs may experience a different reduction in their actual bills. The intervention regulates the maximum medicine price; a family's expenditure also depends on the price previously paid, the prescribed dose and the duration of treatment.

Gopakumar welcomed the move while warning that high starting prices could leave patented medicines beyond many patients' means. He said:

Despite such rationalisation, the costs of the patented medicines are so high that they are unlikely to become affordable for many. However, it is a welcome step and will likely bring down costs of medicines that are out of patent because of competition,

A Tata Memorial Hospital study found that only 1.6% of patients needing patented targeted therapy received it, with cost the main barrier. A margin cap reduces the distribution gap, while the manufacturer's starting price continues to shape affordability.

Courts, hospitals and other ways to lower costs

Supreme Court Justices Vikram Nath and Sandeep Mehta examined large medicine markups while hearing petitions brought by lawyer Kishan Chand Jain and paediatric surgeon Sanjay Kulshrestha. Examples raised before the court included a medicine supplied to retailers for ₹2,700 carrying an MRP of ₹27,000, ten times the supply price, and medicines procured by state governments for ₹1,300 billed to patients at up to ₹32,000.

Private hospital leaders argue that treatment involves costs beyond purchasing a drug. Abhay Soi, chairman and managing director of Max Healthcare Institute, described requirements for staff training, storage, administration and biomedical waste disposal. BS Ajai Kumar, founder of HCG Enterprises, argued that hospitals should be assessed through treatment costs, care quality and outcomes.

Negotiated procurement offers another route to lower medicine spending. A study published in the Bulletin of the World Health Organization in 2023 found that pooled procurement of 40 medicines by the National Cancer Grid saved ₹13.2 billion, or ₹1,320 crore, compared with MRPs. Savings ranged from 23% to 99%. Pooling purchases allows hospitals to negotiate together rather than separately.

Jain's petition also cited retail comparisons: a vial containing 50 mg of doxorubicin cost ₹250 through Jan Aushadhi, against ₹1,230 for the average of three leading brands, while a vial containing 1,000 mg of gemcitabine cost ₹631 against ₹6,412. These figures show why both procurement prices and distribution margins matter to patients.

Keeping medicines available and enforcing the cap

Manufacturers must maintain current production levels. Any proposed reduction in average monthly production requires prior NPPA permission, while discontinuing a formulation requires six months of advance notice through Form IV.

State Drug Controllers are responsible for overseeing compliance by manufacturers and dealers, including retailers, hospitals and medical institutions. Hospitals must monitor covered medicine prices and report violations.

Companies that overcharge are liable to repay the excess with interest under the Drugs (Prices Control) Order, 2013, read with the Essential Commodities Act, 1955. These enforcement and supply requirements accompany the lower MRPs so that patients can obtain medicines at the revised prices without interrupted access.

Key Points

• India has capped trade margins on 137 non-scheduled cancer medicines at 30% of MRP before GST.
• Revised prices take effect on November 9, 2026, and remain in force until further orders.
• Expected MRP reductions range broadly from 20% to 70%, with estimated annual savings of ₹2,500 crore.
• The cap covers listed medicines across combinations, strengths, dosage forms and uses, including patented products unless exempted.
• Existing lower MRPs must remain unchanged, and manufacturers must maintain production levels.
• Hospitals and retailers must display revised prices. Consumers can check them through Pharma Sahi Daam and the NPPA website.