Cancer care: Long battle for affordable treatment

A 45-year-old garment factory worker from Bengaluru Rural diagnosed with stage IV-A cancer of the mouth faces an arduous course of treatment: chemotherapy to shrink the tumour, extensive surgery involving reconstruction, followed by radiation and chemotherapy. The cost of medicines and supportive drugs of around ₹93,000 alone, besides treatment costs, are staggering for her family with a modest monthly income of ₹28,000. With funds running out, she is facing the risk of discontinuing the final stages of treatment.

Likewise, a 56-year-old shopkeeper from Mysuru district, diagnosed with recurrent, inoperable hypopharyngeal cancer involving the oesophagus, has a different but equally difficult challenge. After three cycles of chemotherapy, the disease has shown partial response. Immunotherapy could offer another treatment option, but its cost remains prohibitive. Spending another ₹2.4 lakh to ₹8 lakh over the next 2 to 3 months for bi-weekly immunotherapy is virtually impossible on a ₹45,000/month income.

Doctors said these cases illustrate the financial strain that accompanies cancer treatment, particularly when care involves several cycles of chemotherapy, surgery, radiation, and newer targeted or immunotherapy drugs. While advances in oncology have improved treatment options, their benefits remain out of reach for many patients who cannot afford to complete the prescribed course.

The pharmacy at Kidwai Memorial Institute of Oncology in Bengaluru. While advances in oncology have improved treatment options, their benefits remain out of reach for many patients who cannot afford to complete the prescribed course. | Photo Credit: K. MURALI KUMAR

Price cap and larger challenges

The National Pharmaceutical Pricing Authority’s (NPPA) recent decision to cap trade margins on 137 identified non-scheduled anti-cancer medicines has raised hopes of some relief. The order, which will take effect on November 9, has capped the trade margin at 30% of the price to the retailer. The Centre estimates that this could lead to an annual saving of around ₹2,500 crore for those seeking cancer care. Prices of some medicines are expected to fall by up to 70%, though the reductions will vary across formulations and brands.

The inclusion of medicines used in newer cancer treatments, including targeted therapies and immunotherapy, is significant. However, oncologists and patient-access advocates cautioned that controlling trade margins is only one part of the larger challenge. High manufacturer-level prices, limited availability of affordable alternatives, and the cost of treatment beyond medicines continue to affect patients’ ability to remain on therapy.

For Karnataka, the decision also follows sustained concern over the steep differences between the purchase price and printed maximum retail price (MRP) of several cancer medicines and consumables.

Karnataka flags steep markups

On September 23, 2026, Karnataka’s Health Minister U.T. Khader wrote to Union Health Minister J.P. Nadda seeking intervention over pricing discrepancies involving 253 medicines and consumables. The State flagged instances in which the difference between the landing cost and printed MRP was substantial, arguing that the burden ultimately fell on patients already facing high treatment expenses.

Mr. Khader cited investigations by the Karnataka Food Safety and Drug Administration (FDA) that revealed how pharmaceutical companies are supplying medicines to hospitals at heavily discounted institutional (landing) prices, while patients are being billed at or near the printed MRP — resulting in markups ranging from 10 times to over 52 times the actual procurement cost.

The examples cited in the communication to the Union Minister included Gufipol, manufactured by Criticare, with a landing cost of ₹86 and MRP of ₹4,528; Guficycline-50, with a landing cost of ₹160 and MRP of ₹7,110; and Terlitis, with a landing cost of ₹118 and MRP of ₹4,416. Other examples included Taxocare 120 mg, with a landing cost of ₹1,000 and MRP of ₹21,617; Canmab 440 mg, at ₹6,600 and ₹57,457, respectively; and Bevatas 400 mg at ₹5,850 and ₹62,690, respectively.

The State sought a review of the pricing mechanism and measures to prevent excessive markups. The figures drew attention to the wide gap that can exist between procurement costs and printed prices, particularly in a sector where patients often have little choice but to purchase medicines prescribed as part of a time-sensitive treatment regimen.

