Centre cuts MRPs for trade-margin-capped cancer meds by up to 93%

India’s drug price regulator, the National Pharmaceutical Pricing Authority (NPPA), has revised the maximum retail prices (MRPs) of 543 trade margin-capped cancer drug brands and pack sizes, with reductions of up to 93 per cent in some cases.

Several generic and biosimilar brands have become dramatically cheaper. But some of the most expensive cancer medicines, such as the high-selling Bevacizumab and blockbuster immunotherapy Keytruda, remain unchanged. This exposes the limits of the latest price control intervention. 

The sharpest reductions in the revised list are substantially higher than the government’s earlier projection of price reductions of up to 70 per cent.

The price of Palbopro, a brand of targeted cancer molecule palbociclib marketed by RPG Life Sciences, has fallen from ₹40,421.33 per unit to ₹2,720 per unit, a reduction of 93.3 per cent.

Another palbociclib brand ISOGEN has seen its MRP drop by 91.6 per cent for its 100 milligram (mg) pack.

For patients who need repeated doses, such changes could translate into substantial savings, although the actual benefit will depend on the prescribed brand, treatment regimen and whether hospitals pass on the revised prices. 

On the other hand, innovator drugs and therapies sold by multinational corporations (MNCs) have seen zero changes in MRP, even if the biosimilar and generic versions of the same drugs saw a huge price drop.

The MRP for Avastin – a monoclonal antibody molecule Bevacizumab marketed by Swiss drugmaker Roche – remains unchanged at ₹1.23 lakh per 400 mg vial.

This comes even as similar dosage strength biosimilar versions such as Bevacimab (marketed by Abbott) and Bevakalp (Torrent Pharma) have seen price drops of 86 per cent and 69 per cent, respectively.

Similarly, all versions of cancer drug Nivolumab marketed by Bristol Myers Squibb (BMS) India and Dr Reddy’s have seen no change in their MRPs.

Bevacizumab and Nivolumab are the second and third highest-selling anti-neoplastic drugs in India via retail channels, according to market research firm Pharmarack. 

Another important drug Keytruda, whose active ingredient is Pembrolizumab and is indicated for more than 21 cancer types, remains priced at ₹2.16 lakh.

Patient groups flag patient assistance programs (PAPs) exclusions, data gaps behind partial relief

Officials told Business Standard that the reason for this divergence could be price reduction only for those indications where the MRP was high due to huge trade margins.

Sandeep Nayak, chairman of oncology at Bengaluru's KIMS Hospital added that the price of original manufacturers remaining unchanged indicated that their margins may already have been within the reasonable range.

The move to cap margins comes amid growing scrutiny of cancer drug pricing, with the Supreme Court questioning the government over high medicine costs and the margins charged in the cancer treatment supply chain.

The convener of a Mumbai-based patient support group said, “Many major Indian companies making generic versions of the cancer drugs have been providing huge margins and exploiting patients.”

Malioni Aisola, coconvener of patient advocacy group All India Drug Action Network (AIDAN), said that trade margin rationalisation (TMR) was never about ensuring the affordability of cancer treatments. 

“Even marginal price reductions in the price of exorbitantly priced patented medicines have been scuttled by the conscious exclusion of volumes provided free under PAPs under the TMR,” she added.

PAPs are manufacturer-funded programmes offering free or discounted medicines to eligible patients.

Calling such programmes market-expansion strategies that operate by providing discounts or buy and get some free deals, Aisola said their exclusions have understated trade margins and diluted MRP reductions. 

Experts have also questioned the methodology, calling markups of over 42 per cent in direct hospital sales or shorter supply chains “extremely liberal.”

According to a notification of the NPPA, a 30 per cent cap on the MRP, excluding goods and services tax (GST), translates into a 42.86 per cent markup on the price to a stockist or distributor.

“The supply chain for cancer medicines is limited to a very few middlemen or direct sales to hospitals. Given the high value of these medicines, the markup that would go to 1-2 entities alone was legitimising profiteering,” Aisola said.

The revised list of MRPs is based on company reported data received by the government, and the NPPA has said it will be updated periodically.

Patient groups allege that the NPPA has abdicated its responsibilities towards gathering and maintaining the price data at various points in the supply chain and diverse distribution channels. 

“The paucity of critical data has led to a situation where companies have been asked to calculate their MRPs and self report, and implement the prices, without any verification,” Aisola said.