OBJECTIVES:  Healthcare in India is a rapidly expanding sector. Increased urbanisation, better standards of living, a growing middle class, improvements in health standards cumulatively have led to increased longevity and a shift in burden of disease dominated by infectious diseases to non-communicable diseases (NCDs). NCDs like cancer are now one of the leading cause of morbidity and mortality in India. Oncology therapeutics are generally highly priced and recognised as defining the ‘high-cost drugs’ space in the Indian market. Emerging markets such as India represent untapped revenue potential for the major pharmaceutical companies. We sought to assess market access opportunity for such drugs in India including current disease treatment landscape and reimbursement channels. METHODS:  Research involved targeted review of literature published on the topic, followed by primary research with senior oncologists involved in formulary decision-making and nationally influential on the field of practice. RESULTS:  Various public and private health insurance schemes were identified, particularly those that reimburse high cost drugs. Extrapolating from the cover provided under various schemes and affordability across income groups, a threshold of ₹2 lakh (~$3000) per treatment course was set beyond which any drug was considered high cost. Overall, ~6% of the population receive very comprehensive health cover that reimburse high cost drugs through schemes provided by central government, state government, railway, armed forces. CONCLUSIONS:  At first glance, opportunities for high cost drugs in India can be considered low considering limited reimbursement options and lack of affordability for majority of the population. However, 6% of the population engaged in the public sector have good health cover which include reimbursement for high cost drugs. Together, this is a substantial market and the opportunity should be considered as ‘high’.