Why Vital Chemotherapy Drugs Are in Short Supply in India

India’s shortage of two widely used chemotherapy medicines, cisplatin and carboplatin, exposes a difficult problem at the heart of affordable cancer care: keeping essential medicines inexpensive while ensuring that manufacturers can still produce them sustainably.

The medicines are not new or experimental. Cisplatin and carboplatin have been used for decades and remain important components of treatment for several cancers, including cancers of the lung, ovary, cervix, bladder, head and neck, testis and other solid tumours. Yet hospitals and pharmacies across India have reported difficulty obtaining them.

The immediate explanation is straightforward: the cost of platinum, a crucial raw material for these medicines, has risen sharply. But the shortage cannot be understood by looking at the metal price alone.

A combination of higher raw-material costs, disruptions to international supply routes, import-related delays, currency and duty pressures, and India’s system of medicine price regulation has made production less attractive for some manufacturers. The government responded in June 2026 by allowing a one-time 50% increase in the ceiling prices of cisplatin and carboplatin, but changing the price of a medicine does not instantly restore a disrupted supply chain.

The bigger question is therefore not simply why chemotherapy drugs are in short supply in India. It is why an essential medicine can become vulnerable when one relatively small part of its manufacturing economics changes.

Which chemotherapy drugs are affected?

The current shortage has particularly affected cisplatin and carboplatin, both platinum-based chemotherapy drugs.

These medicines work by interfering with the DNA of cancer cells, preventing them from reproducing and ultimately causing them to die. Their use is determined by cancer type, stage, treatment plan and the patient’s individual circumstances.

They remain important because cancer treatment is rarely built around a single medicine. Chemotherapy may be combined with surgery, radiation, targeted therapies or immunotherapy depending on the disease.

That means a shortage of one established drug can have consequences beyond the medicine itself.

If a particular chemotherapy regimen depends on cisplatin or carboplatin and the medicine cannot be sourced, doctors may have to consider whether another clinically appropriate option exists, whether treatment can be rescheduled, or whether procurement needs to be shifted to another supplier or location.

Not every patient will face the same consequences, and alternatives are not interchangeable simply because they belong to the same broad category. Treatment decisions have to remain with the treating oncology team.

The first pressure point: platinum became much more expensive

The most important part of the supply problem is the economics of platinum.

Platinum is a precious metal with a global market that is influenced by mining output, industrial demand, investment demand and geopolitical developments. Its use extends far beyond pharmaceuticals. Automotive applications, industrial processes and emerging technologies can all affect demand.

For manufacturers of platinum-based medicines, however, the critical issue is what happens when the price of the raw material rises faster than the permitted selling price of the finished drug.

Industry reports in 2026 highlighted a dramatic increase in platinum costs compared with previous years. One manufacturer reported that platinum prices had risen from roughly ₹2,000 per gram in June 2025 to nearly ₹5,000 per gram in 2026. Other industry estimates put the increase even higher depending on the period and market price being considered.

The exact number matters less than the underlying problem: the cost of an essential input had risen sharply while manufacturers could not freely increase the price of the finished medicine.

Why a cheap medicine can become expensive to manufacture

This is where India’s medicine price-control system becomes central to the story.

India regulates prices of essential medicines through the Drugs (Prices Control) Order, 2013. Scheduled formulations are subject to ceiling prices determined by the National Pharmaceutical Pricing Authority, or NPPA.

The system exists for an important public-health reason. Cancer treatment can be financially devastating, and price controls are intended to prevent essential medicines from becoming unaffordable.

But price regulation can create a different problem when production costs change dramatically.

Imagine a medicine whose permitted selling price was established when its critical raw material cost considerably less. If the price of that raw material then rises sharply, the manufacturer’s revenue per vial does not automatically rise with it.

Manufacturers still have to pay for raw materials, energy, labour, packaging, quality testing, transportation, compliance and financing.

If the economics deteriorate far enough, producing more units can become financially unattractive.

That is one of the central mechanisms behind the current shortage.

The price-control dilemma: affordability versus availability

The shortage illustrates a difficult policy trade-off.

Low prices improve affordability when medicines are available.

But a price that is too low relative to production costs can eventually threaten availability.

This does not mean price controls are inherently responsible for shortages. Nor does it mean prices should simply be allowed to rise without safeguards. The challenge is designing a system that recognises when production economics have changed sufficiently to threaten supply.

The Indian government has mechanisms for exceptional price revisions when essential medicines become commercially unviable. In June 2026, the NPPA invoked its extraordinary powers under paragraph 19 of the DPCO and approved a one-time 50% upward revision in the ceiling prices of cisplatin and carboplatin.

