THE PRICE OF SURVIVAL: CONGRESS ACCUSES MODI GOVERNMENT OF FAILING PATIENTS AS SUPREME COURT CHALLENGES INDIA’S MEDICINE-PRICING SYSTEM
October 28, 2026
NEW DELHI, OCTOBER 28, 2026 — The Congress has accused the Narendra Modi government of failing to ensure affordable medicines after the Supreme Court sharply questioned the Centre over the substantial gap between the prices pharmaceutical companies charge retailers and the maximum retail prices paid by consumers. The opposition's criticism follows judicial observations that India's drug-pricing framework appears to favour pharmaceutical manufacturers while patients bear the financial consequences.
Congress general secretary in charge of communications Jairam Ramesh described medicine overpricing and mounting hospital bills as a major failure of the government. He argued that families were being pushed into financial distress to pay for treatment and accused the Centre of remaining indifferent to the burden of healthcare costs.
The political confrontation follows a hearing on October 27, during which a bench comprising Justices Vikram Nath and Sandeep Mehta questioned whether the existing regulatory system adequately protected patients. The court reserved its order in two petitions concerning medicine prices and the regulation of pharmaceutical trade margins.
The proceedings have brought a fundamental public-policy question into focus: when medicines are essential to preserving life, how should the government balance commercial interests with patients' ability to afford treatment?
CONGRESS QUESTIONS THE GOVERNMENT'S RECORD
Ramesh said the rising cost of medicines and hospital treatment had made life increasingly difficult for ordinary families. He argued that inflation in healthcare expenses had compounded the financial pressures households faced from other essential costs.
According to the Congress leader, families were being forced to borrow money to pay for medical treatment, creating a cycle in which illness could lead to long-term financial insecurity. He maintained that the government's responsibility was to protect patients from excessive prices rather than allow commercial interests to dominate the healthcare system.
Ramesh's criticism followed the Supreme Court's questioning of the Centre over the wide difference between the maximum retail price (MRP) of medicines and the price at which retailers purchase them. The court asked why the system appeared to benefit manufacturers and whether such price differences could be justified when patients had limited bargaining power.
The Congress characterised the judicial intervention as evidence of a failure to address an issue affecting millions of households. Its statements, however, represent the opposition's political assessment; the Supreme Court's observations and the government's response must be considered separately from that assessment.
SUPREME COURT QUESTIONS THE PRICE GAP
During Tuesday's hearing, the Supreme Court expressed concern about the substantial difference between medicine prices charged to retailers and the MRPs printed on packaging.
The bench questioned why the regulatory system appeared to operate in favour of pharmaceutical manufacturers and criticised the National Pharmaceutical Pricing Authority (NPPA), the statutory body responsible for overseeing drug prices, describing it as seemingly ineffective.
The judges also questioned the government's position on limiting trade margins for selected medicines rather than extending similar controls more widely. Their remarks focused on whether the existing framework adequately prevented excessive markups throughout the pharmaceutical supply chain.
The court's concerns were not confined to the price of a single drug. They reflected broader questions about how medicine prices are established, how manufacturers and intermediaries determine margins, and whether current controls adequately protect patients who cannot simply postpone treatment.
The bench reserved its order after hearing the parties. Its observations therefore signal serious judicial concern but should not be mistaken for a final ruling on the legality of the existing pricing framework.
THE CANCER-DRUG EXAMPLE THAT SHARPENED THE DEBATE
A particularly striking example discussed in recent proceedings concerned an anti-cancer medicine that a distributor reportedly offered to procure directly from its manufacturer for approximately ₹1,100, while a private hospital charged ₹1.30 lakh for it.
The example raised questions about the difference between procurement costs and the prices charged to patients. It also highlighted the importance of understanding where the additional amount goes and whether the costs and services involved can justify the final price.
A price difference alone does not establish that every component of the markup is unlawful. However, the scale of the discrepancy cited before the court intensified scrutiny of pricing practices and the protection available to patients facing expensive treatment.
The court asked why medicine pricing should be treated primarily as a commercial matter when the consequences of unaffordable treatment can affect patients' lives.
For families dealing with cancer and other serious illnesses, the issue is especially pressing. Treatment may require repeated purchases of medicines, diagnostic tests, hospital stays and specialist consultations, leaving patients with limited opportunities to negotiate prices or seek alternatives.
GOVERNMENT DEFENDS ITS APPROACH TO DRUG PRICING
Representing the Centre, Additional Solicitor General Aishwarya Bhati argued that the government sought to balance affordability with the need to maintain investment, competition and the availability of medicines.
She told the court that medicine prices in India were among the lowest internationally and said the government's approach was not to place the entire pharmaceutical ecosystem under comprehensive price control.
