Co-author,Parikh Nikita Raju
The Non-Communicable Diseases like Cardiovascular diseases (CVD), Cancer, Chronic Respiratory Diseases, Diabetes and other NCDs are estimated to account for 63.0 per cent of all deaths, thus making them the leading causes of death. (Annual Report 2024-25, Department of Health & Family Welfare, Ministry of Health & Family Welfare, Government of India, p.159). The Global Burden of Diseases estimates (2010) put the age-standardized CVD death rate in India at 272 per 100,000 population (global average of 235 per 100,000). The Compound Annual Growth Rate (CAGR) for Cardiovascular Therapeutic Segment Sales (2019-20 to 2023-24) was 7.33 per cent as per the Annual Report of the Department of Pharmaceuticals 2023-24. Cardiovascular Therapeutic Segment Sales for FY24 stood at ₹26,041.80 Crore. In 12 months through April 2025, total Cardiac category sales reached ₹30,483 Crore. High growth rate, substantial market value of CVD segment, escalating disease burden make this segment commercially attractive for pharma companies. Hence, price capping has implications for all stakeholders.
From the point of view of pharma companies, price capping influences their investment decisions, their competitive strategies within the segment, as well as their R&D priorities. From the regulatory, and the patients’ perspective, price capping targets a high-volume, high-need area for affordability, thereby maximizing patient benefits.
The National List of Essential Medicines (NLEM) 2022 which is a key instrument of price control, includes 22 formulations under the Cardiovascular Medicines category. Section 10 of the National List of Essential Medicines (NLEM) 2022 deals with Cardiovascular Medicines which comprises medicines used in Angina (4 medicines), antiarrhythmic medicines (6 medicines), antihypertensive medicines (7 medicines), medicines used in shock and heart failure (5 medicines), antiplatelet and antithrombotic medicines (5 medicines), and hypolipidemic medicines (1 medicine). Certain medicines are listed in more than one section too, e.g., Digoxin as Entry no. 10.2.3 under Antiarrhythmic medicines and as Entry no. 10.4.1 under Medicines used in Shock and Heart failure as a single active ingredient can treat multiple conditions. This highlights the government’s recognition of the essential nature and widespread need for these drugs.
Press release dated August 8, 2025, highlighted that the National Pharmaceutical Pricing Authority (NPPA) has fixed the ceiling prices for 930 scheduled formulations, including 11 anti-diabetic, 131 anti-cancer, and 66 cardiovascular formulations. Retail prices of 3,482 new drugs stood fixed as on 14.07.2025, of which 1,924 were in the anti-diabetic, anti-cancer and cardiovascular categories. Besides this, the maximum retail price (MRP) of 84 cardiovascular non-scheduled medicines has been capped resulting into savings to patients. For non-scheduled formulations, manufacturers are required to not increase MRP of drugs launched by them by more than 10.0 per cent during the preceding 12 months.
Analysis of data obtained from working sheets used by the NPPA regarding all formulations (24 in number) used in treatment of Cardiovascular diseases and brands which fall under each formulation, gives deeper insights, e.g., the highest number of brands, 22 brands were listed for determining the price cap in case of one formulation (Telmisartan IP 40 mg + Cilnidipine IP 10 mg), and the lowest number of brands for one formulation was just 1. In-between, there was huge variation in number of brands under each formulation such as 2 for Ezetimibe 10 mg, 8 brands in case of Lignocaine, and 20 brands for Atorvastatin.
Due to price control on Cardiovascular medicines and calculations based on the working sheets of the NPPA accessed from June 2024 to May 2025, there was revenue loss for pharma companies to the tune of ₹1.75 Bn with Hypertension Management being disproportionately affected as the revenue loss was ₹1.28 Bn for pharma companies as compared to loss of ₹0.47 Bn in Lipid Lowering & Antiplatelet Therapy. In contrast to this, the Anti-Arrhythmic category remained unaffected by price control. Each sub-group within the main group (Cardiovascular drugs) does not get affected in the same way.
Further, Indian pharma companies suffered more revenue loss (₹1721.34 Mn) as compared to revenue loss suffered by Pharma MNCs (₹27.76 Mn). Two Pharma MNCs namely Abbott Healthcare and Merck Specialities were among affected pharma companies. Lupin was the most affected Indian company due to price control on Cardiovascular drugs. Revenue loss was significant for Macleods and Cipla too. Loss of Revenue was worked out by using Moving Annual Turnover (MAT) based on the Ceiling Price minus Original MAT value. This also reflected that pharmaceutical companies with larger market share, or those with specific product portfolios which are heavily weighted towards price-controlled drugs are more vulnerable to revenue erosion.
Certain pharmaceutical companies offered more than one brand for same formulation, e.g., for Cilnidipine IP 10 mg + Telmisartan IP 40 mg + Chlorthalidone IP 12.5 mg, Lupin had two brands (Dilnip Trio and Telista Trio CL), Micro Labs had two brands in the name of Telplus Trio only. Only difference was of pack size of 10 or 15 tablets. Macleods Pharma also had two brands (Macsart CC and Nexovas TC) with no difference in strength and pack size whereas price differential existed. In this sub-category, there were 34 companies which offered this formulation. 17 brands offered by just 14 companies out of 34 were considered for calculation of average price to retailer, and determination of the ceiling price by the NPPA. It is because all those brands and generic versions of the medicine having market share more than or equal to one per cent of the total market turnover based on moving annual turnover of that medicine are considered for determination of the ceiling price under the Drugs (Prices Control) Order, 2013. Hence, all pharmaceutical companies offering same formulation do not get affected.
Based on MAT values, most of the affected brands due to price control belonged to Indian pharma companies. In other words, aggregate turnover of respective pharma companies from these brands got reduced. Top brands which faced the reduction in prices included Telma H of Glenmark Pharma, Cilacar T of J. B. Chemicals & Pharma, Ecosprin Gold of USV Pvt. Limited, Tonact-TG of Lupin, Telma AMH of Glenmark Pharma, Telsartan H of Dr. Reddy’s Labs, Tellzy CH of Alembic, Tazloc Trio of USV, Clopitab CV of Lupin and Telma CT of Glenmark Pharma. Concor AM of Merck Specialities, and Telpres AM of Abbott Healthcare were the most affected brands of Pharma MNCs. Price control resulted into price reduction for these brands anywhere between 50.0 per cent and 81.0 per cent. This essentially shows inter-brand price variability for the same drug formulations. Hence, there exists significant price discrepancies for identical drug compositions in the market before the price caps. Imposition of price ceilings suggests that these regulations are effectively reducing these price gaps.
Conversely, the price of Cardiovascular drugs from pharmaceutical companies such as Aristo Pharma, Mankind and Systopic Labs showed significant negative variations. This indicated that their prices were already below the market average. This also highlights a wide range of pricing strategies for similar treatments before the implementation of price ceilings.
Price capping in India, particularly for cardiovascular drugs, is achieving its aim of reducing drug prices and ensuring affordability. However, for pharma companies’ point of view, this comes at the cost of significant reduction in revenue for the affected pharmaceutical companies. This necessitates careful consideration of market dynamics by pharma companies and potential unintended consequences on innovation and supply.
Dr. Anil Kumar Angrish- Associate Professor (Finance and Accounting), Department of Pharmaceutical Management, NIPER S.A.S. Nagar (Mohali), Punjab
Parikh Nikita Raju– M.B.A. (Pharm.) (2023-25 Batch),Department of Pharmaceutical Management, NIPER S.A.S. Nagar (Mohali), Punjab
*Disclaimer: Views are personal and do not represent the views of the Institute.