The decision specifically recognised that shortages, rising active pharmaceutical ingredient costs and the need for continued availability had created a public-health concern.

Why the government’s price increase has not solved everything

It may seem logical that raising the ceiling price should immediately bring medicines back to pharmacies.

Real pharmaceutical supply chains do not work that quickly.

Manufacturers need raw materials. Raw materials need to be imported, cleared and transported. Production needs to be scheduled. Batches have to pass quality checks. Finished medicines then move through distributors, wholesalers, hospitals and pharmacies.

If manufacturers have already reduced production because of poor economics, raising the permitted price today does not instantly create inventory tomorrow.

There can also be existing purchase contracts, depleted inventories, pending imports and manufacturing schedules to work through.

The NPPA’s June decision also provided for a review of the revised ceiling prices after six months, or earlier if warranted, reflecting the volatility in raw-material prices.

The second pressure point: West Asia disrupted supply routes

The platinum-price problem was compounded by geopolitical disruption.

India relies significantly on imported platinum and platinum-containing pharmaceutical inputs. The United Arab Emirates has been an important source of platinum imports for India, according to industry reporting.

The conflict and shipping disruptions affecting West Asia created additional uncertainty around movement through the region.

This matters because modern pharmaceutical manufacturing is global even when the final medicine is made in India.

A medicine labelled “Made in India” can depend on an international chain involving mined materials, chemical processing, specialised pharmaceutical ingredients, shipping, customs clearance and domestic manufacturing.

Disruption at any stage can affect the finished product.

Import delays add another layer of risk

Industry representatives have also pointed to the time required to obtain approvals for importing platinum-based raw materials.

Reports in June 2026 indicated that certain platinum-based raw materials required special government permission and that the approval process could take several months.

That creates a particularly difficult situation when prices are changing quickly.

A manufacturer may need to decide months in advance how much raw material to procure. But if the market price changes substantially during that period, the financial assumptions behind the purchase can change too.

For an essential medicine, this creates a mismatch between the speed of global commodity markets and the slower administrative processes involved in regulated pharmaceutical supply chains.

Import duties and the rupee also matter

The cost of platinum is not the only financial pressure.

Drug manufacturers have also cited import duties and currency movements as factors affecting production economics. Because some pharmaceutical inputs are imported and international commodities are generally priced in global currencies, a weaker rupee can increase the domestic cost of procurement.

That means manufacturers can face several increases simultaneously:

• Higher platinum prices
• Higher international freight and insurance costs
• Currency-related increases in import costs
• Import duties and related charges
• Longer approval and clearance timelines
• Higher overall manufacturing and operating expenses

When all of those pressures arrive together, a previously sustainable price can become inadequate.

The shortage began before the latest geopolitical disruption

One important point is easy to miss in the headlines: the current crisis was not created entirely by the West Asia disruption.

Industry representatives told reporters that the supply problem had already been developing, with platinum costs and production economics deteriorating before the geopolitical crisis added another layer of pressure.

This distinction matters because it changes how the problem should be solved.

If the shortage were caused only by shipping disruption, restoring normal transport routes might largely solve it. But if the underlying manufacturing economics remain weak, supply could remain fragile even after shipping conditions improve.

The crisis is therefore better understood as a structural supply problem intensified by a geopolitical shock.

Why hospitals feel the impact quickly

Hospitals cannot treat a chemotherapy shortage like an ordinary retail stockout.

Cancer treatment is often organised into planned cycles. The timing of medicines can matter, although the clinical consequences of a delay depend on the cancer, treatment regimen and patient.

When supplies become uncertain, hospital pharmacies and oncology departments may have to spend additional time locating stock through distributors or alternative procurement channels.

Patients and families can experience the problem even more directly.

Reports from hospitals in Delhi and other cities described patients and relatives searching multiple pharmacies for the medicines. That transforms a national supply-chain problem into an intensely personal experience.

For someone already dealing with cancer, uncertainty about whether a prescribed medicine will be available adds another layer of stress.

Why switching to another drug is not always simple

A common misconception during medicine shortages is that doctors can simply replace one drug with another.

In oncology, that assumption can be dangerous.

Different chemotherapy medicines have different mechanisms, toxicity profiles, dosing schedules and evidence for specific cancers. Even drugs that are both platinum-based may not be appropriate substitutes in every clinical situation.

Doctors therefore have to consider the individual treatment plan rather than treating the shortage as a simple pharmacy substitution.

