Supreme Court Flags Tenfold Mark-ups on Cancer Drugs, Calls Pricing Gap 'Carnage'
Supreme Court raises concern over steep mark-ups on essential medicines, especially cancer drugs, and seeks the Centre's response on uniform retailer margins.
The Supreme Court on Tuesday expressed deep concern over the wide gap between the prices at which essential medicines, particularly cancer drugs, are supplied to retailers and the amounts consumers ultimately pay, describing the disparity as "carnage".
A Bench of Justices Vikram Nath and Sandeep Mehta asked the Centre why the 16% retailer margin prescribed under the Drugs (Prices Control) Order, 2013 should not be applied uniformly across essential medicines to check steep mark-ups over the price to retailer (PTR).
"Why not keep the 16% margin on MRP, which is prescribed in the DPCO, on everything? ... Ultimately, the loser is the taxpayer. This is carnage, as simple as that," the Bench observed.
The court was hearing petitions filed by advocate Kishan Chand Jain and paediatric surgeon Sanjay Kulshrestha, which seek regulation of the prices of drugs, medical equipment and generic medicines to make them more affordable. The pleas also seek stricter enforcement of price controls under the DPCO, 2013 to prevent violations of the prescribed pricing mechanism and disproportionate profit margins across the supply chain.
Justice Mehta pointed to an essential cancer drug supplied to retailers for roughly ₹3,000 but sold to consumers for about ₹27,000 — a nearly tenfold mark-up. He questioned who benefited from the difference of almost ₹24,000. "You tell us why this difference... Where does this chunk of money go? Ten times..." he remarked.
Appearing for the Centre, Solicitor General Tushar Mehta acknowledged the concern and said the government would need to find a way forward while "balancing equities". He submitted that private hospitals, rather than pharmaceutical companies, were the beneficiaries of such steep mark-ups. "The pharma company is not the gainer. The gainer is the private hospital," he said.
The Bench also flagged the practice of private hospitals requiring patients to buy medicines from their in-house pharmacies, leaving them with little choice to purchase the same drugs at lower prices elsewhere. It further noted the strain on public finances, observing that when treatment is covered under government-funded schemes such as Ayushman Bharat, the cost is ultimately borne by taxpayers. "Suppose the patient is taking treatment through government services... The government doesn't pay, the taxpayer pays. This affects a larger section of society," the Bench remarked.
The Solicitor General sought time to place before the court details of the existing mechanisms governing drug pricing and assured the Bench that he would make his submissions on the next date of hearing. The matter was posted for further hearing on October 12, 2026.
On an earlier occasion, the top court had likened the wide difference between the price to retailers and the MRP of medicines to "dacoity", pointing to the financial distress faced by patients struggling to meet treatment costs. "The MRP is 10 times the rate at which it is provided to the retailers. If this is not extortion, then what is it? People sell their houses, ornaments to get treatment," the Bench had remarked.