Patients and caretakers at Kidwai Memorial Institute of Oncology in Bengaluru. Patients from tier-two and tier-three towns often travel to Bengaluru for specialised cancer care, adding travel, accommodation and loss of income to their treatment expenses. | Photo Credit: K. MURALI KUMAR

Rising cancer burden

Mr. Khader’s intervention has come against the backdrop of rising cancer burden in the State. Data furnished in the Rajya Sabha in August 2026 estimated that Karnataka’s annual cancer incidence increased from 88,126 cases in 2021 to 97,130 in 2025, a rise of about 10.2%. Estimated cancer deaths increased from 48,290 to 53,253 during the same period. In 2025, Karnataka accounted for about 6.2% of the country’s estimated new cases and 6.1% of cancer deaths.

The figures represent annual estimates of new cases and deaths and not the total number of people living with cancer. At the State-run Kidwai Memorial Institute of Oncology, where BPL patients get free treatment and drugs, around 22,176 new patients are registered annually, apart from more than 3.7 lakh follow-up visits, said Kidwai director R. Krishnappa.

Financial toxicity of cancer treatment

U.S. Vishal Rao, Head and Neck cancer surgeon and member of the Karnataka Health Department’s Vision Group for Cancer, said patients and doctors are confronted with two challenges at the same time: the disease and the financial consequences of treating it. Simultaneously, the biological malignancy of the tumour and the ‘financial toxicity’ of the treatment,” he said.

For patients undergoing prolonged treatment, the expense is not limited to the principal chemotherapy or targeted drug. Supportive medicines, growth factors, antiemetics, and pain medication add to the bill. These can account for up to 30% of the total treatment cost, according to Dr. Rao.

The financial pressure can affect treatment decisions. Some patients discontinue treatment after two or three cycles, delay the next cycle or extend the interval between treatments because they cannot mobilise the money required. This can undermine the benefits of treatment that may otherwise have been effective.

“When we look at the balance sheet of a middle-class family in Karnataka earning ₹25,000 to ₹45,000 a month, a single vial of an overpriced chemo or supportive drug can wipe out their grocery and education budget for the quarter. In private tertiary centres, the cumulative cost of Paclitaxel, Cisplatin, growth factors, and pain medications during a four-month mouth cancer treatment easily crosses ₹1 lakh just on pharmacy bills,” said Dr. Rao.

Rarely a single intervention

In head and neck cancers, treatment is rarely a single intervention. It can involve chemotherapy to reduce the tumour, complex surgery and reconstruction, followed by post-operative chemoradiation. Each stage brings additional expenses, and patients who have exhausted their savings during the initial treatment may struggle to complete the subsequent phases.

“Head and neck cancer treatment is a marathon process involving neoadjuvant chemotherapy to shrink massive mouth tumours, complex surgery, and post-operative chemoradiation,” Dr. Rao said.

The price intervention could improve treatment compliance and reduce the risk of patients abandoning therapy. “By capping the prices of these vital drugs, the government is not merely reducing the cost of medicine; it is directly improving survival rates, treatment compliance, and the socio-economic stability of thousands of households across Karnataka and the country.”

A patient at Kidwai Memorial Institute of Oncology in Bengaluru. The price intervention could improve treatment compliance and reduce the risk of patients abandoning therapy. | Photo Credit: K. MURALI KUMAR

Advanced therapies

Now, the next priority should be to make advanced therapies and targeted treatments accessible beyond patients who can afford high-priced medicines. Patients from tier-two and tier-three towns often travel to Bengaluru for specialised cancer care, adding travel, accommodation and loss of income to their treatment expenses.

“The next frontier is making bi-weekly immunotherapy and targeted agents like Cetuximab equally affordable so that no patient is denied a second chance at life due to financial exhaustion. Early detection at the grassroots level is also essential as diagnosis at an earlier stage can reduce the need for more complex and expensive treatment,” he added.

Dr. Krishnappa said he has appealed to the State Health Department to include immunotherapy drugs under the Ayushman Bharat-Arogya Karnataka (AB-ArK) scheme. “As of now, this is not covered and the exclusion is forcing poor cancer patients to either bear high treatment costs or go without newer therapies,” he said.

