Cancer Drugs Up to 93% Cheaper as NPPA Revises 543 MRPs

India’s drug price regulator has revised the maximum retail prices of 543 cancer drug brands and pack sizes, delivering reductions of more than 90 percent in several cases. The National Pharmaceutical Pricing Authority’s latest intervention targets non-scheduled anti-cancer medicines and is expected to bring meaningful relief for many patients, particularly those relying on generic and biosimilar versions of commonly used therapies. At the same time, the list reveals a clear divide: while numerous formulations have become dramatically cheaper, some of the most expensive originator medicines, including the widely used immunotherapy Keytruda, remain unchanged.

The revised prices take effect from 9 November 2026. They follow the authority’s decision to cap trade margins at 30 percent of MRP for 137 identified non-scheduled anti-cancer drugs. The move builds on an earlier 2019 exercise and is intended to curb excessive mark-ups that have long inflated the final cost of cancer treatment for patients and families.

Steep Reductions on Key Generics and Biosimilars

Among the sharpest cuts is the breast cancer medicine palbociclib. One brand and pack size, previously priced at approximately ₹40,421, has been revised to ₹2,720, a reduction of 93.3 percent. Another formulation of the same drug has seen a cut of more than 91 percent. Thiotepa, a chemotherapy agent used in certain transplant and cancer protocols, has fallen from roughly ₹80,072 per vial to about ₹7,150, representing a saving of nearly ₹72,922 on each vial.

Other significant reductions include formulations of pertuzumab, used in HER2-positive breast cancer, which dropped by more than ₹64,000 per vial in one listed version; anastrozole tablets, which fell by over 90 percent in a specific pack; and several brands of bevacizumab, abiraterone, dasatinib and related therapies. Across the revised list of 543 entries, hundreds of brands and strengths show lower MRPs, with the average reduction among those that declined estimated at around 50 percent and many falling by half or more.

These cuts primarily affect generic and biosimilar products where trade margins had previously been widest. The revised ceiling effectively compresses the gap between the price at the first point of sale and the final MRP charged to patients or hospitals.

Unchanged Prices for Major Originator Brands

In contrast, several high-cost originator and patented medicines show no change in the revised list. Keytruda (pembrolizumab), indicated for more than 20 cancer types, remains listed at ₹2,16,500. Ribociclib, marketed as Kryxana for certain breast cancers, stays at ₹24,435. Other prominent brands such as Tagrisso, Tecentriq, Darzalex and Imfinzi similarly retain their earlier MRPs.

This pattern highlights the limits of the current intervention. Because the measure focuses on rationalising trade margins rather than imposing new ceiling prices on patented molecules, medicines sold under a single brand with tighter existing margins often remain unaffected. Patients dependent on these newer immunotherapies and targeted agents may therefore see little immediate change in the listed price of their treatment.

What the Revisions Reveal About Margins

The scale of the reductions on many generic and biosimilar brands has drawn attention to the size of previous mark-ups. In several cases the gap between the earlier MRP and the new, margin-capped price was substantial, pointing to significant layers of distribution and institutional pricing that patients ultimately absorbed. Hospitals and other institutional buyers have frequently been part of these supply chains, and the revised list makes the extent of those margins more visible.

By setting a uniform 30 percent trade-margin ceiling, the regulator aims to retain a reasonable return for the legitimate supply chain while preventing excessive mark-ups. Manufacturers are required to recalculate and report the new MRPs, and retailers as well as hospital pharmacies must charge the revised rates and display them. The authority has also indicated that production levels should be maintained to avoid shortages.

Expected Impact on Patients and the System

Estimates associated with the measure suggest potential annual savings for patients in the range of several thousand crore rupees, depending on uptake and the mix of drugs used. For families facing the high and often prolonged costs of cancer care, lower prices on frequently prescribed generics and biosimilars can ease the financial burden, particularly in the private sector where out-of-pocket spending remains substantial.

The intervention does not, however, address every dimension of cancer drug affordability. Newer patented therapies that dominate certain treatment protocols continue to carry high list prices. Patient assistance programmes and institutional negotiations may still play a role in reducing the effective cost of those medicines, but the official MRP itself remains unchanged for many of them.

Context and Continuity with Earlier Policy

The current exercise expands on the 2019 trade-margin rationalisation for a smaller set of anti-cancer drugs, which had produced steep cuts and notable savings at the time. By extending the approach to a broader list of 137 molecules and 543 brand and pack-size combinations, the regulator is applying a tested tool to a wider segment of the market. The focus remains on non-scheduled medicines—those not already under direct price control—where trade margins had the greatest scope for inflation.

Implementation will depend on compliance by manufacturers, distributors, retailers and hospital pharmacies. Patients and caregivers are expected to benefit most where generic or biosimilar alternatives are clinically appropriate and readily available. Monitoring of availability and actual transaction prices in the months after 9 November will determine how fully the intended relief reaches those who need it.

A Partial but Meaningful Step

The NPPA’s revision of 543 cancer drug MRPs delivers clear, in some cases dramatic, price reductions for a large number of formulations. It simultaneously underscores the structural realities of the cancer medicines market: generics and biosimilars can be brought down substantially through margin controls, while many high-cost originator products remain outside the immediate effect of such measures. For patients, the changes offer tangible savings on important therapies even as the overall cost of advanced cancer care continues to present significant challenges. The new prices, effective from early November, mark a concrete step toward greater transparency and more manageable expenses in a critical area of healthcare.

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