Strategic purchasing of oncology drugs to improve affordability and access to cancer care in India.

Cancer is a leading driver of catastrophic health expenditure in India, where medicines constitute more than 60% of out-of-pocket expenditure. Fragmented procurement, inefficient supply chains, market-based pricing, and limited public coverage of novel high-cost therapies exacerbate inequities in access and affordability. To address these challenges, we propose a unified strategic purchasing agenda for cancer medicines in India built on two mutually reinforcing pillars. The first pillar, pooled procurement, aims to reduce prices and correct fragmentation for off-patent and widely used oncology drugs, thereby lowering OOPE and improving availability in both public and empanelled private facilities. Global as well as national level models of pooled procurement have illustrated the gains achievable through collective bargaining, demand consolidation, and transparent processes. Complementing this, the second pillar, value-based pricing, seeks to align the prices of high-cost, often patented therapies with their incremental clinical and societal value, through systematic use of HTA and, where feasible, managed entry agreements and reimbursement reforms. Together, these mechanisms offer a complementary pathway to mitigate financial toxicity and strengthen progress toward Universal Health Coverage in India.