Without targeted therapy, patients are left with chemotherapy—more toxic, fewer gains.
Each year, roughly 75,000 Indians die of lung cancer — a disease that increasingly claims non-smokers, women, and the young, yet whose survival odds have scarcely improved in a generation. A government-commissioned study from PGIMER now offers a conditional path forward: two precision drugs, crizotinib and ceritinib, could be folded into India's public health insurance scheme, but only if their prices fall by as much as 92 percent through structured negotiations. The recommendation is less a triumph than a reckoning — a signal that medical progress and public access remain, for now, separated by the vast distance of cost.
- With 82,000 new diagnoses in 2022 and a five-year survival rate frozen at 28 percent, India's lung cancer burden is both enormous and stubbornly resistant to improvement.
- Targeted drugs like crizotinib and ceritinib demonstrably extend and improve lives for patients with specific genetic mutations, yet their monthly cost of Rs 40,000–50,000 places them entirely beyond reach for most Indians.
- PGIMER's analysis reveals a stark arithmetic: ceritinib must become 92 percent cheaper, and crizotinib 81 percent cheaper, before inclusion in AB-PMJAY becomes financially defensible for the public system.
- The report calls for institutional machinery — strategic purchasing bodies, value-based pricing frameworks — without which even a formal recommendation to include these drugs will remain a promise on paper.
- Novartis signaled openness to access negotiations while Pfizer stayed silent, leaving the next move squarely with a government that has yet to build the structures the report says are essential.
Lung cancer is India's second most commonly diagnosed malignancy, claiming around 75,000 lives annually. What makes the crisis particularly urgent is its shifting face: the disease is rising fastest among non-smokers, women, and younger patients — populations not traditionally associated with the illness. Despite advances in medicine, the five-year survival rate remains at just 28 percent. A government-funded study by health economists at PGIMER in Chandigarh is now proposing a concrete intervention: bring two precision oncology drugs into the Ayushman Bharat-PMJAY insurance scheme — but only after their prices are negotiated down dramatically.
The two drugs in question, crizotinib and ceritinib, target specific genetic mutations found in a subset of lung cancer patients — ALK rearrangements and ROS1 changes — that together affect roughly 10 to 14 percent of Indian cases. For these patients, targeted therapy offers meaningfully longer survival and better quality of life than conventional chemotherapy, which is more toxic and less precise. The PGIMER analysis confirmed these superior outcomes but found that at current prices of Rs 40,000–50,000 per month, neither drug is cost-effective within public financing limits. Ceritinib would need to fall by 92 percent; crizotinib by 81 percent.
The report's recommendations land in a charged policy moment. A Parliamentary Standing Committee flagged in 2023 that AB-PMJAY fails to cover many modern cancer therapies, urging the government toward innovative funding models. Oncologists broadly support the study's direction, arguing that personalized treatment aligned to a patient's cancer genetics is both clinically and ethically superior to one-size-fits-all chemotherapy. Novartis expressed willingness to engage on access; Pfizer did not respond.
Yet the report is candid about what is still missing. Price reductions alone will not suffice — the government must build institutional capacity for strategic purchasing and value-based negotiations. Without that infrastructure, the recommendation risks becoming aspirational rather than actionable. The deeper question the study leaves open is whether India's health system will move quickly enough to close the gap between what precision medicine can offer and what its most vulnerable patients can actually receive.
Lung cancer kills roughly 75,000 Indians every year. In 2022 alone, doctors diagnosed nearly 82,000 new cases—more than any malignancy except breast cancer. The disease is spreading fastest among people who have never smoked, among women, and among the young. Yet the five-year survival rate sits at just 28 percent, a figure that has barely budged. Now a government-commissioned study is pushing for a way to change that calculus: by bringing two expensive precision drugs into India's flagship health insurance program, but only if their prices fall dramatically.
The report, prepared by health economists at the Post Graduate Institute of Medical Education and Research in Chandigarh and funded by the Department of Health Research, examined whether two targeted therapies—crizotinib and ceritinib—could be cost-effective alternatives to standard chemotherapy for patients with advanced lung cancer. Both drugs are patented and currently cost between 40,000 and 50,000 rupees per month. The researchers compared them head-to-head against conventional chemotherapy in patients newly diagnosed with advanced or metastatic non-small cell lung cancer, the most common form of the disease.
