Trade Margin Cap on 137 Cancer Drugs: Prices to Fall by Up to 70% from November 9
The National Pharmaceutical Pricing Authority (NPPA), India's medicine price regulator, has capped the trade margin (the extra money added by wholesalers and retailers between the company and the patient) at 30% for 137 non-scheduled anti-cancer medicines.
"Non-scheduled" means these medicines are not on the government's list of essential medicines, so their prices were not directly controlled before.
The order was published in the official Gazette on 17 October 2026 under Paragraph 19 of the Drugs (Prices Control) Order (DPCO), 2013, using the Trade Margin Rationalisation (TMR) method. The new, lower prices apply from 9 November 2026.
The 137 medicines were picked by an expert committee set up under the Directorate General of Health Services (DGHS). It included cancer doctors, hospital experts and government officials. The list will be updated from time to time.
The maximum retail price (MRP) of the covered medicines is expected to fall by up to 70%. The actual cut depends on how big the margin on each brand was before. The cap covers branded and generic, Indian and imported, patented and off-patent versions.
Companies must tell the NPPA their revised prices within seven days, publish new price lists and keep production and supply at current levels so that no shortage is created. Hospitals and chemists must charge and display the new prices. Patients can check prices on the NPPA website and the Pharma Sahi Daam app. State Drug Controllers will enforce the order.
Trade Margin Rationalisation (TMR): A New Pricing Tool
Trade Margin Rationalisation, or TMR, is a way to make medicines cheaper without fixing their final price. Instead, the government limits the gap between the price at which a company first sells a medicine to its distributor and the MRP that the patient pays. That gap is the money the middlemen (stockists, wholesalers, retailers, and sometimes hospitals) keep. When this gap is capped, the MRP has to come down.
The 30% cap on 137 cancer medicines is the biggest use of TMR so far, more than three times the 42 medicines of the 2019 pilot. It works by cutting the middlemen's share, which is why price cuts differ from brand to brand (up to 70%) rather than being one fixed price for all.
Drug Price Regulation in India: DPCO and NPPA
India controls the prices of many medicines so that ordinary people can afford them. The main rulebook is the Drugs (Prices Control) Order, 2013 (DPCO). The body that applies these rules and fixes prices is the National Pharmaceutical Pricing Authority (NPPA), set up in 1997 under the Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers. Together they decide how much a patient pays for medicines that matter most.
The 137 cancer medicines are all non-scheduled, so normally only the 10% yearly price-rise limit applied to them. By using Paragraph 19 of the DPCO, the NPPA has stepped in directly to lower their prices, and it has asked State Drug Controllers to enforce the order.
Out-of-Pocket Expenditure (OOPE) and Catastrophic Health Expenditure
Out-of-pocket expenditure (OOPE) on health is the money a family pays from its own pocket at the moment it gets treatment: doctor's fees, medicines, tests and hospital bills. It does not include money that is paid by the government, by an employer or by an insurance company. When this payment becomes very large compared with what a family can afford, it is called catastrophic health expenditure. High OOPE is one of the biggest reasons Indian families fall into debt or poverty.
Cancer is one of the illnesses most likely to cause catastrophic health spending, because treatment is long and medicines are very expensive. Cutting the MRP of 137 cancer medicines by up to 70% directly lowers what families pay from their own pockets, which is the very problem OOPE measures.
- Number of anti-cancer medicines covered: 137 (all non-scheduled)
- Trade margin cap: 30%
- Expected fall in MRP: up to 70%, varies by brand
- Gazette notification: 17 October 2026; new prices apply from 9 November 2026
- Legal power used: Paragraph 19 of the DPCO, 2013 (Trade Margin Rationalisation)
- Medicines chosen by an expert committee under the Directorate General of Health Services (DGHS)
- Companies must report revised prices to the NPPA within 7 days and keep supply at current levels
- Price check tools for patients: NPPA website and the Pharma Sahi Daam app
- 2019 pilot: 42 anti-cancer medicines, 30% cap, MRP of 526 brands cut by up to 90%
- NLEM 2022: 384 medicines; forms Schedule I of the DPCO
- Non-scheduled medicines: MRP rise capped at 10% in 12 months