A leading private hospitals association has urged the Ministry of Health to review the reimbursement policy under the Central Government Health Scheme (CGHS), warning that the current pricing framework could severely disrupt treatment for advanced cancer patient’s dependent on life-saving immunotherapy medicines. The concern centres around a reimbursement cap that limits payments to hospitals at 70 percent of the Maximum Retail Price (MRP) for high-cost oncology drugs. According to hospitals, the policy is creating unsustainable financial pressure while also threatening continuity of care for critically ill patients.
The Association of Healthcare Providers India (AHPI), which represents more than 20,000 private healthcare providers, has formally written to the health ministry highlighting the issue and identifying several expensive patented cancer drugs affected by the reimbursement restriction.
High-Cost Cancer Drugs Under Financial Pressure
The association stated that multiple advanced oncology drugs are becoming financially unviable for hospitals under the current reimbursement structure. The list includes Keytruda, Imfinzi, Enhertu Imjudo, Zoladex, Adcetris and Tagrisso. According to Association of Healthcare Providers (India) AHPI, these patented medicines carry very limited hospital margins, typically around 10–15 percent, making it impossible for healthcare providers to absorb the financial losses created by the 70 percent reimbursement cap.
AHPI Requests Full MRP Reimbursement
In a letter to the health ministry, Girdhar Gyani, Director, AHPI explained that the issue arises because hospitals have no alternative but to use these patented therapies for advanced cancer treatment. “This is a peculiar situation, which arises out of the necessity to use these patented drugs only,” the letter stated. AHPI has requested that CGHS reconsider its reimbursement policy for this limited category of high-cost cancer drugs and reimburse hospitals at the full MRP instead of the current 70 percent ceiling.
Existing Reimbursement Pathways Create Operational Challenges
Currently, CGHS offers hospitals three different reimbursement pathways for such medicines:
*Patients procure medicines through the CGHS supply system
*Hospitals procure medicines and bill CGHS at MRP, while receiving only 70 percent reimbursement
*Patients independently source medicines and hospitals administer the treatment
However, hospitals argue that each of these options creates serious operational, legal, or medical risks.
Hospitals Cite Legal and Supply Chain Risks
Many hospitals procure patented immunotherapy medicines through confidential agreements with multinational pharmaceutical companies. These contracts often prohibit disclosure of negotiated pricing details to third parties. Healthcare providers warn that submitting purchase invoices to CGHS could violate these agreements, potentially exposing hospitals to legal disputes or even disruption in medicine supply from manufacturers.
At the same time, hospitals say asking patients to independently purchase and transport these medicines is medically risky because most oncology biologics require strict cold chain management and verified storage conditions. Doctors are reportedly becoming increasingly reluctant to administer medicines when the integrity and handling conditions cannot be fully verified.
Delays in CGHS Supply System Affect Treatment Continuity
Hospitals also highlighted operational issues within the CGHS supply mechanism itself. According to healthcare providers, patients frequently experience delays and shortages in receiving cancer medicines through the government supply chain. These interruptions can lead to missed treatment cycles and significantly impact patient outcomes, particularly in advanced-stage cancer therapies where treatment schedules are critical. As a result, hospitals often have no practical option except to procure and administer the medicines directly while billing CGHS at MRP.
Financial Burden Becoming Unsustainable
AHPI stated that hospitals are increasingly being forced to absorb substantial out-of-pocket losses for every infusion administered under the current reimbursement structure. Given the extremely high cost of patented oncology medicines and the already thin operating margins, healthcare providers say the situation is becoming financially unsustainable. “It is quite impossible to sustain this,” the association noted in its communication to the ministry.
Industry Seeks Urgent Policy Review
Healthcare providers are now calling for urgent intervention from the government to prevent disruption in access to critical cancer therapies for CGHS beneficiaries. As reported by indianews-online.com, industry experts believe that revising reimbursement mechanisms for patented oncology drugs could help ensure uninterrupted treatment, protect patient safety, and maintain the financial viability of hospitals delivering advanced cancer care in India.