BACKGROUND:
Medicines remain a major driver of household out-of-pocket expenditure (OOPE) in India, despite multiple policy instruments intended to improve affordability and access¹⁻³.

OBJECTIVES:
To map government-led and government-partnered initiatives targeting medicine affordability in India and to examine implementation pathways and perceived effects through key informant interviews.

METHODS:
A scoping review of central and state government portals, statutory/regulatory publications and linked grey literature was conducted and supplemented with indexed evidence; in parallel, semi-structured interviews were undertaken with policy, procurement, prescribing, dispensing, payer and patient stakeholders. Findings were integrated using triangulation and interpreted within a health-policy analysis framework.

RESULTS:
Initiatives clustered around (i) supply-side provision and market-shaping (e.g., PMBJP/Jan Aushadhi, AMRIT and free-drug service mechanisms), (ii) regulatory interventions (e.g., DPCO/NPPA ceiling prices and procurement transparency), and (iii) demand-side financing (e.g., AB-PMJAY benefit design). Interviews highlighted persistent brand preference and trust deficits, stock-outs and non-availability that shift purchases to higher-cost private retail, and concerns about therapeutic switching for chronic care.

CONCLUSIONS:
Affordability gains depend on reliable supply chains, quality assurance and communication, and aligned incentives for prescribers and dispensers. Strengthening state capacity for procurement and distribution, improving transparency, and addressing demand-side trust barriers are central to sustained medicine affordability.