After Court's ‘Extortion’ Remark, India Makes 137 Cancer Drugs Cheaper: Patients to Save Rs 2,500 Crore a Year
From next month, 137 cancer drugs will become cheaper in India. The government has imposed a fresh cap on mark-ups to rein in medicine prices. Behind the decision lie strong observations by the Supreme Court and a legal battle begun by a patient who is no longer alive.
The story begins with Sarojam Radhakrishnan, a former bank employee in Kerala. She was diagnosed with breast cancer in 2021. Doctors prescribed life-saving targeted treatments, but the monthly cost, of more than 63,000 rupees, was far beyond her family's means. Realising that thousands of families were being ruined by the cost of such drugs, she filed a petition to the Kerala High Court in 2022 demanding government intervention to lower the costs.
When the case reached the Supreme Court, the judges looked at hospitals' and retailers' mark-ups on cancer drugs and called the situation “carnage” and “extortion.” During a hearing on 29 September, Justices Vikram Nath and Sandeep Mehta noted how a life-saving cancer drug supplied to hospitals at 2,700 rupees carried a vastly marked-up price of 27,000 rupees.
The judges found that hospitals, distributors and chemists enjoyed large margins on medicines. Analysis by the National Pharmaceutical Pricing Authority revealed a trade mark-up on some cancer drugs averaging 170 percent, with some extreme examples stretching to more than 700 percent.
A 30 percent trade margin cap on the price of 42 drugs has been in place for some years, but many others remained off this list. Now, prodded by the Supreme Court's findings, the government has imposed the cap on 137 other drugs.
The Department of Pharmaceuticals said in a statement: “The measure is expected to reduce medicine prices by up to 70 percent and help cancer patients save 2,500 crore rupees annually, significantly reducing the amount they pay from their own pockets.”
People on low incomes in India dread illness, as the cost of treatment can mean financial ruin, particularly for cancer patients. With the cost of cancer drugs ranging from 38,000 to 380,000 rupees, many families quietly walk out of the doctor's consulting room upon hearing the estimated cost of treatment.
Studies by the Public Health Foundation of India show that spending on healthcare pushes about 55 million Indians a year below the poverty line. Few Indians can afford the premiums for comprehensive health insurance.
The government's nationwide insurance scheme, Ayushman Bharat, covers treatment for some cancers but provides only 500,000 rupees' worth of annual cover for a family — the cost of just one dose of Kadcyla, a drug used to treat breast cancer. Patients may need up to 14 doses.
Krishan Kalra, a former member of the council of the Rajiv Gandhi Cancer Institute and Research Centre, said that whenever the Indian Cancer Society holds a free diagnosis camp in Gurgaon, he urges local drivers, maids, cooks and tailors to turn up because tests they cannot afford are offered free. But very few people attend. “When I ask why, they say they're too scared — if something serious like cancer is detected, they haven't got the money to pay for the treatment, so they prefer to remain in the dark,” he said.
Dr Ravi Kannan, a surgical oncologist and director of Cachar Cancer Hospital and Research Centre in Silchar, Assam, knows doctors' trauma of seeing patients walk out to go home and die. “Some families start the treatment, hoping against hope to manage the cost. They start but they don't come back for chemotherapy or radiation. They can't sustain the cost,” he said. “The decision is a welcome step if the outcome is that more patients can access the drugs they need.”
India records about 1.56 million new cancer cases annually — up from 1.39 million cases in 2020 — making it a significant public health challenge for the country.
Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, a civil society network, said what was clear was that a “total overhaul” of the healthcare system was needed. “Right from the cost of manufacturing a drug to the point of sale, we need to make the system transparent and regulate the entire supply chain. Only then will these drugs become available to those who need them,” she said. She warned that companies and hospitals were likely to try to find legal loopholes to wriggle out of the 30 percent cap, suggesting hospitals may offset the lower price charged for a drug by raising charges on other items.
The Supreme Court judges have also asked the government's lawyers why the cap should apply only to cancer drugs and not the entire range of non-patented drugs. The court has given the government until 27 October to respond. Unfortunately, the court's ruling came too late for Radhakrishnan, who died in September 2022 while her case was still pending in Kerala.
