Published Oct 31, 2026 | 7:00 AM ⚊ Updated Oct 31, 2026 | 7:00 AM
While several generic and biosimilar medicines have recorded substantial price reductions, many high-priced medicines have retained their MRPs.
Synopsis: The NPPA’s latest price revision has reduced the MRPs of several anti-cancer medicines, but the overall impact remains limited. An analysis by the Working Group on Access to Medicines and Treatments found that 484 of 643 product entries received cuts, while 159 remained unchanged. The group has raised concerns over affordability, originator drugs and trade margins.
The average price reduction of anti-cancer medicines that received a cut under the National Pharmaceutical Pricing Authority’s (NPPA) latest exercise was 50.78%. But when the combined listed maximum retail prices (MRPs) of all 643 product entries are considered, the reduction was only 13.8%, according to an analysis presented by the Working Group on Access to Medicines and Treatments on Friday, 30 October.
The difference, the group said, exposed the limitations of the government’s trade margin rationalisation exercise. While several generic and biosimilar medicines have recorded substantial price reductions, many high-priced medicines, particularly originator brands and products supplied by a single manufacturer, have retained their existing MRPs.
The group’s analysis found that 484 of the 643 entries, or 75.27%, recorded a reduction. The remaining 159 entries, accounting for 24.73%, showed no change. The combined listed MRPs fell from approximately ₹2.51 crore to ₹2.17 crore, a difference of about ₹34.57 lakh.
The 13.8% figure is calculated by comparing the sum of the old and revised listed pack MRPs. It is not weighted by sales volume, prescriptions or the number of patients using each medicine, and should not be interpreted as an estimate of actual patient savings.
“Of course, average can be misleading,” said KM Gopakumar, researcher with the Third World Network and co-convenor of the working group. “This weighted reduction gives us much more a realistic view.”
The group’s analysis also found that the 159 entries with unchanged prices accounted for 86.2% of the combined revised MRP value of all listed entries. Gopakumar said the overall reduction therefore appeared much smaller when the prices of all products were considered together.
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A major concern was that several originator medicines marketed by multinational pharmaceutical companies had not seen any reduction, even when competing generic or biosimilar products were available.
The group’s analysis found no price reduction across 53 listed entries from AstraZeneca, Novartis, Roche and Eli Lilly. All 17 entries from AstraZeneca, 14 from Novartis, 12 from Roche and 10 from Eli Lilly remained unchanged.
These included AstraZeneca’s Koselugo, with an MRP of ₹10,21,992, and Tagrisso at ₹4,16,492.48. Roche’s Perjeta retained its MRP of ₹2,51,877, while its Avastin 400 mg vial remained at ₹1,23,506.
“Major companies like AstraZeneca, zero change,” Gopakumar said during the presentation. Referring to the broader pattern, he said, “This move has resulted in the reduction of price of generics,” but added that “the single-source medicine that is largely due to patent protection has not come down.”
Only Pfizer, a multinational company. for instance, recorded reductions in eight of its 21 listed entries, mostly between 5% and 7%, according to the group’s analysis.
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The difference between originator brands and competing products was particularly visible in the case of bevacizumab, a medicine used to treat certain cancers.
Roche’s Avastin, a 400 mg vial, retained its MRP of ₹1,23,506. In comparison, Reliance Life Sciences’ biosimilar BevaciRel fell from ₹75,718 to ₹12,668, while Abbott’s BEVACIZAB declined from ₹65,205.09 to ₹8,956.75. The revised MRP of Avastin is approximately 13.8 times that of BEVACIZAB.
A similar gap was seen in Pertuzumab. Roche’s Perjeta, a 420 mg vial, remained at ₹2,51,877, while Glenmark’s Hertumab fell from ₹94,951 to ₹30,593.
Gopakumar questioned originator companies for not reducing the prices despite the availability of competing products. He said in a conventional market, the entry of competitors would be expected to put pressure on an existing manufacturer’s prices. However, he argued that this does not always happen in the pharmaceutical market.
