Supreme Court of India Condemns 10-Fold Cancer Drug Markup, Questions Access for Patients Outside Scheme
The Supreme Court of India has raised serious alarm over a massive price gap in cancer medicines. During a hearing on a petition seeking price controls and affordability measures, the court was informed that a critical cancer drug was being sold by manufacturers to retailers at approximately ₹2,700 but carried a Maximum Retail Price (MRP) of ₹27,000—a markup of nearly 900 percent.
Justice Sandeep Mehta, sitting alongside Justice Vikram Nath, characterised the pricing practice as "broad daylight dacoity." The hearing took place in the case of Kishan Chand Jain v. Union of India, a petition that seeks mandatory prescription of generic medicines, regulation of prices for non-scheduled medicines, and price caps on medical devices.
The Scale of the Pricing Problem
When a drug intended to treat cancer carries a retail price ten times higher than the cost at which it reaches the market, patients and families face an impossible choice between treatment and financial ruin. The disparity reveals a systemic issue in India's pharmaceutical market.
The specific case cited involved a single cancer medicine, but the petition addresses a broader category of non-scheduled medicines that fall outside the government's price control regime. These drugs, which include many oncology treatments, cardiac medications, and other life-critical therapies, remain subject only to manufacturers' pricing decisions. The absence of a regulatory ceiling allows companies to set MRPs with minimal constraint, creating the kind of extreme markups that drew the bench's rebuke.
During the hearing, the court sought clarity on how such pricing could be permitted and what safeguards exist to protect patients from exploitation. Justice Mehta's questions reflected frustration with the current regulatory framework and its apparent inability to prevent such disparities.
Jan Aushadhi Kendras: Limited Reach
In response to concerns about affordability, the government has pointed to the Jan Aushadhi Kendra initiative—a scheme that provides generic medicines at significantly lower prices through dedicated outlets. However, the petitioner raised a critical limitation: these kendras account for only a small portion of India's overall pharmaceutical market and stock a limited range of medicines.
Justice Mehta pressed this point directly, asking: "The issue is, for those medicines which are not available in Jan Aushadhi Kendras, where does the patient go?" This question cuts to the heart of the problem. While the scheme has expanded access for some patients seeking affordable generics, it does not solve the pricing crisis for medicines unavailable through its network.
Many cancer drugs, particularly newer therapies and branded formulations, are not stocked through Jan Aushadhi Kendras. Patients requiring these medicines have no alternative but to purchase them at market rates—often at the inflated MRPs that the bench described as dacoity. The government's reliance on the scheme as a solution to affordability, without addressing pricing of non-scheduled medicines, leaves a vast gap in protection.
The Petition's Broader Demands
The petition in Kishan Chand Jain v. Union of India seeks three main interventions. First, it demands mandatory prescription of generic medicines where available, a measure intended to increase uptake of lower-cost alternatives. Second, it calls for regulation of prices of non-scheduled medicines, bringing them under a formal price control mechanism similar to that which applies to scheduled drugs. Third, it seeks price caps on medical devices, another category where costs have spiralled beyond affordability for ordinary patients.
Each of these demands addresses a different segment of the healthcare cost crisis. The Drugs (Prices Control) Order, 1995, currently controls prices only for a limited list of essential medicines. Thousands of other drugs, particularly newer therapies and specialised treatments, remain outside this framework.
The Supreme Court of India has previously recognised the tension between patent protection, innovation incentives, and public health access. The bench hearing this petition appeared focused on the immediate human cost of unregulated pricing—the fact that patients are being charged prices that bear no rational relationship to the actual cost of production or distribution.
The Court's Concerns and Questions
Beyond the specific figures cited, the bench's language revealed a deeper concern about the legitimacy of the pricing system itself. The term "broad daylight dacoity" is not casual criticism; it suggests the court views extreme markups as a form of theft from vulnerable patients with no choice but to pay.
The questions posed by Justice Mehta about Jan Aushadhi Kendras indicate the bench is not satisfied with partial solutions. If a scheme covers only a fraction of the market and a fraction of medicines, it cannot be presented as solving the affordability crisis. The court appears to be signalling that the government must address pricing across the entire pharmaceutical market, not just in designated outlets.
The bench also implicitly questioned why manufacturers should be permitted to charge vastly different prices to different buyers in the same market. The gap between the Price to Retailer (₹2,700) and the MRP (₹27,000) suggests that the manufacturer is capturing most of the retail margin, leaving retailers with minimal profit while patients pay the full burden of inflated pricing.
What Happens Next
The hearing was adjourned to September 29, 2026, for further arguments. At that date, the court will likely press both the government and the petitioner for concrete proposals. The government will need to explain how it plans to address pricing of non-scheduled medicines and whether it is willing to expand price controls. The petitioner will need to clarify the mechanism by which mandatory generic prescription could be enforced and how it would interact with patent rights.
The case also raises questions about the role of the National Pharmaceutical Pricing Authority (NPPA) and whether its mandate should be expanded. Currently, the NPPA operates within a limited framework; expanding its authority to cover non-scheduled medicines would require either legislative change or a reinterpretation of existing law.
For patients currently facing cancer drug prices of ₹27,000 when the underlying cost is ₹2,700, the next hearing represents a critical moment. The bench's strong language suggests sympathy for their position, but sympathy alone cannot change pricing without a coherent regulatory mechanism to enforce it. The court's questions indicate it is searching for a solution that is both legally sound and practically effective. As India's healthcare costs continue to rise and new therapies become available at ever-higher prices, the tension between innovation, patent protection, and public health access will only intensify.
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