A Pill, a ₹24,000 Gap: Inside India's Supreme Court Battle Over Life-Saving Drug Prices # #IndiaHealthcare #DrugPricing #SupremeCourt #CancerDrugs #DPCO #PatientRights #PublicHealth #KishanChandJainCase #AyushmanBharat #HealthcareReform #NPPA #PharmaPricing#

 

Meta Description: A cancer drug bought for ₹2,700 was sold at an MRP of ₹27,000. India's Supreme Court called it "dacoity." Here's why 82% of medicines escape price control — and who pays the price.

One Pill, Ten Times the Price

Two judges of India's Supreme Court looked at a set of numbers and paused.

A life-saving cancer drug was sold by its manufacturer to retailers at a "price to retailer" (PTR) of ₹2,700. The maximum retail price (MRP) printed on the box was ₹27,000.

Ten times.

"If this is not extortion, what is?" Justice Sandeep Mehta asked. His colleague, Justice Vikram Nath, chose an even heavier phrase: "dacoity in broad daylight."

The courtroom atmosphere was not hard to imagine. While ordinary Indian families sell homes and jewellery to afford a single box of cancer medicine, the number printed on that box sits worlds apart from what the drug actually cost to make and distribute.

82% of Medicines Are Outside Price Control

So where does the problem begin?

Under India's Drug Prices Control Order (DPCO), 2013, the National Pharmaceutical Pricing Authority (NPPA) sets ceiling prices for roughly 1,000 "scheduled" medicines listed in Schedule I. These drugs are regulated.

But the petitioners told the court that about 82% of medicines in the market are "non-scheduled."

This means that for the vast majority of drugs, manufacturers can set their own initial MRP at launch. After that, they may raise prices by no more than 10% a year — but nobody regulates where that starting point sits.

"We are not arguing about price ceilings. We are arguing about the initial pricing of non-scheduled drugs," petitioner Kishan Chand Jain told the court.

Jain offered an example that left the bench visibly struck. A common cholesterol drug, Rosuvas, sells for about ₹214 as a standalone because it is non-scheduled. The same molecule combined with aspirin falls under price control — and the combination costs ₹70.

"A combination should cost more, but the gap is so absurd that it reverses," Justice Mehta observed.

Who Keeps the Money?

When the Supreme Court asked where the nearly ₹24,000 difference goes, an interesting defence emerged.

Senior advocate Kapil Sibal, appearing for the pharmaceutical alliance, argued that drug companies do not retain these enormous margins — the problem lies at the retail and hospital level.

The Attorney General, Tushar Mehta, was more direct: "The manufacturers are not the beneficiaries. The private hospitals are."

The court noted a widespread practice: private hospitals require patients to buy medicines only from their in-house pharmacies, or treatment is not guaranteed. A patient lies in a hospital bed while anxious relatives run errands — with neither the strength nor the time to compare prices outside.

"Corporate hospitals will not spare anyone. They will not even let a body be taken out," the judges remarked.

And when these inflated bills are reimbursed through government schemes such as Ayushman Bharat, the ultimate payer becomes the taxpayer. The court explicitly described this as a form of "systematic fraud on the public exchequer."

A Patch That Covers Only Cancer

In a follow-up hearing on 12 October, the central government told the court it had capped trade margins on non-scheduled cancer drugs at 30%.

But the judges did not stop there: why only cancer drugs?

The court went on to cite more examples. A cardiac stent bought for ₹5,000 carried an MRP of ₹25,000. An IV saline tube marked at ₹11 was being sold for ₹270. Azithromycin carried an MRP of ₹78.29 while the price to wholesalers was ₹28.50.

"This is only a problem with cancer drugs. What about the rest?" the bench asked.

The judges even floated a radical alternative: why not apply the 16% retail margin prescribed under the DPCO to all medicines?

"Why should a 16% margin not be maintained for all drugs? Ultimately it is the taxpayer who loses. This is carnage, plain and simple," the court said.

The Bigger Question

This case — Kishan Chand Jain v. Ethics and Medical Registration Board (EMRB) (Erstwhile Medical Council of India) and Dr. Sanjay Kulshresthra v. Union of India — reaches far beyond a handful of drug prices.

It touches a fundamental question: in India, what exactly determines the price of a life-saving medicine?

The current framework looks like this. Around 1,000 "scheduled" medicines have government-set ceilings. For the other 82%, manufacturers decide their own initial MRP, with annual increases capped at 10%. The government does run the Jan Aushadhi network of affordable pharmacies, selling generics at 50% to 80% below branded prices. But as the petitioners pointed out, in a ₹2.5 lakh crore pharmaceutical market, Jan Aushadhi's share is only about ₹22,000 crore.

A drop in the ocean.

"People sell their houses, sell their jewellery to afford treatment," the court said in an earlier hearing.

That sentence would be heartbreaking in any country. In a nation that leads the world in generic medicine production, it sounds absurd.