On Avastin, he said, “They have confidence on their marketing network, basically big hospitals.” He suggested that established relationships with hospitals and prescribing networks could allow an originator brand to retain its price despite cheaper alternatives.
The group also pointed to AstraZeneca’s anastrozole as an example of an older medicine with generic alternatives. “It’s a very old medicine. A lot of generic medicines are there, but AstraZeneca’s price is not reduced,” Gopakumar said. Its listed MRP remained at ₹3,541, while Cipla’s anastrozole fell from ₹784 to ₹146.
The example, the group argued, showed that unchanged prices could not be explained only by patent protection.
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The organisations also questioned how the 30% trade margin could influence hospitals’ medicine procurement and prescribing practices.
Gopakumar argued that a hospital could earn a higher absolute margin by dispensing an expensive originator brand than a cheaper biosimilar, even when the same percentage margin applied to both.
He said hospitals could “manipulate the hospital formulary in such a way to keep the high brand and deny access to affordable brands”. He added that patients receiving treatment in hospitals may not always be in a position to choose an alternative.
“Once you are in the hospital and once you are in consultation with the hospital, you have that pressure to buy it from there,” he said.
The group also warned that this could affect the business model of Indian generic manufacturers, which traditionally rely on selling medicines at lower prices and earning through higher volumes. “That model is getting disturbed because of this approach,” Gopakumar said.
These were the group’s concerns about possible hospital incentives and patient access, rather than findings establishing that hospitals systematically deny cheaper alternatives.
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The group identified 56 medicines supplied by only one manufacturer or supplier. Of these, 42 medicines, represented by around 72 listed brands, appeared in the NPPA list. All but one of those listed brand entries showed no price reduction.
Gopakumar cautioned that the group had not established the patent status of every medicine in this category. “We think that most of it is because of the patented medicine. We know that certain medicines are clearly, but we need to do further check,” he said. He described them as “monopoly medicines”.
The group highlighted Pembrolizumab, marketed as Keytruda, as an example of a high-priced medicine whose MRP remained unchanged at ₹2,16,500. It also referred to other expensive products, including Tagrisso, Koselugo and Avastin.
Chaitali Rao, who also spoke at the briefing, argued that the NPPA’s formula addressed the distribution margin rather than the price at which a manufacturer initially sold a medicine.
“Only addressing the problem downstream won’t help. You have to have regulation upstream also,” she said. “The formula addresses the distribution spread, basically, not whether the manufacturer’s starting price is low enough.”
The group acknowledged that companies could argue that some unchanged MRPs already reflected trade margins below the prescribed 30% ceiling. Gopakumar said, “That would be the standard argument for the unchanged MRPs. Everybody says we are already selling well within the 30% margin, so therefore we don’t have to change it.”
However, Chaitali said companies should disclose “the reference transaction prices and also the calculations explaining why many of these entries have been unchanged”. The group also questioned the reliance on company declarations without routine verification of the underlying calculations.
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The organisations called on the government to go beyond trade margin regulation and address the prices set by manufacturers, particularly for patented and single-source medicines.
They urged the government to consider public-health safeguards under Sections 92 and 100 of the Patents Act to encourage competition. Rao argued that compulsory licensing was an established way to improve access to medicines and said the government should not avoid considering it.
“You have to take the big pharmaceutical companies head on. You have to issue compulsory licences where it matters,” she said.
Gopakumar said, “We cannot wait till the expiry of the patent,” arguing that patients could not be expected to wait for patents to lapse before more affordable alternatives became available.
The group also called for an affordability assessment rather than relying only on percentage price reductions. “What we require to do is an affordability analysis instead of mechanically reducing the prices,” Gopakumar said. “We should see whether this price is really affordable or not.”
The organisations further sought a cap on cancer treatment charges, arguing that lower medicine MRPs would not necessarily translate into lower hospital bills if other components of treatment remained expensive.
“In the absence of such a cap, hospitals can actually find various ways to charge exorbitantly from patients,” Gopakumar said.
(Edited by Majnu Babu)
