Over the last three years, the government has steadily expanded the basic custom duty (BCD) waiver on high-cost medicines with a promise of relief to patients.
In 2024, three cancer medicines were granted waiver; the following year, 36 life-saving drugs (including cancer treatments) were exempted; and in 2026-27 , an additional 17 life-saving cancer medicines were included in the list.
Through the BCD waiver on select cancer and rare disease medicines, the government is clearly acknowledging the access crisis, yet this has barely reduced the catastrophic prices of new cancer drugs.
For example, despite a BCD waiver in 2024, a targeted therapy for breast cancer, trastuzumab deruxtecan, still carries a retail price tag of ₹1.67 lakh per 100 mg vial, or over ₹90 lakh per year (standard clinical dosing). Similarly, the yearly cost of a small molecule drug like ribociclib, listed in 2026, is nearly ₹9.5 lakh. This shows that the BCD waiver, which constitutes only 10-12 per cent of drug price, does not result in meaningful cost reduction.
Out-of-pocket burden
Studies show that cancer care in India is still financed mostly out of pocket, pushing households into debt and distress.
The high price of cancer drugs is rooted in monopoly. Most cancer drugs are protected by primary and multiple secondary patents. Patent monopoly gives companies a wide latitude to set prices regardless of a country’s income levels or disease burden. India’s lawmakers understood this while enacting the Indian Patent Act, building safeguards like government-use licence (Section 100), compulsory licence (Section 84) and curbing the grant of secondary patents through Section 3(d). These were mostly framed to prevent patent monopolies from undermining public health.
Yet, most of the tools remain underutilised and policy interventions gravitate more towards soft measures like BCD and GST waiver.
Further, transparency around pricing is critical. When the government grants a BCD exemption on a drug, it should insist that the company publicly disclose the pre- and post-waiver prices to ensure the fiscal benefit actually reaches patients.
Without such a transparency mechanism, there is a real danger that revenues foregone by the government may end up providing margins to the companies instead of easing the burden of patients, as intended. The persistent high prices of drugs despite BCD waivers clearly suggest that access to life-saving medicines has not improved.
The government must make use of the full range of legal and policy measures, to fulfil its constitutional duty of ensuring affordable care to all.
(The writer is a senior researcher, Third World Network, and member-Working Group on Access to Medicine and Treatment)
Published on February 9, 2026