Earlier this month, Finance Minister Nirmala Sitharaman presented the Budget 2026-27, which mentioned the prices of 17 drugs coming down owing to the exemption of duty taxes. By abolishing basic customs charges on certain drugs, the government intends to make innovative therapies more affordable and accessible, especially for individuals without complete insurance coverage.
Though certain of these 17 drugs are frequently used, the recommendation or implementation for cancer patients solely remains on a scientific basis, noted an oncologist and healthcare expert. Dr Abhishek Shankar, Associate Professor, Department of Radiation Oncology, AIIMS Delhi, pointed out that the usage of drugs like Ribociclib (for breast cancer) and Venetoclax (for leukaemia) will not be changed by duty exemption but with the ‘scientific basis’. However, since these drugs are used for a longer duration, even small savings per cycle will help many families.
‘Not Pricing Alone’
Dinesh Madhavan, President, Group Oncology and International from Apollo Hospitals, mentioned that in cancer care, the first line of treatment is always driven by clinical evidence, disease biology, and guideline-based standards of care.
“Choices such as whether to use a CDK4/6 inhibitor like Ribociclib in hormone-positive breast cancer or Venetoclax in certain leukaemias remain grounded in clinical benefit, not pricing alone. Even before the duty exemption, these drugs were established options for appropriate patient populations, eagerly used in tertiary settings where they improve progression-free survival and quality of life. The budget change doesn’t alter treatment algorithms,” he added.
Experts highlighted that in India, there have been plenty of situations where patients had to opt for conventional chemotherapy instead of targeted therapies, which have better efficacy results only due to cost constraints.
“Those are not ideal choices but are part of real-world decision-making when families have limited ability to bear expenses. With the cost reduction from the duty exemption, in borderline cases where cost was the decisive factor, we may now have more confidence recommending the clinically superior, targeted option upfront rather than compromising based on price alone. For example, in hormone-receptor positive metastatic breast cancer or chronic lymphocytic leukaemia patients where Ribociclib or Venetoclax would be the evidence-based choice, modest reductions in cost can sometimes sway the decision toward the best-in-class therapy rather than a “budget fallback,” stated Madhavan.
Always An Accessibility & Affordability Issue
Dr Abhishek Shankar cited that there was always an accessibility and affordability issue, and it will remain the same for most of the targeted therapy, immunotherapy and CART cell therapy.
“Earlier, treatment decisions were often influenced by affordability and access, which meant we sometimes had to rely on more ‘budget-friendly’ conventional therapies even when more advanced options were available. That reality hasn’t entirely changed. Targeted therapies, immunotherapy, and CAR-T cell therapy represent significant scientific progress and can offer better outcomes in selected patients. However, their cost, often ranging from several thousand to several lakhs per month, continues to be a major barrier. Accessibility remains limited, particularly in resource-constrained settings,” Dr Shankar added.
Talking about the 17 efficacy and side-effect profiles of cheaper generics currently available in India compared to those of 17 specific drugs, cheaper generic options for cancer care, like conventional cytotoxic drugs, still play a vital role in many settings, particularly where targeted therapies are not indicated.
“However, generics do not duplicate the disease-specific efficacy of agents such as CDK4/6 inhibitors or PD-1 inhibitors. These newer drugs are part of “modern oncology care, including immunotherapy, targeted therapy and cell-based treatments.”
Even after the duty cut, these newer drugs command a significant premium because they target specific molecular pathways, often showing improved survival and tolerability profiles in selected patients,” Madhavan pointed out.
Dr Shankar commented that many of the drugs are under patent and they will be costly till the period of patent expires. “Innovator molecules are best to use if your pocket allows for that. These biosimilars are generally not inferior in efficacy and side effects,” he added.
(Ghosh is an independent journalist with a focus on health, climate change, environment and human interest stories)
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