The medicine cost alone accounts for nearly 70% of the overall treatment cost in India. Pharmaceutical companies cautioning that the proposed introduction of a minimum import price on certain essential drug ingredients may push up medicine prices adds to worries about the affordability of the treatment for many patients. A recent report of the Parliamentary Standing Committee on Chemicals and Fertilisers has laid bare how a wide range of frequently prescribed medicines, used for common ailments and chronic conditions, are being sold at high prices with unjustified trade margins. The committee’s finding about the huge difference between Price to Stockist (PTS) and Maximum Retail Price (MRP) is reflective of opaqueness in the pricing of medicines in the country that creates a huge barrier for a large section of people in continuing treatment. The parliamentary panel has pointed out the “inaction of the Department” to curb the trade margins to the tune of 600% to 1,100% and expressed the view that the apparent lack of any control over trade margins, especially in the case of non-scheduled drugs, leaves the door open for widespread profiteering at the cost of patients. The committee rightly noted that the existing Drugs (Prices Control) Order 2013 (DPCO) is structurally inadequate to curb pricing malpractices in India’s pharmaceutical sector. “Whereas the DPCO empowers the National Pharmaceutical Pricing Authority (NPPA) to fix ceiling prices for drugs listed under the National List of Essential Medicines (NLEM), but it fails to extend this regulatory authority to the unscheduled drugs,” the report adds. This sharp observation by the committee explains the medicine pricing paradox in India: the country is the largest producer of generic medicines available at an affordable cost, but high and rising medicine costs continue to pose a significant barrier for a large section of patients to afford treatment for various ailments due to unaffordable retail costs. The committee note that the objective of the National Pharmaceutical Pricing Policy (NPPP), 2012, is to put in place a regulatory framework for the pricing of drugs with a view to ensure the availability of required medicines at affordable prices while providing sufficient opportunity for innovation and competition to support the growth of industry, thereby meeting the goals of employment and shared economic well-being for all. To ensure the availability of essential medicines at affordable prices, NPPA fixes the ceiling price of essential medicines and monitors the prices of non-scheduled drugs in accordance with provisions of DPCO, 2013. The finding by the committee that the PTS of a certain medicine which is used to treat infections is Rs. 450 but its MRP is Rs. 3500 or Rs. 3050. Similarly, the PTS of two medicines used to treat pain, fever, swelling, and the common cold are Rs. 831 and Rs. 316, but their MRP is Rs. 4,560 and Rs. 2,850. Such arbitrary pricing, which puts the common people at a disadvantage in accessing quality healthcare, calls for the department to undertake a study regarding the huge difference between PTS and MRP as recommended by the parliamentary panel. Identifying the reasons for the difference, as envisaged by the Committee, can be expected to provide relief to the end consumers – the patients and their households – through reduction in the prices of medicines. The report also points to the delay in settling the issue of Trade Margin Rationalisation, which has been under consideration of the Department for a long time, but the final decision is still pending while the prices of essential medicines/formulations have been rising and have become out of the reach of the common man. Urgent implementation of the Committee’s recommendation for more regulatory control over multinational pharma companies and for evolving a mechanism to provide medicines to the people at the prevailing PTS under the Pradhan Mantri Jan Aushadhi Yojana (PMJAY) can provide relief to the common man from exorbitant and arbitrary prices of medicines. The Committee’s observation that the absence of a legal provision to audit drug costs under the existing law limits the ability to check whether MRPs of cancer medicines are truly justified has great significance for the northeast region, as the incidences of cancer are rising alarmingly for various reasons. The Committee found that although NPPA is endowed with exceptional powers to cap prices and margins, the lack of a permanent, legal mechanism for trade margin control remains to weaken long-term price regulation and transparency and needs to be addressed with top priority and urgency. The committee, therefore, strongly recommends that the department urgently introduce a clear legal provision in the Drug Price Control Orders (DPCO), 2013, by way of appropriate amendments for effective implementation of Trade Margin Rationalisation (TMR), and the Northeast region can press the department for implementation of the recommendation to ensure availability of cancer medicines at affordable cost. Putting in place a system to regularly monitor MRPs and trade margins for life-savingfor life-saving drugs like anti-cancer medicines, recommended by the committee, is an urgent need of the hour.