Cost of Targeted Therapy in India: — What Each Drug Class Actually Costs

Some targeted therapies are included in PMJAY package lists for eligible cancer diagnoses, but not all. Coverage depends on your cancer type, the specific drug, and whether your treating hospital is empanelled for that package. The Ayushman Mitra at your hospital can check your eligibility and confirm which drugs fall under your entitlement in minutes. Coverage is tied to your registered cancer type and the defined procedure package — so an in-person check is the only reliable way to know, not a general assumption based on drug class.

Many policies cover it, but the terms vary significantly. Some cover cancer treatment broadly, then exclude high-cost oral targeted drugs under a sub-limit or require pre-authorisation for each cycle. Before you start treatment, call your insurer with the exact drug name and ICD-10 diagnosis code and ask whether it is covered as inpatient, day care, or not at all. Get the answer in writing. Policies bought before targeted therapies became widely used may carry exclusions you are not aware of — do not assume you are covered until you have confirmed it in writing.

For some drugs, yes. Originator companies run programmes — sometimes called access schemes or expanded access — where patients who cannot afford the branded drug apply through their oncologist. Eligibility is usually income-based and sometimes requires evidence that insurance has declined to cover the drug. These programmes are not advertised widely, and your oncologist or counsellor will need to initiate the application. The process can take several weeks, so start it as early as possible alongside other options — you do not need to wait for other funding routes to be exhausted first.

Yes. CDSCO requires that generic targeted drugs contain the same active molecule at the same dose and meet bioequivalence standards before approval. The active ingredient that does the clinical work is identical to the branded version. The difference between generic and branded is the manufacturer, the inactive ingredients, and the price — not the mechanism of action. NCCN and ESMO guidance explicitly supports generic substitution for approved drug classes. There is no clinical reason to pay branded prices when a CDSCO-approved generic exists for your cancer type — confirm with your oncologist that the generic is recommended for your specific regimen.

The fastest way is to ask your oncologist directly. You can also search the CDSCO website using the drug's International Non-proprietary Name — the generic chemical name rather than the brand name — to see which Indian manufacturers hold approval. A hospital pharmacist can tell you what is currently stocked and at what price. Generic availability in India has expanded quickly; drugs that had no Indian generic three or four years ago may now have several approved versions. Even when a generic exists, confirm with your oncologist that it is recommended for your specific cancer type and treatment regimen before switching.

They can verify your PMJAY or Aarogyasri eligibility on the spot, confirm which drugs and procedures are covered under each scheme at your specific CION centre, help initiate a patient assistance programme application, and review your insurance terms against the treatment your oncologist has recommended. They cannot negotiate your insurance policy terms or access government funds for hospitals that are not empanelled. But they know exactly what options exist for your situation before you start spending — and the service costs you nothing.