The Centre has also pointed to its decision to cap trade margins at 30 per cent of MRP for 137 anti-cancer medicines, which it estimates could save patients approximately ₹2,500 crore annually.
The government has argued that broader regulation must account for the possible effects on medicine availability and commercial incentives. The court, however, questioned why similar scrutiny should not extend to other medicines and why the margin cap should be limited to the selected category.
The dispute therefore concerns both the level of prices and the design of regulation: whether targeted controls are sufficient or whether a broader framework is needed to prevent excessive margins.
HOW INDIA'S MEDICINE-PRICING SYSTEM WORKS
India regulates drug prices under the Essential Commodities Act, 1955, and the Drugs (Prices Control) Order, 2013.
Under the current framework, medicines included in the scheduled category are subject to government-set ceiling prices. The system is linked to the National List of Essential Medicines, which identifies drugs considered important for meeting the country's healthcare needs.
Medicines outside the scheduled category generally do not have the same ceiling-price restrictions. Manufacturers can set their initial prices, although the DPCO limits subsequent increases in the prices of non-scheduled formulations to no more than 10 per cent within 12 months.
This distinction is central to the litigation. Petitioners have challenged aspects of the system that permit substantial differences between procurement prices and the prices ultimately charged to patients. They have also sought stronger controls over trade margins and greater accountability across the medicine supply chain.
The legal challenge raises the question of whether existing safeguards are sufficient to prevent excessive pricing in a market where patients often have little choice but to purchase prescribed treatment.
JAN AUSHADHI AND THE LIMITS OF AFFORDABILITY MEASURES
The Centre has also defended its efforts to make lower-cost generic medicines available through Pradhan Mantri Bhartiya Janaushadhi Kendras.
These outlets provide generic medicines at prices intended to make treatment more affordable. The government has cited the scheme as one way of improving access to essential drugs without imposing comprehensive price controls across the pharmaceutical industry.
However, access to cheaper generic medicines does not resolve every concern raised in the court proceedings. The availability of alternatives varies by medicine, location and prescription, while patients may face additional charges through hospital pharmacies and other parts of the treatment process.
The petitioners have argued that affordability measures must be assessed against the wider scale of India's pharmaceutical market and the pricing practices affecting patients who depend on particular medicines.
THE FINANCIAL CONSEQUENCES FOR PATIENTS
Medicine prices are only one component of the cost of healthcare, but they can represent a substantial burden for patients undergoing long-term treatment.
Families may need to finance medicines alongside hospital charges, diagnostic tests, travel and lost earnings during illness. When these expenses exceed available savings, households may resort to borrowing or postpone other essential expenditure.
The consequences are particularly serious for people with chronic illnesses, cancer or conditions requiring continuous medication. Unlike many discretionary purchases, essential treatment cannot always be delayed until prices fall or household finances improve.
The Congress has used these concerns to argue that affordable healthcare should be treated as a public responsibility rather than solely as a market outcome. The government's position is that regulation must protect patients while preserving a sustainable supply of medicines.
The challenge for policymakers is to establish a system that achieves both objectives and ensures that commercial incentives do not undermine access to necessary treatment.
A JUDICIAL TEST OF THE REGULATORY FRAMEWORK
The Supreme Court's intervention has placed the existing pricing regime under renewed scrutiny. Its reserved order in the two petitions could have implications for how the government approaches trade margins, the categories of medicines subject to price control and the obligations of regulators.
Any eventual directions will need to be read in the context of the court's final order rather than its oral observations alone. Until then, the precise extent of any changes to the regulatory framework remains uncertain.
The case also raises questions about the effectiveness of regulatory oversight. A pricing system can contain formal safeguards yet still face challenges if enforcement, transparency or the ability to identify excessive margins is inadequate.
The proceedings could therefore influence the broader debate over how India monitors pharmaceutical prices and protects patients against costs that threaten access to treatment.
HEALTHCARE AFFORDABILITY AT THE CENTRE OF PUBLIC POLICY
The Congress's criticism has transformed the medicine-pricing dispute into a wider political argument over the government's responsibility to protect household finances and ensure access to healthcare.
The Supreme Court's questions have independently highlighted concerns about substantial price differences and the adequacy of existing controls. The Centre, meanwhile, maintains that its approach seeks to balance affordability with investment, competition and the availability of medicines.
The central issue is whether that balance provides sufficient protection for patients who have little bargaining power and cannot avoid essential treatment.
For millions of families, affordable medicine is not an abstract question of economic policy. It can determine whether treatment begins on time, whether a patient completes a prescribed course and whether a household can meet its basic expenses without accumulating unsustainable debt.
The outcome of the legal proceedings remains pending. But the debate has made one point unavoidable: India's medicine-pricing system must be judged not only by its commercial structure or stated policy objectives, but also by how effectively it protects patients from unaffordable treatment.
