This is just one situation that India’s pricing policy hasn’t envisaged. There are more. The NPPA’s recent actions on drugs outside price control are made possible by a provision that allow it to intervene when companies raise prices beyond 20 per cent in 12 months. But what if it is expensive at launch? Take Neupogen. Roche’s drug shores up white blood cell count of patients on chemotherapy. Launched a decade ago, it was priced at around Rs 5,000 a vial even in the early 2000s. Today, it costs a few hundred rupees, thanks to economies of scale and competition.

A similar case is that of Eli Lilly’s Xigris, a drug for serious blood poisoning that cost Rs 5,00,000 for a dose at the time of its launch in 2002. Lilly cut prices by 40 per cent within two years on the back of a customs duty waiver. This is true of most breakthrough life-saving treatments. They are initially priced high and as the market grows and competition comes in, prices fall. There is hardly any NPPA intervention when prices are at their peak.

By default, India’s price control formula targets top brands thrown up by market research firm ORG-IMS’s surveys for periodic mass consumption. “NPPA does not target sub-segments like therapeutic groups,” says chairman Kumar. That is another reason why such products tend to work under its radar.

But until prices fall, patients who cannot afford these medicines effectively have to do without them. This is what happened in the case of Vandana Gupta, a cancer survivor, who now runs a non-profit centre for cancer patients in Mumbai. About 14 years ago, when Gupta was on chemotherapy, a drug that could help control the resulting nausea cost Rs 1,800 a bob (now it is a fraction of that). “The doctor didn’t prescribe it because he thought I couldn’t afford it,” she recalls.

Even today, says Batura of TMC, doctors tend to prescribe what they think patients can afford. That encourages them to complete treatment. “But should patients be denied medicine just because they can’t pay for them?” asks Dr Purvish Parikh, chief of medical oncology at the same hospital. Some even challenge the $7-billion (Rs 28,700 crore) pharma industry’s stance that competition suffices to keep prices down.