Cancer Drug Price Caps Announced: Which Treatments Could Get Cheaper?

The Indian government’s decision to cap trade margins on 137 cancer medicines has led pharmaceutical companies to announce revised maximum retail prices (MRPs), bringing substantial reductions in the cost of some treatments. However, the price changes are uneven: while certain chemotherapy and breast cancer medicines have become significantly cheaper, several expensive patented cancer drugs remain unaffected.

Data covering 543 formulations of the selected medicines shows that the impact varies considerably across brands, strengths and formulations. Prices remained unchanged for 146 formulations, while 21 formulations saw reductions of less than ₹100. Although a few medicines recorded steep price cuts, the average reduction across all formulations was just over ₹5,000.

The changes highlight both the potential and the limitations of trade margin regulation as a way to improve access to cancer treatment in India. For patients who depend on costly therapies, the central question is whether the revised prices will translate into meaningful savings throughout their treatment.

Cancer Drug Price Caps: Which Medicines Saw the Biggest Reductions?

Among the reported price revisions, the largest reductions were recorded for Thiotepa, a chemotherapy medicine, and Pertuzumab, an immunotherapy medicine used in certain breast cancer treatment settings.

1. Thiotepa: Price falls by 91%

Thiotepa, sold under the brand name Samtepa by Samarth Life Sciences, recorded the steepest price reduction in the reported data.

The price of a 100 mg vial fell from ₹80,071 to ₹7,150, representing a reduction of approximately 91%. This is one of the most substantial cuts among the formulations covered by the revised pricing exercise.

The reduction could make this formulation considerably less expensive than before. However, the actual savings for an individual patient will depend on the prescribed treatment, dosage, number of vials required and other costs associated with cancer care.

2. Pertuzumab: Price falls by 68%

Pertuzumab, sold as Hertumab by Glenmark, also recorded a major price reduction. The price of a 30 mg vial declined from ₹94,951 to ₹30,593, a reduction of approximately 68%.

Pertuzumab is a targeted cancer therapy used in specific treatment settings, particularly for certain forms of breast cancer. Its suitability depends on factors such as the cancer’s biological characteristics and the patient’s clinical circumstances.

The revised price represents a significant reduction for the listed formulation. Nevertheless, patients should confirm the applicable price, strength and brand with their treating hospital or pharmacy before estimating their treatment costs.

3. Other cancer medicines

The reported data also includes reductions in the prices of other cancer medicines, including Bevacizumab. However, the available source information does not provide a complete revised-price comparison for this medicine.

Across the wider list, the scale of the reductions differs sharply. Some formulations became substantially cheaper, while others saw only marginal changes. The lowest reported reductions began at ₹0.79, mainly among medicines that already cost a few hundred rupees to around ₹2,800.

This variation means that the overall impact cannot be judged by looking only at the medicines with the largest percentage reductions.

What Do the Revised Prices Mean for Cancer Patients?

Cancer treatment can involve several different expenses, including medicines, hospital charges, diagnostic tests, medical consultations and supportive care. For patients who need expensive injectable medicines or repeated treatment cycles, even a moderate reduction in medicine prices can matter.

The revised prices for Thiotepa and Pertuzumab are particularly notable because their previous listed prices were high. If patients need the affected formulations and purchase them at the revised MRPs, the price changes could reduce the medicine component of their treatment bills.

However, a lower MRP does not automatically mean that every patient will experience the same level of savings. Actual expenditure depends on the medicine prescribed, its dose, treatment duration, the number of units required and the price charged by the supplier within the applicable rules.

Patients should also distinguish between a reduction in the listed retail price and a reduction in the full cost of cancer care. The latter can include substantial expenses beyond the medicine itself.

Why Have Some Expensive Cancer Drugs Remained Unchanged?

One of the most important findings from the revised price list is that medicines covered by patents, licences or other protection mechanisms remained unchanged in price.

This includes pembrolizumab, sold as Keytruda by Merck, and ribociclib, sold under brands including Kryxana and Kisqali by Novartis.

Pembrolizumab: Keytruda price remains unchanged

Pembrolizumab is an immunotherapy medicine used in the treatment of several cancers, including certain lung and breast cancer cases, depending on the specific indication.

According to the reported data, its price remained at approximately ₹2.16 lakh per 100 mg vial.

The unchanged price is significant because the medicine is expensive, and affordability has been a concern for patients. An investigation by The Indian Express reportedly found that some patients struggled to afford the drug even with assistance through patient support programmes.

The latest revision therefore illustrates a limitation of trade margin controls: even when distribution margins are regulated, the price of a medicine may remain high if the policy does not directly reduce the underlying price and there is limited competition.

Ribociclib: Monthly treatment costs remain a concern

Ribociclib, marketed under the brands Kryxana and Kisqali, is used in specific breast cancer treatment settings. Its listed price also remained unchanged.

The reported price of a pack containing 21 tablets of 200 mg each remained ₹24,435.

Ribociclib has previously been the subject of affordability concerns, including a petition by patients before the Kerala High Court seeking government intervention to improve access.

According to the source report, its monthly cost increased from approximately ₹58,000 in 2022 to ₹78,000 in 2025, despite the medicine having been included in an earlier government pilot initiative aimed at addressing medicine prices.

These figures underline the distinction between regulating trade margins and bringing down the total cost of treatment. For patients who require long-term therapy, even small price differences can accumulate into substantial expenses over time.

