Health

Anti-Cancer Drugs Show 100‑700% Mark‑ups Despite 2019 Trade Margin Cap

By Rema Nagarajan

A review of the National Pharmaceutical Pricing Authority’s (NPPA) 2026 list shows that most anti‑cancer drugs listed for trade‑margin reduction in 2019 now have mark‑ups ranging from 100% to 700%. The All‑India Drug Action Network (AIDAN) highlighted that one‑time reductions in maximum retail price (MRP) are ineffective without a permanent margin cap and ongoing monitoring.

NPPA had capped trade margins at 30% on the selling price of 42 anti‑cancer drugs in February 2019. Of the 137 drugs now listed for margin reduction, 34 were from that 2019 list. The 2026 list shows that many of those drugs have exceeded the 43% mark‑up threshold, which corresponds to a 30% trade margin because the margin is calculated as a percentage of the final MRP while the mark‑up is a percentage of the price to the stockist.

Data indicate that one‑time caps provide limited relief. The mark‑ups in 2026 were higher than before the 2019 order, and the percentage price reductions are generally larger than seven years ago. However, for drugs that saw steep MRP cuts in 2019, the 2026 reductions are smaller. For example, the MRP of a Pemetrexed brand fell from ₹7,000 to ₹800 in 2019, but in the latest reduction it fell from ₹1,095 to ₹297.

Many multinational companies that cut MRPs significantly in 2019 have made little or no further reductions, and some originator companies have not lowered MRPs much on either occasion. Only five brands from the 2019 list had a mark‑up of 43% before the latest order; another four had mark‑ups between 43% and 100%. The remaining 39 brands had mark‑ups ranging from 100% to over 700%.

Malini Aisola of AIDAN said the NPPA’s labeling of the measure as “trade margin capping” is misleading, as it is merely a one‑time MRP reduction that does not prevent mark‑ups from rising again, as happened after 2019.