Cost Variation and Affordability of Oral Targeted Cancer Therapy in India: Comparison of Branded and Janaushadhi Products.

Background The rising cancer burden in India has increased the need for effective and affordable treatment. Over the past two decades, oral targeted therapies such as TKIs (tyrosine kinase inhibitors), PARP (poly(ADP-ribose) polymerase) inhibitors, CDK4/6 (cyclin-dependent kinase 4/6) inhibitors, and BCR-ABL (breakpoint cluster region-Abelson) inhibitors have transformed cancer care but remain highly expensive, leading to significant out-of-pocket costs. Although the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) provides low-cost generic medicines, coverage of targeted therapies remains limited. Evaluating cost variation and affordability across branded and Janaushadhi formulations is, therefore, essential for guiding rational prescribing and policy decisions. Methodology This cross-sectional descriptive study was conducted over a period of six months using publicly available price data. Drug prices were extracted primarily from the Current Index of Medical Specialties (CIMS 2024-2025), which listed 33 oral targeted anticancer drugs meeting the inclusion criteria. Janaushadhi prices were obtained from the PMBJP portal. For each drug, the maximum and minimum brand prices, the median equivalent 28-day costs, cost ratios, and the percentage cost variation were calculated. Affordability was computed as the percentage of national per capita monthly income required to purchase a 28-day treatment course. A statistical comparison between branded and Janaushadhi affordability was performed using the Wilcoxon signed-rank test. Results A total of 33 oral targeted anticancer drugs were analyzed, of which TKIs constituted the majority (72.73%). Percentage cost variation ranged from 8% (Bosutinib) to 14,774.74% (Midostaurin), with corresponding cost ratios up to 148.75. Janaushadhi formulations were available for 14 of the 33 drugs. Absolute savings versus median branded costs ranged from ₹2,968 (Dasatinib) to ₹25,270 (Lapatinib), while percentage savings ranged from 58.89% (Dasatinib) to 91.32% (Imatinib). Affordability analysis revealed that branded formulations required 29.46%-3721.66% of the monthly per capita income, whereas Janaushadhi versions required only 3.44%-73.64%. Statistical analysis demonstrated a significant improvement in affordability with Janaushadhi products (W = 55.0, p = 0.002). Conclusion This study shows wide inter-brand price differences among oral targeted anticancer drugs in India, making many branded options poorly affordable. Janaushadhi formulations, where available, substantially improve affordability and reduce financial burden. However, limited PMBJP coverage restricts their overall benefit. Expanding Janaushadhi availability, improving price regulation, and encouraging rational prescribing are crucial to ensure equitable access to targeted cancer therapies in India.