Generic Medicine Access: PMBJP, Cancer Drug Margins and Barriers to Affordable Care

The news

The Supreme Court has slammed a 1,000 per cent markup on life-saving cancer drugs, calling the practice “broad daylight dacoity” and asking the Centre, “Can you justify this loot?” The bench was hearing a case where a chemotherapy injection supplied to retailers for ₹2,700 was stamped with an MRP of ₹27,000. Following the court’s heat, trade margins on several anti-cancer formulations were capped at 30 per cent. The court has also asked why this cap cannot be imposed on all other life-saving drugs and posted the case for the central government’s response to a short date.

Yet, as Justice (retd) K Kannan writes in a column for The Indian Express, the deeper problem is why even ordinary branded medicines, which have identical and vastly cheaper unbranded generic equivalents, are persistently rejected by Indian consumers. India runs the Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP), where high-quality generic drugs are available at a fraction of branded market costs. But generic outlets often sit quiet while commercial private pharmacies thrive. The reason, the column argues, is a tri-party dynamic involving doctors, hospital pharmacies, and patient psychology. The National Medical Commission directs practitioners to prescribe active chemical names rather than brand labels, but compliance remains abysmal. Hospital pharmacies, operating as high-margin profit centres, often refuse to allow patients to buy from outside vendors. And patients themselves, conditioned by decades of aggressive drug branding, equate low price with poor quality and insist on the exact expensive brand printed on the prescription.

How are drug prices set in India?

A parliamentary statement on February 6, 2026 confirmed that pricing follows a market-based system and the government does not maintain the cost data of pharmaceutical companies. The ceiling price is calculated by adding a 16 per cent retail margin to the average price to retailer (PTR) of quality brands. Margins at different levels in the supply chain are not regulated. Because non-scheduled generic and branded drugs permit wide initial price fixation under the Drugs (Prices Control) Order, pharma companies offer lucrative trade margins to institutional buyers, giving hospital pharmacies little commercial incentive to stock cheaper generics.

What has the Supreme Court achieved and what remains?

The court’s intervention has pushed the state to cap trade margins on several anti-cancer formulations at 30 per cent, addressing the most egregious price-gouging. But the column argues that fixing retail prices or capping margins targets only the symptom. The deeper barriers are behavioural and systemic: doctors’ brand-name prescribing habits, hospital pharmacy purchasing restrictions, and patient distrust of low-cost generics. The court has asked the Centre to respond on extending the cap to all life-saving drugs, but the column questions whether legislative mandates alone can force a doctor to change their clinical handwriting or a patient to trust an unbranded pill.

What is the next step for building trust in generics?

The column suggests that stronger quality audits by the Central Drugs Standard Control Organisation (CDSCO) could help build public faith in low-cost generics. Better adherence to generic-name prescribing and patient awareness campaigns are also needed. Until these deeper trust deficits are solved, the column concludes, affordable healthcare will remain written on paper but out of reach in practice.