₹80,000 injection to cost just ₹7,000:Prices of 543 cancer medicines cut; new rates effective from 9 November

Prices of 543 cancer drug brands and packs in India have been revised. Following a decision by the National Pharmaceutical Pricing Authority (NPPA), prices of 397 drugs, or 73%, have been reduced. Prices of 217 drugs have fallen by more than half. The prices of 97 drug brands have been cut by over 70%, while 50 have seen reductions of more than 80%. Prices of five drugs have been reduced by over 90%. The biggest reduction is for Samtepa injection, whose price has been cut from ₹80,071 to ₹7,150. The price of a pack of 21 Palbopro capsules has fallen from ₹40,421 to ₹2,720. The government has capped the trade margins of 137 anti-cancer drugs at 30% of the maximum retail price (MRP). On Tuesday, the Supreme Court questioned the NPPA over why drug prices were not being regulated. Companies have since announced revised prices, which will come into effect from November 9. However, prices of 146 brand-pack combinations remain unchanged. Prices of some expensive drugs remain unchanged Prices of several cancer drugs have been reduced, but some expensive medicines continue to cost the same. These include Keytruda, an immunotherapy drug used to treat more than 21 types of cancer. Its price remains ₹2,16,500. The price of ribociclib, used to treat breast cancer, also remains unchanged at ₹24,435. Prices of other drugs, including Tagrisso, Tecentriq, Darzalex and Imfinzi, have also not changed. Reducing the prices of patented drugs is difficult because they involve new technologies and patent rights. Companies may reduce or stop supplying these drugs in India if their prices are lowered. Supreme Court’s last 3 hearings on excessive profits from medicines The Supreme Court is continuing to hear a case concerning excessive profits on medicines used to treat cancer and other diseases. During a recent hearing, the court also raised the issue of an injection costing ₹13,000 being sold for more than ₹1 lakh. October 27: The entire system is helping drug manufacturers The Supreme Court questioned the government over the huge difference between the maximum retail price (MRP) of medicines and the prices at which retailers purchase them. The court asked why the entire system was helping drug manufacturers. The court said the practice was taking place right under the government’s nose and questioned whether it should be allowed to continue unchecked. After hearing both cases, the Supreme Court reserved its verdict. October 12: Questions raised over trade margins on anti-cancer drugs The Supreme Court described the Centre’s response on capping trade margins on anti-cancer drugs at 30% of the MRP as barely satisfactory. The court asked why the government could not cap trade margins on other medicines as well. The Centre, which had faced sharp criticism from the Supreme Court over hospitals adding hefty margins to cancer drugs, said it had taken a significant decision to cap trade margins on anti-cancer medicines at 30% of the MRP. According to the Centre, the decision is expected to save patients around ₹2,500 crore annually. September 29: Supreme Court says high cancer drug prices are like genocide During an earlier hearing, the Supreme Court questioned the Centre over why a cancer drug costing ₹2,700 had an MRP of ₹27,000. Expressing anger over drug prices, the court said, “This is genocide.” How are medicine prices determined? 4 points 1. The Drug Price Control Order (DPCO) regulates the prices of essential medicines. Under the 2013 DPCO, the government fixes the ceiling prices of medicines included in the National List of Essential Medicines (NLEM). 2. The ceiling prices of essential medicines are determined based on the prices of medicines available in the market. Selling a medicine above the prescribed ceiling price is illegal. 3. The Health Ministry prepares the list of essential medicines, taking into account their safety, effectiveness and prices. The list considers common diseases in the country and people’s healthcare needs. 4. The list is reviewed periodically, and new medicines are added as required. The government has less direct control over the prices of medicines that are not included in this list. Flaws in the government’s Trade Margin Rationalisation (TMR) policy The price cuts clearly indicate that generic drug companies had been charging patients hefty margins. However, the government’s Trade Margin Rationalisation (TMR) policy has serious flaws and contradictions. 1. Why have prices of patented drugs not fallen? The TMR formula allows margins of up to 42.8% on the price to stockist. Since these medicines are extremely expensive, the margin translates into a substantial amount. There are only one or two intermediaries in the supply chain for cancer drugs, or the medicines are sold directly to hospitals. This allows a few players to make huge profits. This could also be one reason why TMR has not affected the prices of patented drugs. 2. Opportunity to provide relief to patients missed Medicines provided free of charge under patient assistance programmes have been excluded from TMR calculations. Including these medicines could have led to some reduction in the prices of patented drugs. 3. High margins for intermediaries Patients could have received greater relief if the 16% margin cap applicable to medicines regulated under the Drug Price Control Order (DPCO) had also been applied to cancer drugs. The significant price cuts in medicines subject to margin caps in 2019 indicate that companies had been charging excessive margins even before. 4. Questions over the NPPA The National Pharmaceutical Pricing Authority (NPPA) does not have robust data on prices across the supply chain. Companies have been allowed to implement prices and report them themselves without an independent audit.