A 30% ceiling on trade margins now governs 137 non-scheduled anti-cancer medicines identified by the National Pharmaceutical Pricing Authority, with updated maximum retail prices scheduled to come into force on 9 November 2026. Patients with cancer and their households stand to see costs fall by as much as 70 percent through the measure, though the actual reduction at any given point will depend on what pricing structures are already in place.
Gazette notification S.O. 5690(E), published on 17 October 2026, carried a directive from the authority — which operates within the Department of Pharmaceuticals under the Ministry of Chemicals and Fertilizers — drawing on the special provisions set out in Paragraph 19 of the Drugs (Prices Control) Order (DPCO), 2013, to put the order into effect. Spanning all 137 listed drugs — whether taken alone or blended together — the directive extends to non-scheduled preparations regardless of potency, physical form, or how the substance enters the body. The same coverage extends to cases where those preparations are deployed for different medical indications.
The ministerial release identified the medicines as spanning immunotherapy agents deployed across more than 20 cancer varieties, Denosumab prescribed to patients managing breast or prostate cancer, Pegfilgrastim administered to reduce the risk of neutropenia during cancer treatment, and Bevacizumab indicated for colon, ovarian, and cervical cancers. Three treatments falling under the scheme's remit — Pembrolizumab, Durvalumab, and Osimertinib — rank among the therapies in broad clinical use.
The NPPA highlighted that households across India routinely face substantial out-of-pocket costs when a family member undergoes cancer treatment, with expenditure at that scale capable of destabilising a family's finances entirely. Objections to the pricing of anti-cancer medicines had been voiced across a broad front — by government bodies, patients, advocacy groups, and online platforms — with particular attention drawn to the wide gap separating what suppliers charged at procurement and what end-users ultimately paid at retail.
Pricing data drawn from the market revealed that certain anti-cancer medicines outside the scheduled-drug list carried average trade mark-ups well above typical levels. Gaps between what retailers charge and what hospitals pay — each channel operating under its own discount structure relative to the printed price — point to real-world transaction figures that can stray noticeably from the MRP shown on packaging.
Under this order, trade margin is defined as the gap between what a manufacturer charges a stockist or distributor and the maximum retail price that a patient ultimately pays, with GST set aside from that calculation. According to the document, India's 2022 National List of Essential Medicines catalogues 388 pharmaceutical products in total, among them 63 oncology treatments whose pricing falls under the regulatory framework established by the Drug Price Control Order of 2013.
Pricing controls for scheduled formulations take the form of ceiling caps, whereas products outside that classification fall under a separate oversight pathway — one that tracks whether annual MRP increases stay within the boundary set by Paragraph 20. Rooted in a 2019 government pilot programme that applied Trade Margin Rationalisation principles to 42 non-scheduled anti-cancer drugs under Paragraph 19, the current policy extends that earlier framework further. When a 30% ceiling on trade margins was applied to non-scheduled anti-cancer medicines, the maximum retail prices of drugs spanning 526 brands fell by as much as 90%.
Convening for its 283rd plenary session — the 151st conducted under DPCO, 2013 — on 8 October 2026, NPPA turned its attention to the question of trade mark-ups that had grown beyond acceptable bounds. The body reviewing the matter determined that the circumstances were sufficiently unusual to warrant action on behalf of the public — specifically to address distortions in the market, rein in excessive profit-taking, and bring prices to a level that consumers could reasonably afford.
Following that, a formal request went out from the Department of Pharmaceuticals to the Ministry of Health and Family Welfare, asking that an Expert Committee be assembled within the Directorate General of Health Services to draw up a list of medicines warranting inclusion. Drawn from oncology, broader medical practice, hospital networks spanning the country, and government administration, the panel brought together professionals across those fields. Following a review of available data, perspectives, and affordability-improvement options, the body put forward 137 anti-cancer medicines not currently on the scheduled list.
At its 284th general session and 152nd convening under DPCO, 2013 — proceedings that ran across October 16 and 17, 2026 — NPPA reviewed the recommendations and resolved to publish the list. Adjustments to the roster will be made on a rolling basis, guided by shifts in the marketplace and any emerging public-health factors.
