NPPA Revised Drug List Shows Steep Price Cuts for Generic and Biosimilar Cancer Medications

A revised drug price list published by the National Pharmaceutical Pricing Authority (NPPA) outlines the initial effects of the government’s 30 per cent cap on trade margins for cancer drugs. The regulatory move, which follows an October 17 order, applies to 137 non-scheduled anti-cancer drugs—treatments not listed on the government’s essential medicines list. The pricing intervention is executed using Paragraph 19 of the Drugs (Prices Control) Order, 2013, which allows for price regulation in the public interest.

Under the updated framework, trade margin is defined as the difference between the price charged by a manufacturer to a stockist or distributor and the maximum retail price (MRP) printed on the pack. Companies are required to set the MRP at the distributor price—based on the average for March 2026—divided by 0.7, plus GST. This regulation applies across all strengths, dosage forms, and combinations of the listed medications, including patented drugs unless an exemption has been officially approved. The filings, running up to October 27, are based on data submitted by companies so far and remain subject to finalization.

Out of the 137 targeted drugs, 110 currently appear in the company filings. These entries are categorized into three distinct groups: 35 drugs show price reductions across every listed brand, including generic and biosimilar variants such as abiraterone, dasatinib, erlotinib, azacitidine, and pomalidomide. Another 47 drugs, predominantly newer patented products sold under a single brand like pembrolizumab (Keytruda), nivolumab, and osimertinib, show no price changes. The remaining 28 drugs reflect mixed outcomes, where generic and biosimilar versions became cheaper while the original brands, such as Avastin and Lynparza, remained unchanged.

In total, the published list contains 543 entries covering various brands, strengths, and pack sizes. Approximately 73 per cent, or 397 entries, show a lower MRP, while 146 entries remain unchanged. Among the reduced entries, the average price cut is about 50 per cent, with more than 200 entries falling by half or more. Notable examples include a 125 mg pack of palbociclib dropping by roughly 93 per cent from ₹40,421 to ₹2,720, and a thiotepa 100 mg vial decreasing from ₹80,072 to ₹7,150. Meanwhile, high-cost therapies like Keytruda maintain their previous price point of ₹2,16,500, largely because many original brands were already priced close to distributor levels before the order took effect.

The NPPA guidelines also address distribution channels where cancer drugs move directly from manufacturers to hospitals. In such cases, the hospital acts as the distributor for pricing calculations, and institutions are mandated to monitor MRPs, display revised prices on their websites, and report violations. State drug controllers hold responsibility for ensuring compliance among manufacturers, distributors, retailers, and hospitals. Companies failing to file revised prices are treated as non-compliant, and instances of overcharging are subject to recovery of excess amounts with interest under the pricing order and the Essential Commodities Act, 1955.

"The NPPA's implementation of trade margin caps highlights a targeted approach to managing healthcare costs, specifically reducing financial burdens on patients relying on generic and biosimilar cancer treatments. However, the distinct pricing behavior observed in patented, single-brand drugs indicates that regulatory frameworks must carefully navigate market dynamics to balance manufacturer incentives with patient affordability. For businesses operating in the pharmaceutical and healthcare sectors, strict adherence to compliance, distribution tracking, and transparent pricing structures will be critical as regulatory oversight continues to evolve." — Dr. Shishir Gupta, Founder & CEO, StartupLanes