Evaluation of brand, ceiling and generic price differences in anti-epileptic drugs marketed in India: a novel cost variation analysis

Background: Epilepsy affects 6–10 million people in India, where over 60% of healthcare spending is out-of-pocket. Wide price differences in branded antiepileptic drugs (AEDs) can hinder adherence and increase financial burden. While DPCO sets ceiling prices and Jan Aushadhi offers low-cost generics, no Indian study has compared AED prices across both schemes. To assess price variation among 17 commonly used AEDs and compare brand prices with DPCO ceilings and Jan Aushadhi rates. Methods: A cross-sectional cost analysis was conducted using MRPs from the Current Index of Medical Specialties, NPPA database and Jan Aushadhi Scheme database. Price variation and ratios were calculated. Median brand prices were benchmarked against DPCO and JAS prices to evaluate cost gaps. Results: Pregabalin 75 mg capsules showed the highest inter-brand cost variation (564.7%), followed by pregabalin 150 mg tablets (487.9%) and levetiracetam 750 mg tablets (370.4%). Phenytoin 300 mg ER tablets were priced 39.63% above the DPCO ceiling and sodium valproate 200 mg tablets exceeded it by 36.7%. Branded AEDs were 0.7 to 8 times costlier than Jan Aushadhi generics; pregabalin 75 mg capsules were 667.73% more expensive. Conclusions: This first dual-layered analysis of AED pricing in India shows wide price variation and poor compliance with controls. Expanding DPCO coverage, promoting generics and educating prescribers on drug costs can improve affordability and adherence.