OBJECTIVES: Pharmacotherapy has improved survival for non-small cell lung cancer (NSCLC) but is limited by financial burden in resource poor settings. National list of essential medicines (NLEM) and drug price control in India intend to reduce this burden. This study was planned to compare costs among advanced NSCLC patients who get essential vs non-essential medicines. METHODS:  Patients diagnosed with advanced NSCLC from July 2016 to January 2017 were enrolled in this prospective, observational study. Data on demography, quality of life and estimate of treatment related costs (direct and indirect) was collected. Group A patients received essential medicines (NLEM) and group B received medicines outside NLEM. Indian costs were converted to USD (per patient per month) and data is expressed as mean±SD/ median (range). RESULTS:  Forty advanced NSCLC patients (age 55.4±10.5 years; 33% females; 38% nonsmokers; 25% local residents) were enrolled. Median treatment duration was 2.75 (0.33–14) months in group A (n=16) and 6.5 (0.5– 72) months in group B (n=24). Average cost incurred was 750.1 (235–5304) in group A and 541.1 (40–4258) in group B. Cost of medicines was 55.6 (0.5–2731) and 87.2 (3.6–2517) respectively. Cost of hospitalization did not differ significantly but cost of investigations was 103.3 (0–1175) and 69.1 (6.1–1468) respectively. Indirect costs were 398.9 (54.3–2564) and 234.3 (5.1–1777) respectively. Among these, transportation for outstation patients and work loss for young accounted for major expenditure. CONCLUSIONS: There has been a great emphasis on affordability of anticancer medicines in India. However, medicines accounted for only 1/5^th costs in our study. Medical investigations and/or indirect costs substantially add to the overall financial burden. Additional measures such as judicious use of investigations and optimizing outpatient treatment are required to ensure treatment access in the absence of widespread medical insurance.