New Delhi: The Goods and Services Tax (GST) Council announced slashing tax rates on three key anti-cancer drugs from 12 to 5 percent on Monday. The Union government decided to waive the basic customs duty (BCD) for the same drugs in July.
The anti-cancer medicines on which the government has offered BCD concession and now GST reduction include immune and targeted therapies such as trastuzumab deruxtecan, osimertinib, and durvalumab—all three by British-Swedish pharma giant AstraZeneca.
The moves will reduce the cost of these prohibitively expensive drugs by up to 15-20 percent. However, top oncologists said that the majority of the new drugs continue to be out of reach for the vast majority of cancer patients due to high costs.
“We welcome the government’s pivotal move to reduce the GST on innovative cancer medicines in India, thereby providing relief to cancer patients. This step highlights the nation’s keen focus on progressive access strategies to tackle challenges posed by cancer,” said an AstraZeneca spokesperson in response to a query by ThePrint.
“As a company driven by science and patient-centricity, AstraZeneca stands in full support of this policy adjustment. We are actively engaging with our partners to ensure that patients can leverage the advantages of this change.”
Several cancer experts, however, underlined the need to reduce the prices of a larger number of anti-cancer drugs to widen their accessibility to those in need.
A crucial study that the Tata Memorial Centre published in 2022 showed that less than three percent of cancer patients in India have access to promising new cancer treatments. Immunotherapy costs Rs 50 lakh per annum in some cases.
Another global study that year showed that most high-priority cancer medicines identified by Indian oncologists, despite being generic chemotherapy agents, were comparatively cheaper but remained inaccessible to patients due to financial burdens.
“The reduction in GST from 12 to 5 percent for (some) cancer medicines is a welcome move that will to some extent, at least make these drugs more affordable and accessible,” Dr C.S. Pramesh, the director of the Tata Memorial Hospital and the professor and head of thoracic surgery at the hospital, told ThePrint.
“Many of the new cancer drugs are out of reach for the vast majority of cancer patients in India because of the high costs—the pharmaceutical industry needs to look at some innovative solutions so that these effective drugs reach the people they will benefit.”
Dr Kumar Prabhash, a senior medical oncologist with the hospital who specialises in lung cancers, said that considering the cost of newer life-saving treatments, “we need to do much more to make it affordable to most of our patients.”
He said he hoped that many more drugs would make the list of tax concessions.
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Cancer-related financial toxicity
In 2022, over 14.6 lakh new cancer cases were diagnosed in India, with a crude incidence rate of 100.4 per 100,000 individuals. While lung cancer ranked highest among males, breast cancer held the top spot among females, according to the national cancer registry maintained by the Indian Council of Medical Research (ICMR).
According to estimates, medicines, followed by diagnostics, are the major contributors to out-of-pocket expenditure or financial toxicity for cancer patients.
Also, the prevalence of catastrophic healthcare expenditure and impoverishment was higher among patients seeking outpatient treatment during cancer over hospitalisation, mainly because there is no insurance benefit for treatment in OPD.
“More than 50 percent of patients in India suffer from catastrophic health expenses when suffering from cancer—drug expenses contributing to a major part of it. Reducing or removing taxes on cancer drugs is one among several things—and the easiest—the government can do,” said Dr. Aju Mathew, a medical oncologist based in Kochi, Kerala.
Crucial drugs, but basket is too small
Trastuzumab deruxtecan, sold under the brand name Enhertu, was initially used for HER2-positive breast cancer, a particularly aggressive type of breast cancer.
Earlier this year, the Drug Controller General of India (DCGI) also granted AstraZeneca approval to import and distribute the drug for HER2-low metastatic breast cancer—another aggressive and fast-growing subtype of breast cancer—and locally advanced or metastatic gastric cancer.
Before the BCD exemption, Enhertu’s cost was Rs 1.6 lakh per vial in India.
Osimertinib, sold under the brand name Tagrisso, is a targeted therapy drug used to treat non-small cell lung cancer (NSCLC) with specific mutations in the epidermal growth factor receptor (EGFR) gene.
Before the BCD exemption, a strip of ten pills of this drug cost Rs 1.5 lakh and, according to data available with the National Pharmaceutical Pricing Authority (NPPA), the annual turnover of osimertinib for 2023-24 was Rs 52.26 crore.
This drug was also on the list of 42 anti-cancer drugs for which the Union government regulated the trade margin under the trade margin rationalisation approach of 2019.
The third drug in the list, durvalumab, sold as Imfinzi, is an immunotherapy drug, specifically a monoclonal antibody that targets PD-L1, used primarily to treat non-small cell lung cancer and certain types of urinary bladder cancer.
Every 10 ml vial of this drug costs Rs 1.5 lakh for Indian patients.
These drugs—much like several other immunotherapy and targeted therapy drugs, which are effective but very expensive—can be used by only 5 percent of those who may need them, pointed out Dr Ramesh Sarin, a senior oncologist with Indraprastha Apollo Hospital, Delhi.
“There is a big inequality in the treatment of those who can afford it and 95 percent of the population who can not afford it—it is disheartening to see that only a few drugs are on the list of exemption,” she said.
(Edited by Madhurita Goswami)
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