By Dr. Gyan Pathak
PM Narendra Modi led Government has been successfully marketing its slogan “Affordable medicine for all” ever since it started implementation of Jan Aushadhi scheme under Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) launched in 2015-16, but on the ground level pharmaceutical companies and hospitals were allowed to charge exorbitant and unaffordable prices, which a Supreme Court bench called extortion and loot.
The Supreme Court Bench comprising Justices Vikram Nath and Sandeep Mehta questioned the Centre’s pharmaceutical pricing policy and the functioning of the NPPA on October 27, 2026. The Supreme Court’s proceedings have exposed the shocking disconnect between medicine procurement prices and the amounts demanded from patients.
During the hearings, the Court questioned reported examples of a cancer injection available to a distributor for approximately ₹11,000 but being charged at ₹1.30 lakh by a hospital. It also questioned a saline drip line reportedly procured for ₹15 but billed at ₹250. Justice Sandeep Mehta asked, “Can you show any justification for this loot, please?”
The Court also questioned the enormous difference between the purchase price and printed MRP of another cancer medicine. These were not trivial observations. They were questions about the exploitation of people who often have no meaningful choice but to purchase the medicines prescribed to them. The proceedings exposed an uncomfortable truth that India’s medicine-pricing system has not adequately protected patients against excessive prices and margins.
A government that advertises affordable medicines while allowing patients to confront astronomical medicine prices has a serious problem of credibility. Opening low-cost medicine shops is not a substitute for controlling an exploitative pharmaceutical market.
Modi government presented Janaushdhi Scheme under PMBJP as a major public-welfare intervention. Government had launched the scheme saying that ordinary people would be able to purchase quality generic medicines from these centres at substantially lower prices. By December 2025, the government have opened 17,990 Jan Aushadhi Kendras.
However, affordable medicines were genuinely not the government’s priority. Had it been priority millions of patients would not have been left exposed to exorbitant prices in the larger pharmaceutical market?
The government cannot claim success merely by counting Jan Aushadhi Kendras while patients suffering from cancer, heart disease, diabetes and other serious illnesses continue to struggle with the cost of treatment.
A poor patient does not have the luxury of choosing between competing government schemes and private pharmaceutical companies. A patient needs the prescribed medicine. If it is unaffordable, treatment is interrupted, delayed or abandoned. For that patient, an expensive medicine is not a matter of market economics. It is a matter of survival.
Let us be fair. Jan Aushadhi has helped many patients. Its expansion has created a valuable alternative to expensive branded medicines. But a government scheme cannot become an excuse for regulatory failure. The fundamental problem is that PMBJP operates as an alternative distribution system. It does not impose fair prices across the entire pharmaceutical market.
A patient who cannot find a particular medicine at a Jan Aushadhi outlet, who requires a specialised cancer drug, or who receives treatment in a private hospital remains exposed to the prices prevailing in the wider market.
What happens when the medicine is unavailable in the Janaushadhi Kendras? What happens when the doctor prescribes a specialised formulation outside the scheme’s product basket? What happens when a hospital insists on dispensing its own medicines? The patient pays. The government may advertise thousands of medicine outlets, but the patient cannot get treatment from an advertisement. The patient needs an affordable, available and reliable medicine. Affordable medicines cannot be a privilege available only to those fortunate enough to find the right product at the right outlet. They must be a guarantee of public policy.
The most troubling contradiction is that the government itself determines the extent of price regulation. India has a drug-price regulatory framework under the Drugs (Prices Control) Order, 2013. The National Pharmaceutical Pricing Authority (NPPA) is responsible for implementing important aspects of this system.
Yet the distinction between scheduled and non-scheduled medicines has left substantial parts of the market outside the stricter ceiling-price mechanism. For non-scheduled formulations, manufacturers generally retain discretion over initial prices, although subsequent annual increases are restricted. This creates a serious loophole.
A restriction on annual price increases does not necessarily prevent an excessively high price from being introduced in the first place. The government has the power to intervene in the public interest. It has used those powers selectively, including for certain anti-cancer medicines, recently after the Supreme Court’s observation. However, they many prices are not touched, and for many the prices are still out of reach of the common people.
The obvious question is: why was a more comprehensive system not established earlier? Why should a patient have to wait for a Supreme Court hearing before the government seriously confronts the problem?
The Centre may invoke innovation, competition, or pharmaceutical investment and growth of the industry, as it has said in the Supreme Court. But none of these arguments justifies abandoning the basic responsibility to ensure that life-saving medicines remain affordable.
A government’s first responsibility in healthcare is to protect the patient, not to preserve every commercial advantage enjoyed by the industry.
As for Jan Aushadhi, one must note the 50 per cent discount illusion. Jan Aushadhi pricing model is also not justified. For medicines outside the National List of Essential Medicines, PMBJP pricing is linked to the average MRP of leading equivalent branded products, with the scheme generally offering at least a 50% reduction.
But is a discount from an inflated price necessarily a fair price? Answer is big NO. Suppose three branded medicines have MRPs of ₹180, ₹200 and ₹220. A generic product priced at ₹100 would satisfy a 50% reduction from their average MRP. But what if the medicine could reasonably be supplied at ₹30?
The patient may be receiving a substantial discount compared with the branded product, but that does not establish that the price is economically justified. This is the central weakness of a policy that measures affordability primarily by comparison with branded-market prices.
A government serious about affordability should determine what a medicine ought reasonably to cost, not merely how much cheaper it can be sold than an expensive branded competitor.
The government must publish transparent medicine-wise procurement costs, tender prices, selling prices and quality-assurance expenses. Patients deserve to know whether the savings advertised by the government reflect genuine cost efficiencies or merely a discount against an inflated market benchmark.
Then there is a big question about political donations by the pharmaceutical companies, and there were examples, as we have seen in the Electoral Bond case. Many companies donated to the governments after proceedings against them were already launched. They raise an unavoidable question about conflicts of interest. When pharmaceutical companies make substantial political contributions, and the government simultaneously decides the extent of price controls, industry concessions and regulatory enforcement, citizens have every right to demand transparency. The problem is not merely the possibility of corruption. It is the danger that a system of political and commercial influence may undermine the government’s obligation to protect patients.
The pharmaceutical industry has powerful manufacturers, distributors, trade associations and commercial networks. Private hospitals have negotiating power, procurement departments and financial resources. The government has regulatory institutions, legal powers and access to market information. But what does the ordinary patient have? Often, nothing except a doctor’s prescription and the money needed to buy the prescribed medicine. They may have to sell land, mortgage jewellery, borrow money or exhaust its savings. A person with a chronic illness may have to choose between purchasing medicines and meeting basic household expenses. A country cannot call itself committed to universal healthcare if the ability to remain alive and receive treatment depends so heavily on purchasing power.
India has a case for reforming the entire pharmaceutical pricing system, but it requires confronting entrenched commercial interests, revisiting regulatory policy, strengthening enforcement and accepting political responsibility. The right to affordable medicines cannot depend on political slogans, government publicity or the commercial goodwill of pharmaceutical companies. It must be guaranteed through effective regulation. (IPA Service)
