India’s drug price regulator has revised the maximum retail prices (MRPs) of 543 cancer drug brands and pack sizes, with reductions of more than 90% in some cases. But while several generic and biosimilar brands have become dramatically cheaper, some of the most expensive cancer medicines, including the blockbuster immunotherapy Keytruda, remain unchanged, exposing the limits of the latest price-control intervention.The revised list issued by the National Pharmaceutical Pricing Authority (NPPA), brings down the price of palbociclib, used to treat certain breast cancers, from Rs 40,421 to Rs 2,720 for one brand and pack size.The price of thiotepa, a chemotherapy drug, falls from about Rs 80,072 to Rs 7,150 a vial.

Other steep reductions include those for dasatinib, lenvatinib, abiraterone and olaparib, used in the treatment of different cancers.Yet Keytruda, whose active ingredient is pembrolizumab and which is indicated for more than 21 cancer types, remains priced at Rs 2,16,500. Ribociclib (Kryxana), used to treat breast cancer, is unchanged at Rs 24,435.

Other originator brands, including Tagrisso, Tecentriq, Darzalex and Imfinzi, also show no change in their listed MRPs. The revised prices will take effect on November 9, following the NPPA’s decision to cap trade margins at 30% of MRP for 137 non-scheduled anti-cancer drugs.The move comes amid growing scrutiny of cancer drug pricing, with the Supreme Court questioning the government over high medicine costs and the margins charged in the cancer treatment supply chain.

The Court is now considering a wider intervention: capping trade margins on all non-scheduled drugs in the country. Its order in the case has been reserved, leaving the next steps uncertain.The debate has wider implications as India faces a growing cancer burden and patients grapple with the cost of treatment.

Cancer care can involve not just expensive medicines but also surgery, radiation, diagnostics, hospitalisation and repeated follow-up.For families paying out of pocket, the cumulative cost can force difficult choices between treatment, household expenses and borrowing. This financial toxicity can undermine access to care even when treatment is medically available.K M Gopakumar, a legal researcher with Third World Network, which works on access to medicines in developing countries, said the revised list exposed the extent of the problem. “The revised list exposes the level of exploitation that has been carried out by hospitals in the country,” he said, adding that the benefit should be passed on to patients immediately.He also pointed to the limits of the intervention.

With the prices of several critical medicines, including Keytruda and ribociclib, unchanged, he said the government should explore measures such as compulsory licencing – allowing generic versions of innovator medicines to be made despite patents – to improve access to life-saving drugs.WHERE CUTS BITEThe sharpest reductions in the revised list are substantially higher than the government’s earlier projection of price reductions of up to 70%.Palbopro, a brand of palbociclib 125 mg, falls from Rs 40,421.33 to Rs 2,720, a reduction of 93.3%. ISOGEN, another palbociclib brand, drops by 91.6% for its 100 mg pack.WOMAZOL, anastrozole 1 mg, falls from 458.85 to 39.52, while SAMTEPA, thiotepa 100 mg, drops from 80,071.86 to 7,150.33 per vial.The reduction in the price of SAMTEPA alone amounts to nearly Rs 72,922 per vial.

For patients who need repeated doses, such changes could translate into substantial savings, although the actual benefit will depend on the prescribed brand, treatment regimen and whether hospitals pass on the revised prices.The cuts are not uniform even among brands containing the same molecule. While some palbociclib brands have seen dramatic reductions, PALENO’s price for the 100 mg pack moves only marginally, from Rs 5,717.81 to Rs 5,624.10.Such disparities raise questions about the relationship between medicine prices, manufacturing costs and the margins built into the supply chain.

They also underline why a headline percentage reduction does not tell the whole story: the impact on an individual patient depends on which brand is prescribed and how much of the total treatment bill is accounted for by that medicine.THE LIMITS OF PRICE CAPSThe contrast between the steep cuts in several generic and biosimilar brands and the unchanged prices of major originator products is central to the debate over affordability.The NPPA’s intervention targets trade margins rather than directly imposing a uniform reduction in the prices of every drug. Where large margins exist across the distribution chain, limiting them can produce substantial price cuts.But the effect can be more limited for costly medicines whose prices are not substantially reduced through this mechanism alone.Pembrolizumab or Keytruda, for instance, is an important immunotherapy used across multiple cancer types, but the latest revision has not reduced its listed MRP.

The same is true of several other originator medicines. The revised list is based on company-reported data received by the government, and the NPPA has said it will be updated periodically.- Ends