Why does Gleevec, a leukemia drug that costs $70,000 per year in the United States, cost just $2,500 in India? It's seemingly simple. Gleevec is under patent in the U.S., but not in India. Accordingly, Novartis, its Swiss-based manufacturer, may prevent competitors from making and selling lower-cost versions of the drug in the U.S., but not in India. Last week, India's highest court rejected an application to patent Gleevec. While the legal issue in the case is important -- the patentability of modifications to existing drugs under Indian law -- the impact of the decision will likely be broader than just that issue, escalating a long-simmering fight over patented cancer medications in emerging markets.