India
oi-Prakash KL
The Supreme Court has questioned the Centre over the huge difference between the prices at which medicines are bought by hospitals and retailers and the much higher MRPs printed on them, Live Law reported.
The court asked why the government has not brought more medicines under price control, especially when patients often have little choice but to pay whatever hospitals or pharmacies charge.
The Supreme Court questioned the Centre on large medicine price mark-ups, asking why more drugs aren’t price-controlled given examples like a ₹1.3 lakh cancer injection sold from an ₹11,000 procurement price; the court reserved its order after hearing arguments.
A bench of Justices Vikram Nath and Sandeep Mehta was hearing a case on regulation of medicine prices. The court repeatedly questioned the Centre’s policy of allowing market forces to determine prices for a large section of medicines.
Justice Sandeep Mehta pointed to instances where medicines were sold at prices several times higher than their procurement cost. He cited the example of a cancer patient whose chemotherapy injection was available to a dealer for around ₹11,000 but was reportedly sold by a hospital for ₹1.3 lakh.
The judge questioned how such a difference could be justified when patients are dealing with life-threatening illnesses.
The Centre defended its existing policy, saying it was trying to balance affordable medicines with competition, innovation, employment and the growth of the pharmaceutical industry. The government argued that putting the entire pharmaceutical market under price control was not the answer.
Under the current system, medicines listed as essential are subject to price ceilings. A large number of other medicines, however, remain outside this stricter control.
This became one of the main concerns raised by the court. Justice Vikram Nath asked why the government could not bring a much larger number of medicines under the price-control system if there was no legal barrier to doing so.
The court also questioned how medicines are selected for inclusion in the controlled list. Justice Mehta pointed out that medicines containing the same active ingredient could be treated differently depending on the product or brand.
The judges also raised concerns over medicines whose MRPs can be set at very high levels initially. They questioned whether limiting subsequent price increases to 10% really helps if the starting MRP itself is heavily inflated.
The issue of cancer medicines came up repeatedly during the hearing. The court questioned why it took years for the government to introduce controls on the prices of certain cancer medicines.
The Centre’s own affidavit acknowledged that patients are at a disadvantage because they generally do not know the procurement prices, available alternatives or the margins earned by pharmacies and hospitals.
Justice Mehta cited another example where a medicine bought for ₹6 was sold at an MRP of ₹270. He also referred to a saline drip line with an MRP of ₹15 being sold for ₹270, the report said.
The court questioned whether such large differences could be justified in the name of market competition.
The Centre said higher margins can sometimes be necessary because of distribution costs, cold-chain requirements, low sales in rural areas and the risk of medicines expiring before they are sold.
Hospitals, meanwhile, argued that medicine margins help them meet the cost of running hospitals, including expensive equipment, infrastructure and staff. They said reducing these margins could force hospitals to increase charges for other services.
The court questioned why patients should have to pay the full MRP when hospitals buy medicines at substantially lower prices.
The Supreme Court has now reserved its order. The parties have been given two weeks to submit their written arguments.
How the case began
The case traces back to Sarojam Radhakrishnan, a retired bank employee from Kerala who was diagnosed with breast cancer in 2021. Her monthly treatment expenses crossed ₹63,000, putting a major strain on her family’s savings and pension, according to a report in The Print.
She approached the Kerala High Court in 2022, raising concerns over the cost of life-saving medicines. She died later that year, but the court continued with the matter as a public interest case.
The Supreme Court took up the issue on its own in July 2026. During the proceedings, the court expressed concern over medicine mark-ups of more than 1,000% between the price paid by retailers and the MRP.
