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Published: February 8, 2026
NEW DELHI — A scathing report tabled in the Indian Parliament has sent shockwaves through the healthcare sector, revealing that ordinary citizens are being charged markups as high as 1,831% on essential medications. On February 2, 2026, Rajya Sabha MP Swati Maliwal spearheaded a demand for urgent regulatory intervention, questioning how common treatments for allergies, acidity, and hypertension—often costing pennies to manufacture—are being sold at premium prices. The Standing Committee on Chemicals and Fertilizers, chaired by Azad Kirti Jha, warns that these “unconscionable” trade margins are pushing millions of households into medical poverty and demands a systemic overhaul of India’s drug pricing framework.
The Price of Survival: A Tale of Two Numbers
At the heart of the controversy is the staggering disparity between the Price to Stockist (PTS)—what the manufacturer charges wholesalers—and the Maximum Retail Price (MRP) paid by the patient at the pharmacy counter.
While India is often celebrated as the “pharmacy of the world” for its low-cost generic production, the committee’s report, titled “Price Rise of Medicines in the Pharmaceutical Sector Impacting the Lives of Ordinary Citizens Adversely,” suggests these savings rarely reach the consumer’s pocket.
Data Snapshot: The Markup Reality
The committee scrutinized popular brands from industry giants including Aristo, Alkem, and Cipla. The findings highlight a trend where non-scheduled drugs—those not currently capped by the government—see astronomical price hikes.
| Category | Brand (Company) | Composition | PTS (₹) | MRP (₹) | Margin % |
| Anti-allergy | Cetrest (Aristo) | Cetirizine 10 mg | 1.85 | 21.06 | 1,038% |
| PPI/Acidity | Nexom 40 (Aristo) | Esomeprazole 40 mg | 13.95 | 170.00 | 1,119% |
| Calcium | Aristocal CT (Aristo) | Calcium carbonate | 16.95 | 327.30 | 1,831% |
| Hypertension | Amlip-AT (Cipla) | Amlodipine + Atenolol | 9.60 | 72.60 | 656% |
“This unchecked profiteering turns healthcare into a luxury, not a right,” MP Swati Maliwal asserted during her Rajya Sabha intervention. She noted that when a simple allergy pill is sold at 10 to 13 times its production-adjusted cost, the system is no longer serving the patient, but the middleman.
The Regulatory Loophole: Scheduled vs. Non-Scheduled
The current crisis stems from a binary regulatory system. Under the Drugs (Prices Control) Order (DPCO) 2013, the National Pharmaceutical Pricing Authority (NPPA) only sets “ceiling prices” for medicines listed on the National List of Essential Medicines (NLEM).
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Scheduled Drugs: Approximately 1,000 formulations are strictly regulated, with retailer margins capped at 16%.
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Non-Scheduled Drugs: These make up the bulk of the market. Manufacturers are permitted to increase prices by up to 10% annually.
The committee argues that pharma companies are exploiting this “non-scheduled” status. Because the PTS remains low, companies can offer massive “trade margins” to retailers and stockists as an incentive to push their specific brands over cheaper alternatives.
Expert Perspectives: Why Prices Stay High
“While India produces the world’s cheapest generics, supply chain opacity allows 600–1,800% markups,” says Dr. Anish Desai, a public health and pharmacology expert. “This exacerbates out-of-pocket expenses, which still comprise nearly 60% of outpatient costs in India. When a patient in a rural area walks into a private pharmacy, they aren’t paying for the medicine; they are paying for the massive incentives baked into the distribution layers.”
However, industry bodies like the Indian Pharmaceutical Alliance offer a different perspective. They argue that high percentage margins are often necessary for “trade generics” in rural areas, where low volume, high logistics costs, and the need for credit financing make slim margins unsustainable for small-town pharmacists.
The Human Cost: Poverty via Pharmacy
The implications for public health are dire. Despite government efforts, approximately 55 million Indians fall into poverty annually due to healthcare expenses. Medicines account for 40% to 60% of this “Out-of-Pocket Expenditure” (OOPE).
For a family in a region like Mandi, Himachal Pradesh, the choice is often binary. “When an allergy pill costs ₹21 instead of the ₹2 it costs to make, a laborer has to choose between a day’s worth of milk for their children or their own medication,” the report notes. This financial strain leads to “medication non-adherence”—where chronic patients skip doses of hypertension or diabetes meds—eventually leading to expensive emergency hospitalizations.
Government Defenses and “Safety Nets”
The Department of Pharmaceuticals has defended its record, pointing to the PM Jan Aushadhi Pariyojana, which provides high-quality generics at 50% to 80% less than branded costs. To date, the scheme has reportedly saved citizens over ₹38,000 crore.
Additionally, the government highlighted the Trade Margin Rationalization (TMR) pilot, which successfully capped margins on 42 anti-cancer drugs at 30%. They argue that India’s medicine prices remain significantly lower than those in Brazil, Bangladesh, and the United States.
Potential Limitations of the Report
Critics of the parliamentary report point out that it relies heavily on data from Pharmarack, which may not capture the full complexity of rural logistics or the absolute “thinness” of margins when expressed in rupees rather than percentages. For example, a 1,000% markup on a 10-paisa pill is still only one rupee, which must cover storage, transport, and the pharmacist’s livelihood.
Furthermore, some pharmaceutical manufacturers argue that aggressive price caps could stifle innovation and lead to drug shortages if production becomes unviable.
The Road Ahead: Recommendations for Reform
The Standing Committee has proposed several “medicine-for-all” reforms to bridge the affordability gap:
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Mandatory Trade Margin Caps: Amending the DPCO to cap margins on non-scheduled drugs at 15–20%.
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Expansion of NLEM: Moving more “everyday” medications for cough, cold, and pain into the regulated category.
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Audit Powers: Empowering the NPPA to conduct mandatory cost audits of pharmaceutical firms to ensure transparency.
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Scaling Jan Aushadhi: Increasing the density of generic stores in remote mountainous and rural regions.
What Can Consumers Do?
Until policy catches up with practice, medical experts recommend that patients:
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Ask for Generics: Specifically request “Jan Aushadhi” or unbranded generics from their doctors.
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Price Check: Use the ‘Pharma Sahi Daam’ mobile app provided by the NPPA to check the ceiling price of medicines.
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Consult Public Facilities: Utilize government hospital pharmacies where many essential drugs are provided free of charge.
As the government weighs these recommendations, the message from Parliament is clear: the “pharmacy of the world” must ensure its own citizens can afford the medicine it produces.
References
- https://medicaldialogues.in/news/industry/pharma/from-allergy-pills-to-ppis-mps-flag-massive-overpricing-of-medicines-seek-pricing-reforms-164194
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
