The growing burden of cancer drugs

Six months ago, Surekha Panicker (name changed), a 65-year-old retired professional from Kerala, stared at her diagnosis in shock—stage-2 breast cancer. She had no family and limited savings. She went to an oncologist at a leading private hospital to figure out a treatment plan. They decided on immunotherapy, particularly Roche’s injection Phesgo, which would cost Rs 5 lakh for the first loading dose of a 1,200 mg vial and over Rs 2 lakh for subsequent doses. She was offered a “buy one, get one” deal under Roche’s patient assistance programme— you pay for one cycle and the next will be free. She was prescribed eight cycles.After two cycles, Panicker developed a severe bacterial infection and had to pause the treatment and go for surgery. The free offer lapsed due to the break. She has paid over Rs 35 lakh from her own pocket—for the treatment of the infection, the surgery, all subsequent cycles of immunotherapy and other hospital charges. Her funds are almost exhausted. Panicker doesn’t know how to pay for another course of treatment.Also Read: NPPA caps trade margins on 137 cancer drugs at 30%, revised prices from Nov 9“My husband died two decades ago. I have no kids or close relatives. I spent my savings on immunotherapy in the hope that it would buy me at least 10 years. I don’t know how I will manage if I need to continue the treatment,” says Panicker.135023376It is not just Panicker’s plight. Millions of cancer patients in India have to bear the double burden of the disease and the dreadfully expensive treatment.A PRESCRIPTION AWAY FROM BANKRUPTCYThe high cost of cancer drugs is in full public glare after the Supreme Court criticised the massive markup in their prices. A bench of Justices Vikram Nath and Sandeep Mehta, hearing two writ petitions filed by lawyer Kishan Chand Jain and paediatric surge on Sanjay Kulshrestha, said medicines that are purchased by retailers for Rs 2,700 are being sold to patients for Rs 27,000. They called it “broad daylight dacoity”.The anger of the bench resonates with the people. In a country where 1.5 million cancer cases are detected every year, a diagnosis very often leads to a long painful road of financial distress. Patients drain bank accounts, wipe out savings and even sell land just to get their hands on these promising but prohibitively expensive new medicines. How did India fail to make life-saving drugs affordable for its population?A Mumbai-based oncologist says the situation is dire. “People are only a prescription away from bankruptcy,” he says.Patients have no hope in the absence of a fair pricing mechanism, a pooled procurement plan by hospital networks and an effective insurance and reimbursement system, he says on condition of anonymity.There are exceptions though. The Tata Memorial Centre in Mumbai procures drugs on a negotiated model, at rates that are far less than the maximum retail price (MRP), which makes them cheaper for its patients.A study by top oncologists published in the Bulletin of the World Health Organization in 2023 showed that a pooled procurement of 40 drugs by the National Cancer Grid—a network of over 250 cancer centres—saved `13.2 billion compared with MRP. The savings ranged from 23% to 99%.COST OF CARETop private hospitals do not agree that they are committing medical dacoity. In addition to the retail price of the medicine, they say, the hospital bill includes the cost of administration, use of facility, storage, training and consumables.Abhay Soi, chairman and managing director of Max Healthcare Institute, says at the end of the day, a hospital is not selling an IV fluid bag. “A hospital is administering an injection. There is a particular training, a particular storage requirement, the administration of medicine and then the disposal through proper biomedical waste processes. There is an entire value chain,” he says.Also Read: Supreme Court questions govt over drug pricing, asks why cap limited to anti-cancer medicinesHospitals have thousands of individual billing items, with margins varying across products and services, he says. “Some won’t have a margin, some will have a margin. Ultimately, it translates to 8-9% net profit,” says Soi. He says hospital profitability needs to be viewed against the sector’s capital intensity and continuing investment requirements. “Your equipment gets totally depreciated. You replace the entire equipment every 10 years. Eventually, you must reinvest as well,” he says.BS Ajai Kumar, founder of specialty cancer hospital group HCG Enterprises, backs Soi’s point. He says it is important to understand that India provides high-quality cancer treat ment at a much lower cost than many Western countries like US. Private hospitals, he adds, should be assessed not simply by the markup on an individual drug but the overall cost of treatment relative to the quality of care and outcomes delivered.135023362MARK THE MARKUPSHealth activists, however, note that hospitals lack transparency. They ask: what is the…