Price cuts do not address the entire problem

An analysis by the Working Group on Access to Medicines and Treatments pointed to the limits of relying on trade-margin regulation alone.

The group examined 643 product entries in the revised price data. Of these, 484 entries, or 75.27%, recorded price reductions, with an average reduction of 50.78%. The remaining 159 entries, or 24.73%, showed no change.

The combined MRP value of the listed products fell from about ₹2.51 crore to ₹2.17 crore, a reduction of approximately ₹34.57 lakh, or 13.8%. Products whose prices remained unchanged accounted for 86.2% of the combined revised MRP value.

The group cautioned that these calculations are based on the listed product entries and are not weighted by sales volumes, prescriptions, or actual patient use. They, therefore, cannot be treated as an estimate of the savings patients will receive. The analysis nevertheless indicated that substantial price reductions in several products coexist with high prices for a significant share of the listed value.

The medical store at Kidwai Memorial Institute of Oncology in Bengaluru. | Photo Credit: K. MURALI KUMAR

Single manufacturer medicines

The group also found that 56 medicines had a single manufacturer or supplier, with almost all corresponding brand entries remaining unchanged. Where there is no meaningful competition, controlling trade margins may have limited effect on the underlying price.

Its central argument is that margin regulation addresses the distribution chain but does not necessarily bring down the price set by manufacturers. This is particularly relevant for patented and single-source medicines, where patients may have few alternatives.

The group has called for closer scrutiny of manufacturer pricing calculations, affordability assessments and measures to address high prices where competition is absent. It has also raised the need to examine options such as compulsory licensing in appropriate cases and to regulate the overall charges associated with cancer treatment.

Affordability beyond the medicine price

Pavan T. Sugoor, associate professor of Surgical Oncology at Kidwai, said the financial consequences of cancer are particularly severe for young patients. “A cancer diagnosis in a young person is not merely a medical event. It can interrupt education, derail careers, threaten financial independence, and place enormous emotional strain on families,” he said.

He described the NPPA intervention as an important step, but argued that price regulation must be accompanied by stronger public procurement and institutional mechanisms to ensure that lower prices translate into affordable treatment.

Public hospitals could use pooled procurement, competitive tendering, and negotiated pricing to improve their bargaining power. The availability of subsidised targeted therapies and immunotherapy drugs in government cancer centres would also help patients who cannot afford treatment in the private sector.

Pooled procurement

The National Cancer Grid’s pooled procurement pilot, which covered 40 high-value oncology and supportive-care medicines across 23 centres, demonstrated the potential for substantial savings against MRPs. Such mechanisms need to be strengthened and expanded, Dr. Sugoor said.

He also pointed to the importance of quality assurance, proper storage, traceability, and continuity of supply. Lower prices will offer little relief if hospitals face stock-outs or are forced to make emergency purchases at higher rates. Monitoring should therefore extend to medicine availability, treatment delays and patients’ actual out-of-pocket expenditure.

The private sector, too, needs greater transparency. Patients should receive written estimates of treatment costs, clear bills, and access to financial counselling so that they can understand the likely expenses before beginning treatment, he said.

The medical store at Kidwai Memorial Institute of Oncology in Bengaluru. | Photo Credit: K. MURALI KUMAR

Treatment-cost studies

Evidence from treatment-cost studies underlines the scale of the problem. A prospective study by Tata Memorial Centre involving 500 breast cancer patients found that the average out-of-pocket expenditure was about ₹1.86 lakh, accounting for 72.2% of the recorded total treatment cost. Financial assistance was common, but often insufficient to meet the full expense.

Dr. Sugoor said access to effective treatment cannot be measured only by whether a drug is available or whether a price has been reduced. “The availability of an effective treatment means little if a patient cannot afford to receive it. Scientific progress must therefore be accompanied by policies that ensure its benefits reach those who need them the most.”

The NPPA order is an important intervention in a treatment area where costs can be overwhelming. But its impact will depend on how effectively the revised prices are implemented, whether savings reach patients, and whether hospitals and pharmacies maintain adequate supplies, the doctors added.