Karnataka flags 50x MRP markup on cancer drugs, seeks Centre's action
Synopsis
Karnataka has exposed a jaw-dropping pricing scandal: 253 drugs sold to patients at MRPs up to 52 times what hospitals paid for them. With a formal letter to the Union Health Ministry and a push to amend the DPCO, the state is forcing a national reckoning on hospital billing opacity — and cancer patients are at the centre of it.
Key Takeaways
The Karnataka FDA identified 253 drugs with extreme MRP-to-landing-cost disparities during recent hospital inspections.
Gufipol had the starkest gap — procured at ₹86 , sold at an MRP of ₹4,528 , a 52.6-fold difference.
Cancer drugs such as Bevatas 400 mg were procured at ₹5,850 against an MRP of ₹62,690 .
Health Minister U.T.
Khader wrote to the Union Health Minister on 23 September seeking national intervention.
Karnataka has demanded mandatory disclosure of landing costs on patient bills, DPCO expansion and trade margin regulation.
A verification drive on 25–26 September covered more than 768 consumable items and 189 high-cost drugs across Bengaluru and districts statewide.
The Karnataka government has flagged a stark disparity between the institutional procurement cost and the Maximum Retail Price (MRP) of high-cost medicines, cancer drugs, antibiotics, medical devices and hospital consumables — with some products sold to patients at MRPs more than 50 times their landing cost. The state has formally sought intervention from the Union Ministry of Health and Family Welfare and the National Pharmaceutical Pricing Authority (NPPA) to prevent what it describes as excessive billing of patients.
What the Inspections Uncovered
The Food Safety and Drug Administration (FDA), Karnataka, made the findings during recent inspections of hospitals treating cancer patients and other establishments across the state. According to the department, pharmaceutical companies supply certain medicines to hospitals at heavily discounted institutional prices, while patients are billed at or near the printed MRP. Investigations have identified 253 drugs with extreme pricing disparities.
Among the starkest examples: Gufipol, supplied by Criticare, was procured at a landing cost of ₹86 while its MRP was ₹4,528 — a 52.6-fold difference. Guficycline-50 injection had a landing cost of ₹160 against an MRP of ₹7,110, a 44.4-fold gap. Terlitis was procured at ₹118 against an MRP of ₹4,416, while Taxocare 120 mg had a procurement cost of ₹1,000 against an MRP of ₹21,617.
Cancer-related drugs were also flagged. Canmab 440 mg had a landing cost of ₹6,600 against an MRP of ₹57,457, and Bevatas 400 mg injection was procured at ₹5,850 against an MRP of ₹62,690. The disparity extended to hospital consumables: an adult nebuliser mask with a landing cost of ₹44.50 carried an MRP of ₹950, while an IV set procured at ₹14.75 had an MRP of ₹295.
What the Karnataka Government Has Demanded
Health and Family Welfare Minister U.T. Khader, in a letter dated 23 September, wrote to the Union Health Minister seeking urgent intervention. The state has called for mandatory disclosure of both landing cost and MRP on patient bills, expansion of price-controlled medicines under the Drug Price Control Order (DPCO), regulation of trade margins on essential high-value medicines and consumables, and the constitution of an inter-ministerial expert group to study the issue comprehensively.
Karnataka has also proposed amendments to the Drugs (Prices Control) Order, 2013, rationalisation of trade margins, cost-to-MRP transparency norms, expansion of the National List of Essential Medicines, and a formal audit and enforcement mechanism.
Scale of the Verification Drive
The FDA and Drugs Enforcement Officers conducted a special verification drive on 25 and 26 September at wholesale premises, hospitals and other establishments in Bengaluru and districts across Karnataka. The inspections covered more than 768 consumable items and 189 high-cost drugs. Findings are to be submitted to the Central Government.
The department confirmed that the verification exercise will continue in phases, with the next phase focusing on anti-retroviral drugs, critical and higher-generation antibiotics, medical devices and hospital consumables involving substantial financial implications for patients.
Why This Matters for Patients Nationwide
This comes amid long-standing concerns in India about the opacity of hospital billing practices, particularly for patients undergoing cancer treatment or intensive care — where high-cost drugs and consumables can account for a significant share of out-of-pocket expenditure. Notably, this is not the first time state drug regulators have flagged trade margin abuse; however, Karnataka's structured push for NPPA intervention and specific legislative amendments represents one of the more detailed state-level escalations in recent years.
Analysts and patient advocacy groups have argued that without mandatory transparency on institutional procurement prices, patients remain vulnerable to what critics call 'MRP exploitation' — a practice enabled by the wide gap between controlled procurement pricing and the unregulated retail ceiling. The Karnataka government said it would continue efforts to improve transparency in healthcare billing and protect patients from avoidable financial hardship.
Point of View
But the structural problem — a dual-price system where hospitals buy cheap and bill at MRP — has been an open secret for years, and the NPPA's existing enforcement has been selective at best. The real test is whether this state escalation moves the Centre to amend the DPCO in ways that mandate procurement-price disclosure on every patient bill, not just for a curated list of essential medicines. With cancer care costs already driving millions into medical poverty, the political cost of inaction is rising — yet the pharmaceutical lobby's influence on pricing policy has historically outweighed patient-side pressure. Karnataka is doing the right thing by documenting the gap systematically; whether that documentation becomes enforceable national policy is the question.
NationPress
1 Oct 2026
Frequently Asked Questions
What did Karnataka's drug inspections find about medicine pricing?
The Karnataka FDA found that 253 drugs were sold to patients at MRPs far exceeding their institutional procurement cost, with some products priced at more than 50 times the landing cost. For example, Gufipol was procured at ₹86 but carried an MRP of ₹4,528 — a 52.6-fold difference.
Why is there such a large gap between landing cost and MRP?
Pharmaceutical companies supply medicines to hospitals at heavily discounted institutional prices, but patients are billed at or near the printed MRP. Critics argue this system allows hospitals and manufacturers to exploit the gap between regulated procurement pricing and the unregulated retail ceiling, particularly for high-cost and cancer drugs.
What has the Karnataka government asked the Centre to do?
Karnataka Health Minister U.T. Khader wrote to the Union Health Minister on 23 September seeking mandatory disclosure of landing costs on patient bills, expansion of the DPCO's price-controlled drug list, regulation of trade margins, and the formation of an inter-ministerial expert group. The state also proposes amendments to the Drugs (Prices Control) Order, 2013.
Which patients are most affected by this pricing disparity?
Cancer patients and those requiring intensive care are most vulnerable, as high-cost oncology drugs, antibiotics and hospital consumables account for a disproportionately large share of their out-of-pocket expenses. The next phase of Karnataka's inspections will also cover anti-retroviral drugs and higher-generation antibiotics.
What happens next with Karnataka's findings?
The FDA's findings from the 25–26 September verification drive — covering 768-plus consumable items and 189 high-cost drugs — will be submitted to the Central Government. The verification exercise will continue in phases, with the state pressing for a national audit and enforcement mechanism.
