India is touted as the world’s pharmacy bowl, but ironically a large chunk of its population slips below the poverty line due to exorbitantly priced medicines, mostly for cancer, injuries and heart ailments.

A study published in British Medical Journal (BMJ) points out that the proportion of the population reporting out-of-pocket (OOP) payments on medicines has increased from about 60 per cent in 1993-1994 to 80 per cent in 2011-12. The study, the first ever attempt to link health expenditure to disease conditions, was released on June 6.

In 2011-12, OOP for medicines pushed about 3.8 crore persons into poverty, of the 5.5 crore that were impoverished due to total health costs, including lab tests, diagnostics, doctor and surgeon fees.

“Among the leading cause of diseases that caused significant OOP payments are cancers, injuries, cardiovascular diseases, genitourinary conditions and mental disorders,” said Sakthivel Selvaraj, Director, Health Economics, Financing and Policy, at the Public Health Foundation of India (PHFI).

Households incur the highest monthly per-capita OOP on account of cancer followed by injuries and cardiovascular diseases. For example, the average maximum retail price (MRP) of the top three leading brands for Bortezomib injection, an anti-cancer drug, is ₹11,411. A patient has to make repeated purchases of the drug over the period of treatment.

According to the State-specific poverty line defined by the Tendulkar Committee as ranging from a person earning ₹695 a month in Odisha to ₹1,018 a month in Kerala, the percentage of households falling below the poverty line increased from 4.19 in 1993-94 to 4.48 in 2011–12, the study notes.

Apart from Rajasthan and Tamil Nadu, no State has an effective drug supply chain. Strengthening government intervention in providing medicines free in public health facilities can reduce spending on medicine, said Selvaraj.