Inside India’s medicine pricing maze: Who sets the cost and who pays the price?

Walk into two pharmacies on the same street in India and ask for the same prescription. Chances are, you will walk out with two very different bills. For millions of Indians managing diabetes, blood pressure, thyroid disorders or heart conditions, this pricing uncertainty is not an occasional inconvenience—it is a monthly reality.

India is often called the “pharmacy of the world”, yet domestically, medicine pricing remains one of its most confusing healthcare challenges. To understand why, one must look beyond manufacturing costs and into a maze shaped by branding, regulation, distribution margins and patient perception.

How medicine prices are decided in India At the manufacturing level, most commonly used medicines—especially for chronic conditions—are off-patent. This means multiple companies are legally allowed to produce the same formulation. In theory, competition should drive prices down. In practice, it does not always work that way.

India follows a mixed pricing model. Certain essential medicines fall under government price control, regulated through ceiling prices. However, a significant portion of branded generics operates outside strict controls. Companies are free to set their own maximum retail price (MRP), often factoring in marketing budgets, trade margins and brand positioning.

A former pharmaceutical pricing analyst explains it simply, “Two tablets can have the same molecule, same dosage and same manufacturing standards, yet differ in price because one brand spends more on promotion than the other.”

Branded generics vs generics: the misunderstood divide Unlike many Western markets, India is dominated by branded generics rather than unbranded ones. While chemically identical, branded versions are aggressively promoted to doctors, creating strong recall and preference. Over time, this branding translates into higher prices, even when lower-cost alternatives exist.

For patients, the distinction is rarely explained. Prescriptions usually carry a brand name, not the molecule. Pharmacists, bound by prescriptions and influenced by margins, may not always suggest alternatives unless explicitly asked.

This leads to a paradox: affordable medicines exist, but patients often do not access them.

The hidden cost of long-term treatment Pricing gaps hurt most in chronic care. A difference of ₹50 per strip may seem small, but over years of lifelong medication, it becomes substantial. For families managing multiple conditions, medicine costs can quietly become one of the biggest household expenses.

A Mumbai-based physician notes, “Patients often return after a few months saying they skipped doses because medicines were getting expensive. This is not a clinical problem—it’s an economic one.”

Trust, not supply, is the real gap One of the least discussed aspects of medicine pricing is trust. Many patients hesitate to switch brands even when cheaper options are available. The fear is not irrational—medicine is deeply personal, and consistency feels safer than experimentation.

What is missing is guided information. Patients rarely receive clear explanations about equivalence, quality standards or why prices vary so widely. Without that reassurance, higher-priced brands are perceived as more reliable, even when there is no clinical difference.

Where Truemeds fits into the picture It is within this gap—between affordability and trust—that Truemeds found its purpose. The idea emerged from observing how patients paid vastly different prices for the same medicines, especially those managing long-term conditions. The founders noticed that higher costs were often driven by branding and promotions rather than formulation quality.

Founded by Akshat Nayyar and Dr. Kunal Wani, Truemeds approached the issue from both operational and clinical perspectives. Their early research revealed that the problem was not a lack of affordable medicines, but a lack of awareness and medical reassurance around switching.

Instead of positioning itself purely as an online pharmacy, Truemeds built a consultation-led model. Prescriptions are reviewed, alternatives are explained, and substitutions are suggested only with structured communication. The aim is not to push cheaper medicines, but to help patients understand their options before making a decision.

As one Truemeds team member puts it, “Affordability works only when trust comes first. Patients need clarity, not just lower prices.”

Technology meets regulation Platforms operating in this space must also navigate strict compliance requirements. Prescription validation, sourcing standards and substitution protocols are not optional—they are central to patient safety. By investing early in these systems, Truemeds positioned itself among a new wave of Indian healthtech companies attempting to blend digital convenience with medical oversight.

This approach reflects a broader shift in Indian healthcare entrepreneurship: solving structural inefficiencies not through disruption alone, but through transparency and patient education.

Why the pricing maze persists Despite policy interventions, India’s medicine pricing remains fragmented. Doctors, pharmacies, manufacturers and regulators all play a role, but the patient often sits at the end of the chain with the least information.

Until prescriptions become more molecule-focused and price conversations become routine in clinical settings, disparities will continue. Digital platforms, regulatory reforms and patient awareness together may gradually narrow the gap—but there is no single switch to flip.

The price we really pay Ultimately, medicine pricing is not just about numbers on a strip. It affects adherence, health outcomes and financial stability. When patients ration medicines or abandon treatment due to cost, the system fails its most basic purpose.

As one public health expert sums it up, “Affordable healthcare does not begin at the factory. It begins when patients are empowered to make informed choices.” In India’s medicine pricing maze, clarity may well be the most powerful—and affordable—intervention of all.