Cancer Drug MRPs Could Fall 20-70% Under NPPA's Proposed Trade Margin Cap
New Delhi: The National Pharmaceutical Pricing Authority (NPPA) has approved in principle a 30% trade margin cap on MRP for identified non-scheduled anti-cancer drugs, with the proposed intervention expected to reduce MRPs by 20-70%.
The approval is subject to finalisation of the list of anti-cancer medicines to be covered under the exercise.
The decision was taken at the Authority’s 151st meeting under DPCO, 2013, and its 283rd meeting overall, held on October 8, 2026, under the chairmanship of Shri Manoj Joshi, Secretary, Department of Pharmaceuticals.
According to the minutes, the proposed Trade Margin Rationalization (TMR) exercise is expected to reduce MRPs broadly by 20–70%, depending on the existing trade structure and mark-up of individual medicines. The intervention is estimated to generate annual savings of approximately ₹2,500 crore, while reducing patients’ out-of-pocket expenditure and improving the affordability and accessibility of anti-cancer medicines.
During its deliberations, the Authority noted that NPPA is mandated to fix/revise and monitor prices of drugs/formulations and oversee implementation of DPCO, 2013. The objective of DPCO, 2013 is to ensure availability of essential drugs at affordable prices. While scheduled formulations are subject to price control, non-scheduled formulations are monitored to ensure that such increases do not exceed 10% in a year.
The Authority further noted that the NLEM, 2022 comprises 388 drugs inter-alia covering 63 anti-cancer drugs. These scheduled medicines are already subject to price control through the ceiling-price mechanism.
The anti-cancer drugs market comprises approximately 225 drugs and 500 formulations, with an annual turnover of around ₹12,500 crore. Of this, scheduled cancer drugs account for approximately ₹2,250 crore, with the balance comprising non-scheduled drugs.
Analysis of Pharmarack data indicates that non-scheduled anti-cancer drugs carry an average trade mark-up of approximately 170%, with mark-ups of up to 700% in certain cases. The Authority also noted substantial variations in transaction prices across retail, hospital and e-pharmacy channels, including significant differences in discounts from MRP.
The Authority accordingly noted that high trade margins, particularly in non-scheduled anticancer formulations, are a significant factor contributing to the high prices of such medicines.
The Authority took note of the precedent of Trade Margin Rationalization (TMR) undertaken in 2019. In the context of high trade margins in non-scheduled anti-cancer medicines, a trade margin of 30% from the first point of sale was considered. The intervention, notified on 27.02.2019, covered 42 non-scheduled anti-cancer drugs and was undertaken in public interest by invoking the extraordinary powers under Paragraph 19 of DPCO, 2013. The 2019 exercise resulted in substantial reductions in MRP, including reductions of up to 91% for 526 brands, with annual savings of approximately ₹984 crore.
The Authority was informed that the D/o Pharmaceuticals (DoP) has directed NPPA to implement TMR on non-scheduled anti-cancer drugs under Paragraph 19 of DPCO, 2013 in public interest, as was done in 2019. Further, DoP has requested the Ministry of Health and Family Welfare to constitute an Expert Committee under DGHS for recommending the list of anti-cancer drugs to be covered under the proposed exercise, with the report requested by 14.10.2026. The positive list may be updated periodically, as warranted by market developments and public health considerations.
The Authority deliberated upon the need to address excessive trademark-ups in nonscheduled anti-cancer medicines and observed that extraordinary circumstances warrant intervention under Paragraph 19 of DPCO, 2013 in public interest.
The Authority unanimously agreed that, in view of excessive profiteering in anti-cancer drugs and its impact on patients, consumer interest must remain paramount. The Authority observed that extraordinary circumstances existed warranting urgent action under Paragraph 19 of the DPCO, 2013, to address market distortions, curb profiteering, and ensure fair and affordable prices.
The Authority deliberated on the proposal to regulate the trade margin for identified non-scheduled anti-cancer medicines by capping the trade margin at 30% of MRP on the same lines as the TMR exercise undertaken in 2019.
The Authority noted that the proposed intervention is expected to reduce MRP broadly in the range of 20–70%, depending upon the existing trade structure and mark-up of individual medicines, and is estimated to result in annual savings of approximately ₹2,500 crore. The expected benefits include reduction in out-of-pocket expenditure, improved affordability and accessibility, reduction of excessive trade mark-ups and greater transparency in prices applicable to patients.
After detailed deliberation, the Authority approved, in principle, the proposal for Trade Margin Rationalization of identified non-scheduled anti-cancer drugs under Paragraph 19 of DPCO, 2013, by capping the trade margin at 30% of MRP subject to finalization of the list of anti-cancer drugs to be covered under the exercise.
