最高法院质疑为何许多药品仍处于政府价格管控之外，以及为何患者最终面临的账单可能远高于最高零售价（MRP）。法院还询问政府现有措施是否足以解决这一问题。
The Supreme Court has questioned why many medicines remain outside government price controls and why patients can end up facing bills far higher than the maximum retail price (MRP). It has also asked whether the government’s existing measures are enough to address the problem.
政府向法院表示，贸易利润率已被设定上限，且政府可将更多药品纳入价格管控。然而，法院指出这些措施可能无法解决更广泛的问题。下一次听证会定于10月27日举行。
The government has told the court that trade margins have been capped and that it can bring more medicines under price control. However, the court has indicated that these steps may not address the wider problem. The next hearing is scheduled for October 27.
赛普拉和格伦马克制药前全球首席法律顾问穆拉利·尼拉坎坦认为，解决之道不在于扩大价格管控。他在接受CNBC-TV18采访时主张，药品分销和销售方式需要更严格的审视，更强的竞争和政府采购可为价格上限提供替代方案。尼拉坎坦为何质疑药品价格管控？
Murali Neelakantan, former global general counsel of Cipla and Glenmark Pharma, believes the solution lies beyond expanding price controls. In an interview with CNBC-TV18, he argued that the way medicines are distributed and sold needs closer scrutiny, and that stronger competition and government procurement could offer alternatives to price caps. Why does Neelakantan question drug price controls?
尼拉坎坦批评依靠价格管制来让药品变得负担得起。他提到早前对《药品价格管制令》的挑战，质疑最高法院认为价格管控可无限期持续的立场。
Neelakantan criticised the reliance on price regulation to make medicines affordable. Referring to an earlier challenge to the Drug Price Control Order, he questioned the Supreme Court’s position that price controls could continue indefinitely.
“说我们将对几乎所有药品永久实施价格管控，这是非常糟糕的政策，”他说。
“It’s very poor policy to say that we will have price control on virtually all drugs permanently,” he said.
他认为，扩大价格管控不一定能解决影响药品价格的深层经济问题。他还质疑司法机构在制定经济政策中的角色，表示政府应关注市场如何运作，而非依赖永久性价格管制。分销利润率如何影响药品价格？
He argued that extending price controls does not necessarily address the underlying economic issues affecting medicine prices. He also questioned the judiciary’s role in shaping economic policy, saying the government should focus on how the market operates rather than rely on permanent price regulation. How do distribution margins affect medicine prices?
尼拉坎坦论点的一个关键部分涉及分销商和零售商获得的利润率。他说，制造商获得的利润率往往低于分销商和零售商，并质疑为何分销成本应与药品的最高零售价挂钩。“为什么分销成本要与最高零售价挂钩？”他问道。
A key part of Neelakantan’s argument concerns the margins earned by distributors and retailers. He said manufacturers often earn a smaller margin than distributors and retailers, and questioned why distribution costs should be tied to a medicine’s MRP. “Why should the distribution cost be related to the MRP?” he asked.
他将药品配送与过路费和快递服务进行了比较。司机不会因为车辆更贵而支付更高的过路费，而快递费用也不一定基于所递送物品的价值。
He compared medicine distribution with toll charges and courier services. A motorist does not pay a higher toll simply because their car is more expensive, while courier charges are not necessarily based on the value of the item being delivered.
同样，尼拉坎塔南认为，药品的配送成本不应仅仅因为其最高零售价（MRP）较高而自动上升。他承认，某些产品，如抗癌药物，可能需要特殊处理并产生额外成本。然而，他说这并不能成为将配送利润空间与药品价格广泛挂钩的理由。
Similarly, Neelakantan argued, the cost of delivering a medicine should not automatically rise just because it carries a higher MRP. He acknowledged that certain products, such as cancer drugs, may require specialised handling and involve additional costs. However, he said this did not justify broadly linking distribution margins to medicine prices.
在他看来，配送利润空间的结构值得关注，就像哪些药品应纳入价格控制的问题一样。他提出了哪些价格上限的替代方案？
In his view, the structure of distribution margins deserves attention alongside the question of which medicines should be brought under price control. What alternatives to price caps does he propose?
尼拉坎塔南认为，仅靠价格控制无法解决可负担性问题。相反，他建议政府应鼓励竞争，并通过政府采购和配送使药品以合理价格提供。
Neelakantan argued that price controls alone would not solve the affordability problem. Instead, he suggested that the government should encourage competition and make medicines available at reasonable prices through public procurement and distribution.
