The Indian government has moved to reduce the price of cancer drugs after a retired bank clerk took her case to the supreme court.
From next month, ۱۳۷ cancer drugs in India will be cheaper as the government tries to tackle the tragedy of poorer patients either forgoing treatment, selling land or falling into debt to meet the high cost of some medicines, which are making large profits for hospitals and pharmacists.
Sarojam Radhakrishnan, a former bank employee in Kerala, was diagnosed with breast cancer in ۲۰۲۱. Doctors prescribed life-saving targeted treatments but the monthly cost, of more than ۶۳,۰۰۰ rupees (£۵۰۰), was far beyond her family’s means.
Realising that thousands of families were being ruined by the cost of such drugs, Radhakrishnan filed a petition to the Kerala high court in ۲۰۲۲ demanding government intervention to lower the costs.
When the case reached the supreme court, the judges looked at hospitals’ and retailers’ mark-ups on cancer drugs and called the situation “carnage” and “extortion”.
During a hearing on ۲۹ September, justices Vikram Nath and Sandeep Mehta noted how a life-saving cancer drug supplied to hospitals at ۲,۷۰۰ rupees carried a vastly marked-up price of ۲۷,۰۰۰ rupees.
The judges found that hospitals, distributors and chemists enjoyed large margins on medicines. Analysis by the National Pharmaceutical Pricing Authority revealed a trade mark-up on some cancer drugs averaging ۱۷۰%, with some extreme examples stretching to more than ۷۰۰%.
A ۳۰% trade margin cap on the price of ۴۲ drugs has been in place for some years but many others remained off this list. Now, prodded by the supreme court’s findings, the government has imposed the cap on ۱۳۷ other drugs.
“The measure is expected to reduce medicine prices by up to ۷۰% and help cancer patients save ۲,۵۰۰ crore rupees [£۱۹۹m] annually, significantly reducing the amount they pay from their own pockets,” a statement from the Department of Pharmaceuticals said.
People on low incomes in India dread illness, as the cost of treatment can mean financial ruin, particularly for cancer patients.
Whenever the Indian Cancer Society holds a free diagnosis camp in Gurgaon where he lives, Krishan Kalra urges local drivers, maids, cooks and tailors to turn up because tests they cannot afford are offered free.
As a former member of the council of the Rajiv Gandhi Cancer Institute and Research Centre, Kalra knows the importance of early diagnosis, but he said very few people attended. “When I ask why, they say they’re too scared – if something serious like cancer is detected, they haven’t got the money to pay for the treatment so they prefer to remain in the dark,” he said.
With the cost of cancer drugs ranging in price from ۳۸,۰۰۰ to ۳۸۰,۰۰۰ rupees, many families quietly walk out of the doctor’s consulting room upon hearing the estimated cost of treatment.
Studies by the Public Health Foundation of India show that spending on healthcare pushes about ۵۵ million Indians a year below the poverty line.
Few Indians can afford the premiums for comprehensive health insurance. The government’s nationwide insurance scheme, Ayushman Bharat, covers treatment for some cancers but it provides only ۵۰۰,۰۰۰ rupees’ worth of annual cover for a family – the cost of just one dose of Kadcyla (ado-trastuzumab emtansine), a drug used to treat breast cancer. Patients may need up to ۱۴ doses.
Dr Ravi Kannan is a surgical oncologist and director of Cachar cancer hospital and research centre in Silchar, Assam. He has worked in hospitals elsewhere in India and is familiar with doctors’ trauma of seeing patients walk out to go home and die.
“Some families start the treatment, hoping against hope to manage the cost. They start but they don’t come back for chemotherapy or radiation. They can’t sustain the cost,” he said. “The decision is a welcome step if the outcome is that more patients can access the drugs they need.”
India records about ۱.۵۶m new cancer cases annually – up from ۱.۳۹m cases in ۲۰۲۰ – making it a significant public health challenge.
As the supreme court delves deeper into the subject, what was clear, said Jyotsna Singh, co-convener of the Working Group on Access to Medicines and Treatments, a civil society network, was that a “total overhaul” of the healthcare system was needed.
“Right from the cost of manufacturing a drug to the point of sale, we need to make the system transparent and regulate the entire supply chain. Only then will these drugs become available to those who need them,” she said.
Singh said companies and hospitals were likely to try to find legal loopholes to wriggle out of the ۳۰% cap, suggesting that hospitals may offset the lower price charged for a drug by raising charges on other items.
The supreme court judges have also asked the government’s lawyers why the cap should apply only to cancer drugs and not the entire range of non-patented drugs. The court has given the government until ۲۷ October to respond.
Unfortunately, the court’s ruling came too late for Radhakrishnan, who died in September ۲۰۲۲ while her case was still pending in Kerala.