This is one reason the availability of established, relatively inexpensive chemotherapy medicines matters so much: their value is not merely in their price but in the decades of clinical experience surrounding their use.

The affordability paradox

The chemotherapy shortage creates a particularly uncomfortable paradox for India’s healthcare system.

Price regulation is designed to protect patients from excessive medicine costs. But if a medicine becomes unavailable, patients can face a different set of expenses: travel between cities, emergency procurement, private-hospital charges or more expensive clinically appropriate alternatives where available.

In other words, the cheapest listed price is not necessarily the same as the lowest real-world cost when supply disappears.

This does not weaken the case for affordability. Instead, it shows why affordability and availability have to be considered together.

What the government response tells us

The government’s decision to permit a 50% increase in the ceiling prices of cisplatin and carboplatin is significant because it acknowledges that an essential medicine can become unavailable when the regulated price no longer reflects its production economics.

But the response also highlights a broader policy question: should price revisions happen only after shortages become visible?

A more resilient system would ideally identify essential medicines whose production margins are deteriorating before hospitals begin reporting empty shelves.

That requires better visibility into the entire supply chain.

What could prevent the next shortage?

There is no single fix. The problem requires coordination across pricing, imports, manufacturing and inventory management.

1. Faster review of essential medicines

Price ceilings should be capable of responding to extraordinary changes in critical input costs. The challenge is doing this without undermining affordability.

2. Better early-warning systems

Government agencies could monitor manufacturing volumes, import orders, API prices and hospital inventory for particularly critical medicines. Falling production combined with rising input costs should trigger investigation before shortages become widespread.

3. More resilient raw-material sourcing

Heavy dependence on a limited number of international sources can make an essential medicine vulnerable to geopolitical events. Diversifying suppliers and developing domestic capabilities where economically and technically feasible can improve resilience.

4. Faster regulatory coordination

When an essential medicine depends on imported specialised raw material, lengthy approval processes can magnify a temporary shortage. Regulatory safeguards remain necessary, but emergency pathways for critical medicines can help prevent avoidable gaps.

5. Strategic inventories

For medicines that are difficult to replace and essential to common cancer-treatment protocols, policymakers and health systems could consider whether minimum buffer stocks are appropriate.

A warning for India’s cancer-care ambitions

India has made major progress in expanding cancer diagnosis and treatment capacity. But expanding hospitals is only part of building a reliable cancer-care system.

A modern oncology system also requires dependable access to medicines, trained personnel, diagnostics, blood products, radiotherapy capacity and supply-chain infrastructure.

The cisplatin-carboplatin shortage demonstrates how a vulnerability in one relatively specialised input can affect treatment at the patient level.

It also reveals a broader truth about generic medicines: low prices are possible partly because manufacturers operate at scale and within tightly controlled margins. When a critical raw material suddenly becomes much more expensive, that model can become fragile.

What happens next?

The immediate outlook depends on whether higher permitted prices translate into improved manufacturing incentives and whether platinum supply and import logistics stabilise.

The June 2026 price revision is an important intervention, but it should be viewed as a bridge rather than the final solution.

If raw-material prices remain volatile, manufacturers continue to face import delays or supply routes remain disrupted, the market could remain vulnerable to periodic shortages.

Conversely, if input costs stabilise, procurement improves and manufacturers rebuild inventory, availability should become more reliable.

The six-month review mechanism for the revised prices is therefore important. It gives regulators an opportunity to assess whether the intervention has actually restored sustainable supply rather than merely changing the number printed on the price list.

The bigger lesson: medicine security is supply-chain security

The shortage of cisplatin and carboplatin is not simply a story about expensive platinum.

It is a story about how modern healthcare depends on an interconnected chain that stretches from mining and chemical processing to international shipping, government regulation, pharmaceutical manufacturing and hospital procurement.

A disruption thousands of kilometres away can eventually become a missing vial in a hospital pharmacy.

That is why the solution cannot focus only on the final medicine. India needs a clearer understanding of the vulnerabilities buried inside the supply chains of its most essential drugs.

The immediate priority is restoring reliable access to chemotherapy medicines without making cancer treatment less affordable. The longer-term priority is building a system that can detect and absorb commodity-price shocks and geopolitical disruptions before patients feel them.

The real test of India’s medicine-pricing policy is therefore not whether an essential drug has the lowest possible price. It is whether patients can reliably obtain that medicine when their treatment depends on it.

For cisplatin and carboplatin, the current shortage has made that distinction impossible to ignore.