Sitting on Monday, a Supreme Court bench posed questions about why the government's proposed ceiling on trade margins had been drawn narrowly around a subset of cancer drugs, and went on to probe whether comparable oversight ought to cover the broader pharmaceutical sector — medical devices included — given the wide disparities between what suppliers pay at procurement and what patients ultimately face at the retail end, which raised doubts about whether current pricing frameworks offer adequate protection against disproportionate markups.

The two justices — Vikram Nath and Sandeep Mehta — acknowledged the government's plan to place a 30 per cent ceiling on trade margins for certain cancer medications, yet pressed for an explanation as to why the scope of any such review ought to be confined to oncology drugs alone.

Solicitor General Mehta set out a plan under which the government would draw up a roster of cancer treatments falling within the proposed price cap, with that roster subject to periodic revision to bring in further anti-cancer medicines as market conditions and public-health factors warrant, though affordably priced drugs would sit outside its scope.

Prices at which medicines and medical devices moved along the supply chain to reach retailers were, in several instances the bench highlighted, far below the maximum retail figures that patients ultimately paid at the point of purchase. Among the examples put forward was a saline drip line, alongside a domestically manufactured cardiac stent whose retail price had been set at roughly ₹5,000 yet carried a maximum retail price tag of ₹25,000.

Pricing gaps of that magnitude, the bench held, called for closer examination — and the panel raised the question of whether placing an upper limit on profit margins across the board might dampen the financial pull toward procedures that patients may not actually need. Mehta noted that price controls on cardiac stents were already in place.

Azithromycin's pricing also drew attention from the bench, which raised questions about whether the protections available to patients through current frameworks were adequate.

Additional Solicitor General Aishwarya Bhati, presenting her submissions to the court, put forward the case that drug pricing policy needed to weigh affordability and product availability alongside the longer-term health of the market, cautioning against an overly restrictive regulatory hand. Her position held that medicine pricing in the country already ranked among the lowest anywhere in the world, and that tightening regulatory controls carried a risk of unsettling supply chains and reducing the accessibility of drugs.

When counsel put forward the position that wholesale control of the pharmaceutical sector lay outside the government's intentions, the bench questioned whether broader oversight spanning the full range of drugs might nonetheless be warranted.

Before the bench lay a petition calling for government-set entry-level pricing on non-scheduled medicines and enforceable cost limits on medical devices. A follow-up hearing in the matter is scheduled for 27 October.