Why Trade Margin Caps May Not Reduce Every Medicine’s Price

Trade margin regulation seeks to limit the difference between the price at which a medicine enters the distribution chain and the price at which it is sold further along that chain. By restricting the margin available to intermediaries, the government aims to prevent excessive mark-ups and improve affordability.

However, the final retail price is influenced by more than distribution margins alone. Manufacturing or import costs, the price charged at the first point of sale, the presence of competing products and the medicine’s patent status can all affect the outcome.

K. M. Gopakumar, co-convenor of the Working Group on Access to Medicines and Treatments, said the revised MRPs supported concerns that trade margin rationalisation was unlikely to reduce the prices of patented medicines in the absence of competition.

He also pointed to the continued inclusion of 34 of the 42 medicines covered by a government pilot project launched in 2019. In his assessment, the persistence of these medicines on the current list raised questions about how effectively the measure had controlled costs and improved affordability.

The experience of ribociclib is one example cited in the report: despite being part of the earlier pilot, its reported monthly cost rose between 2022 and 2025.

Why the Point at Which Margins Are Capped Matters

Experts have argued that trade margin controls could have a greater effect if margins were calculated against manufacturing or import costs rather than the price at the first point of sale.

The distinction matters because the price used as the starting point determines how much room remains for mark-ups across the distribution chain.

Gopakumar previously illustrated the concern with a hypothetical example involving a company selling 1,000 medicine vials to a distributor at an inflated price and offering another 500 vials free. Such arrangements, he argued, could allow prices to remain artificially high even when a margin cap was formally observed.

The example reflects a broader policy challenge: controlling a percentage margin does not necessarily guarantee that the underlying price is reasonable. If the starting price is already high, a regulated margin may still leave patients facing a substantial bill.

For this reason, the design of pricing rules and how prices are monitored and enforced can be as important as the headline percentage used to cap margins.

What Role Can Competition and Patent Rules Play?

The unchanged prices of some high-cost patented medicines have renewed attention on the relationship between competition and affordability.

When several manufacturers offer comparable generic medicines, competition can place pressure on prices. Patented medicines, however, may face fewer direct competitors while patent protection remains in force.

Gopakumar argued that mechanisms available under Indian patent law, including compulsory licensing or government use of a patent, should be considered where necessary to improve the affordability of patented medicines.

These are distinct legal mechanisms with specific conditions and procedures; they are not automatic consequences of a trade margin cap. Their use would depend on the applicable legal framework and the circumstances surrounding the medicine.

The wider policy question is whether trade margin controls should operate alongside other measures designed to address high medicine prices, particularly where limited competition leaves patients with few affordable alternatives.

Did the Price Cuts Meet the Government’s Expectations?

The National Pharmaceutical Pricing Authority had indicated that reductions in MRP following the intervention would broadly fall in the range of 20% to 70%.

The reported revisions included reductions within that range and a few even larger cuts, such as those for Thiotepa. Yet the overall picture remains mixed because a substantial number of formulations did not become cheaper.

The data covering 543 formulations shows why the average figure needs to be interpreted carefully. A handful of large reductions can raise the average monetary saving, even when many products experience little or no change.

Conversely, a reduction of several thousand rupees may be important for an expensive medicine but relatively small as a percentage of its original price. Both the absolute saving and the percentage reduction are therefore useful measures when evaluating the policy.

The unchanged prices of expensive patented therapies also demonstrate that the intervention has not addressed every source of high medicine costs.

What Should Patients Check Before Buying Cancer Medicines?

Patients and caregivers can take several practical steps to understand whether the revised prices apply to their prescribed treatment.

• Check the exact formulation: Confirm the medicine’s name, strength, dosage form and pack size. Prices can differ across formulations and brands.

• Ask for the revised MRP: Request a bill or price quotation showing the applicable price for the prescribed medicine.

• Compare equivalent options with a doctor: Where clinically appropriate, ask the treating oncologist whether another brand or formulation is suitable. Do not switch cancer medicines without medical guidance.

• Ask about patient assistance: Hospitals, manufacturers and charitable organisations may offer support programmes for eligible patients, although availability and eligibility vary.

• Separate medicine costs from other charges: Confirm whether the quotation includes only the medicine or also administration, hospital and other treatment-related expenses.

Patients should not delay or alter prescribed treatment solely because a medicine’s price has changed. Any substitution or adjustment should be discussed with the treating oncologist.

The Bigger Picture: Price Regulation Is Only One Part of Cancer Care Affordability

The revised cancer medicine prices represent a meaningful change for some formulations, particularly Thiotepa and Pertuzumab. Their reductions show that regulating trade margins can coincide with substantial cuts in listed prices for selected medicines.

But the unchanged prices of pembrolizumab and ribociclib demonstrate the limits of relying on this approach alone. Where the underlying price is high and competition is limited, restrictions on distribution margins may not be enough to make treatment affordable.

The next challenge for policymakers is to assess how the intervention affects patients in practice, whether the revised prices are being implemented across the supply chain and what additional measures may be needed for high-cost medicines.

For patients and families facing cancer treatment expenses, the key takeaway is clear: some medicines have become significantly cheaper, but the benefits are not uniform across the full range of cancer therapies. The affordability of cancer care will depend on how pricing regulation works alongside competition, access programmes and other policy mechanisms.