The findings were striking but sobering. Both drugs did offer superior health outcomes. Patients treated with crizotinib or ceritinib lived longer and with better quality of life than those receiving chemotherapy alone. But for these medicines to fit within India's publicly financed health insurance scheme—Ayushman Bharat-PMJAY, which covers hospitalizations up to 5 lakh rupees and includes oncology services—their prices would need to plummet. Ceritinib would have to drop by 92 percent. Crizotinib would need to fall by 81 percent. The report recommends that these drugs be included in the scheme only after such price negotiations are completed, and only at what it calls "value-based" prices.
The context matters. About 70 percent of lung cancer patients in India arrive at the clinic with locally advanced or metastatic disease already present. Most have adenocarcinoma, a particularly aggressive variant. In recent years, precision oncology has made it possible to identify specific genetic drivers of these cancers—mutations in genes like EGFR, or rearrangements in ALK and ROS1. About 30 percent of Indian lung cancer patients carry EGFR mutations; roughly 10 percent have ALK rearrangements; and between 2.8 and 4.1 percent have ROS1 changes. For patients with these specific mutations, targeted drugs like crizotinib and ceritinib can be transformative. They work by attacking the cancer cells directly while sparing healthy tissue, reducing side effects and improving quality of life compared to the blunt force of chemotherapy.
But access remains the barrier. Molecular testing to identify these mutations is expensive. The drugs themselves are expensive. Most patients in low- and middle-income countries cannot afford them. Without targeted therapy, patients with ALK- or ROS1-positive cancers are left with chemotherapy—a treatment that is more toxic, causes greater side effects, and delivers poorer outcomes. The PGIMER analysis showed that for ALK-positive patients, lifetime treatment costs ranged from 3.32 lakh rupees with chemotherapy to 23.37 lakh rupees with ceritinib, while quality-adjusted life years improved from 1.20 to 3.34 months. For ROS1-positive patients, the gap was similarly stark.
The report's recommendation arrives at a moment when India's health system is under pressure to expand cancer care. In 2023, a Parliamentary Standing Committee noted that AB-PMJAY does not cover all the latest cancer therapies and urged the government to explore innovative funding models. A senior health ministry official told reporters that this study was an attempt to assess whether new drugs could be cost-effective within the constraints of public health financing. Novartis, which manufactures ceritinib, said it was unaware of the report but expressed willingness to work with the government on access solutions. Pfizer, maker of crizotinib, did not respond to requests for comment.
Oncologists outside government have echoed the study's findings. Targeted therapy, they argue, offers personalized treatment tailored to each patient's specific cancer genetics, leading to better outcomes and fewer side effects than one-size-fits-all chemotherapy. The path forward, according to the report, requires more than just price cuts. It calls for the establishment of institutional structures within government to handle strategic purchasing and price negotiations for these medicines. Without such infrastructure, even a recommendation to include these drugs in the scheme will remain theoretical. The question now is whether the government will move to create it.
Notable Quotes
Targeted therapy gives personalised treatment, tailor-made to the specific characteristics of the patient's cancer, leading to better outcome.— Dr Rathna Devi, senior consultant–radiation oncology, Apollo Cancer Centre, Chennai
We are always willing to work with the government and other stakeholders to find innovative solutions to improve access of our medicines to patients.— Novartis spokesperson
The Hearth Conversation Another angle on the story
Why does this report matter right now? Lung cancer treatment hasn't changed overnight.
Because for the first time, a government study is saying these expensive drugs could actually fit into India's public health budget—but only if prices fall hard. That's a signal that inclusion might be possible.
The price cuts sound brutal. Ninety-two percent for one drug?
They are. But the researchers are saying that's what it takes for the math to work in a country where most patients can't pay out of pocket. It's not arbitrary—it's based on what the drugs actually deliver in health gains versus what India's system can afford.
What happens to patients right now who have these specific mutations?
Most can't access the targeted drugs at all. They get chemotherapy instead, which is harsher on the body and doesn't work as well. If you're poor, you're stuck with the older treatment even if your cancer type would respond better to something newer.
So this is really about equity?
Partly. But it's also about efficiency. The report is arguing that targeted drugs deliver better outcomes per rupee spent—if the price is right. That's a language governments understand.
Will the drug companies actually cut prices that much?
That's the open question. Novartis said they're willing to talk. Pfizer hasn't responded. The government would need to actually negotiate, which means having the institutional muscle to do it. Right now, it's not clear they have that.
What's the timeline?
Unknown. The report is out, the recommendation is made. But moving from recommendation to actual inclusion in the scheme requires bureaucratic steps, price negotiations, and political will. That could take months or years.