他以粮食为例进行了类比，认为政府可以通过参与市场而非仅仅固定价格来帮助稳定价格。
He drew a comparison with food grains, arguing that governments can help stabilise prices by participating in the market rather than simply fixing prices.
对于药品，他提出鼓励各品牌之间的竞争，采购更多产品，并通过政府医院、药店和Janaushadhi商店进行供应。他还建议用通过这些公共渠道采购的药品替换私立医院提供的药品。
For medicines, he proposed encouraging competition among brands, procuring more products and supplying them through government hospitals, pharmacies and Janaushadhi stores. He also suggested replacing medicines supplied by private hospitals with medicines purchased through these public channels.
他认为，这样做的目标是让患者能够获得更便宜的替代药品，而不是仅仅依赖政府对单种药品价格的决定。为什么私立医院药店成为辩论的一部分？
The aim, he argued, would be to give patients access to cheaper alternatives instead of relying exclusively on government decisions about the prices of individual medicines. Why are private hospital pharmacies part of the debate?
尼拉坎塔南认为，接受医院治疗的患者可能没有自由选择购买药物的地点。与普通市场中的消费者不同，他们可能无法在其他地方购买药物并用其替代医院提供或开具的药物。“这是一种虚拟垄断，打破这些垄断是良好的经济政策，”他说。
Neelakantan argued that patients receiving hospital treatment may not have the freedom to choose where they buy their medicines. Unlike consumers shopping in an ordinary market, they may not be able to purchase medicines elsewhere and substitute them for those supplied or prescribed within the hospital. “It’s a virtual monopoly, and it’s good economic policy to break these monopolies,” he said.
他还批评了印度竞争委员会（CCI），称其最近得出结论认为，医院无需就此问题接受调查，因为市场具有竞争力。在他看来，竞争监管机构本可以帮助解决这一问题，但所做的还不够。他认为，加强竞争和提高患者选择可能比仅依赖价格管控更有效。新冠疫情经验揭示了司法干预的什么问题？尼拉坎塔南还质疑司法观察是否必然转化为医疗政策的持久变化。
He also criticised the Competition Commission of India (CCI), saying it had recently concluded that hospitals did not need to be investigated over these concerns because the market was competitive. In his view, the competition regulator could help address the problem but had not done enough. He believes stronger competition and greater patient choice could be more effective than relying on price regulation alone. What does the COVID experience reveal about judicial intervention? Neelakantan also questioned whether judicial observations necessarily translate into lasting changes in healthcare policy.
他提到最高法院在新冠疫情期间的干预，回忆称法院曾要求政府探索包括药品采购、强制许可以及政府非商业使用专利药品在内的措施。
Referring to the Supreme Court’s intervention during the COVID-19 pandemic, he recalled that the court had asked the government to explore measures including drug procurement, compulsory licensing and government non-commercial use of patented medicines.
他质疑这些程序之后发生了什么，称该自动受理案件最终不了了之，所提出的措施也没有带来有意义的行动。
He questioned what followed those proceedings, saying the suo motu case eventually disappeared and the proposed measures did not lead to meaningful action.
在他看来，这一事件凸显了司法干预的实际影响问题，因为政策变化的实施最终取决于政府。仅靠价格管控能否使药物负担得起？
In his view, the episode raises questions about the practical impact of judicial intervention when implementing policy changes ultimately depends on the government. Can price controls alone make medicines affordable?
最高法院的问题集中在现有价格管控的覆盖范围以及药品的最高零售价（MRP）与患者实际支付金额之间的差距。政府指出了贸易利润的上限以及其将更多药物纳入价格管控令的权力，但法院质疑这些措施是否足够。
The Supreme Court’s questions have focused on the coverage of existing price controls and the gap between a medicine’s MRP and what patients ultimately pay. The government has pointed to capped trade margins and its power to bring more medicines under pricing orders, but the court has questioned whether these measures are sufficient.
尼拉卡南坦认为，这个问题还需要关注药品分销的利润空间、市场竞争以及低价药品的获取渠道。他认为，扩大政府采购规模，并通过公共销售点增加药品供应，有助于在不完全依赖价格上限的情况下，使药品更加负担得起。
Neelakantan believes the problem also requires attention to distribution margins, competition and access to lower-priced medicines. Wider government procurement and greater availability through public outlets, he argues, could help make medicines more affordable without relying exclusively on price caps.
10月27日的下一次听证会将为法院再次审视政府立场提供机会。更广泛的问题在于，扩大价格管制是否足够，或者是否还需要对药品的分销和供应方式进行调整。
The next hearing on October 27 will give the court another opportunity to examine the government’s position. The broader question is whether expanding price controls will be enough, or whether changes to how medicines are distributed and supplied are also needed.