Under DPCO, 2013, price fixation rules extend to patented medicines as well, with the sole carve-out applying to those products that have received an exemption through Paragraph 32. Under the pricing rules that apply, the trade margin feeds into a bracketed multiplier that is added to one before being applied against the Price to Stockist or Price to Distributor — the value recorded at the first point of sale — with the resulting figure then adjusted upward by any GST that falls due; expressed as a formula: MRP = PTS/PTD × {1 + [TM ÷ (100 − TM)]} + applicable GST. In this formula, TM denotes the trade margin, a figure capped at a maximum of 30.
To arrive at the PTS/PTD figure for March 2026, the manufacturer's aggregate net sales realisation for that product across the month is divided by the corresponding total units that changed hands during the same period. In any month during April 2025 through March 2026 where a manufacturer recorded no transactions, the applicable unit price is derived by dividing that full-year net sales realisation figure by the corresponding total volume of units moved across the entire period. Revenue figures spanning every sales channel — government transactions excluded — are required for the analysis.
Any product entering the market after 31 March 2026 will have its MRP derived from the prevailing PTS/PTD figures at the time of launch. In cases where a manufacturer delivers goods directly to a hospital or other medical institution, that facility is classified in the same way as a stockist or distributor, with the manufacturer's invoice records serving as the foundation for any pricing calculation.
Drug volumes delivered through manufacturer-operated Patient Assistance Programmes (PAPs) may be excluded from PTS/PTD and MRP calculations, provided that certain protective conditions are met. Patients are entitled to receive those medicines at no charge. Under the undertaking required from manufacturers, NPPA would receive a commitment to keep detailed logs covering each patient's full name, age, gender, home address, and contact information; verified proof of identity and residence for both the patient and any caregiver involved; documentation of the diagnosed condition along with the prescribed dosage; and a running account of every drug imported, received, and administered.
Any inaccurate, misleading, or wrongly submitted declarations under DPCO, 2013, and the Essential Commodities Act, 1955, expose the company to legal accountability for whatever consequences follow. Annexure I disclosures are due from manufacturers no later than seven days after the relevant order appears in the Official Gazette under Paragraph 9(2) of DPCO, 2013 — a deadline that holds regardless of any movement in their maximum retail prices. Updated pricing details are required to reach both the NPPA and the relevant State Drug Controller through formal submission.
Where a retailer omits the required declaration, regulators treat that omission as a failure to reduce the maximum retail price, opening the door to recovery action for any amounts charged above the permitted level. Under Paragraph 25 of DPCO, 2013, the applicable Form V price list is to be generated and uploaded via IPDMS, with copies reaching the relevant State Drug Controller, dealers, and any other designated parties no later than seven days after Gazette publication. Retailers, dealers, hospitals, and institutions are all required by Paragraph 25(3) to post manufacturers' price lists in a location clearly visible to anyone visiting their premises.
Under the revised framework, healthcare facilities and medical bodies are required to track notified maximum retail prices, keep their websites updated with the adjusted figures, and channel any breach of pricing rules to the NPPA for follow-up. Starting 9 November 2026, the lower pricing takes effect as an obligation for both retailers and hospitals. Updated drug prices are accessible to buyers through two official channels: the Pharma Sahi Daam mobile application and the NPPA's dedicated website.
Output levels at existing thresholds are what producers in this sector are now required to hold. Cuts to average monthly output fall under NPPA's approval process before they can take effect. Under the Drug Price Control Order 2013, any producer or importer planning to halt the supply of a regulated formulation is required to file the details set out in Form IV of Schedule II no fewer than six months ahead of the targeted withdrawal date.
Oversight of adherence to pharmaceutical regulations — spanning manufacturers, distributors, hospitals, and medical facilities — falls within the remit of State Drug Controllers. Manufacturers found to have charged prices above permitted levels face an obligation under DPCO, 2013 — read alongside the Essential Commodities Act, 1955 — to return the excess amount together with applicable interest. Those announced prices are set to hold until a new directive is issued.
Under Paragraph 20(1), a right to raise prices once per year becomes available to manufacturers, provided the maximum permissible trade margin remains unbroken from the point at which the relevant Gazette notice takes effect. Where earlier directives had set ceiling prices under Paragraph 4 or retail prices under Paragraphs 5 and 15 for any drugs appearing on the list, those orders are overridden by this notification. The order targets markups across distribution and retail channels that authorities consider outsized, while a secondary strand of the framework works to safeguard producer revenue and maintain a steady supply of medicines.
