Multinational life science firms have been present in India for decades. However, they have often eschewed bringing their latest products to a country that has long prioritised affordability above innovation. Now though, as India’s GDP and market value soar and the policy environment shifts towards prioritising the domestic development of more advanced products, opportunities are opening up for MNCs – with well-planned strategies in place – to bring their latest innovations to the country.


The pharmaceutical industry, both domestic and multinational, shares a positive outlook

Vikrant Shrotiya, corporate VP and managing director, Novo Nordisk India


In conversation with PharmaBoardroom, leaders of the local affiliates of multinational pharma companies with a presence in the country expressed their optimism about the evolution and growth of the Indian market and how they adopt their approaches to its specificities. “The Indian pharmaceutical market is on a trajectory akin to China’s a decade ago,” says Suresh Pattathil, managing director and GM of AbbVie’s local affiliate and president of the Organization of Pharmaceutical Producers of India (OPPI). “The pharmaceutical industry, both domestic and multinational, shares a positive outlook,” agrees Vikrant Shrotiya, corporate VP and managing director at Novo Nordisk India.


Policy Changes and Improved Business Environment

Recent policy changes and emerging access models have had a positive influence on how companies view India as a business destination. “The attractiveness of the Indian market for pharmaceutical companies, both domestic and global, hinges on policy changes and evolving access models,” Pattathil asserts.

Girisan Kariangal, managing director of Menarini India, agrees, adding that, “The business environment in India has experienced notable improvements, marked by changes in the government’s procedures and infrastructure development.”

The business of creating and managing local affiliates has become easier, Kariangal says, with the digitization of government processes, including for new drug approvals and registrations. In addition, multinationals no longer need to rely on intermediaries. “The implementation of direct subsidies through bank accounts has eliminated intermediaries, ensuring that benefits reach citizens directly,” stresses Kariangal. “This simplification and transparency contribute to a more positive perception of the business landscape.”

Apart from these improvements, Kariangal also notes infrastructure development, which has positively impacted logistics and distribution, and the introduction of the Goods and Services Tax (GST), which has streamlined taxation. “This reform has eliminated state-wise check posts and reduced delays in transportation, positively affecting the movement of goods,” he says.

“The Indian government is actively steering the nation towards a path that nurtures economic prosperity,” Pratima Reddy, GM of Merck Healthcare India, concurs. “Visible strides include simplifying business processes, refining tax structures, and promoting online transactions. The emphasis on enhancing regulations to attract foreign investments is noteworthy.” Reddy also remarks on the creation of the National Health Authority, which “underscores the commitment to improving patient flow and accessibility to medical treatments.”


Bringing Innovation to India

Historically, global pharmas hesitated to bring their latest portfolios to India, citing challenges that made the market seem unappealing. “In the Indian healthcare market, the predominant value, approximately EUR 24 billion out of 25 billion, is comprised of branded generics, with the innovative portfolio representing a comparatively smaller share,” says Reddy of Merck, a company that employs some 4,000 people locally as one of the firm’s largest affiliates.

Astellas Pharma, another international innovator firmly established in India and primarily present in the transplant space, had not seen any new launches in the country for several years. “Previously, challenges related to ease of doing business, regulatory frameworks, and cumbersome approval processes did act as a deterrent for global pharmaceutical companies looking to introduce their latest innovator drugs,” asserts Sampada Gosavi, GM and managing director India of Astellas Pharma.

However, encouraged by recent policy shifts, Astellas is now looking to launch more innovative products in the country, especially in areas such as oncology and women’s health. “There has been a considerable improvement in the regulatory environment,” says Gosavi. “The intellectual property (IP) regime has been strengthened, positioning India as a promising market for new portfolios. From 2013 to 2021, close to 70 innovator brands launched in India, indicating a positive shift in the country’s perception within the global pharmaceutical landscape.”


Medtech: Adapting to a Unique Market

The Indian market continues to have its particularities. For Japan-headquartered medtech giant Terumo, present in India for over a decade, establishing itself meant adapting. “Adapting our strategy to suit the diverse Indian healthcare market has been crucial for the success of Terumo,” says Shishir Agarwal, president and managing director of the Indian affiliate.

Specifically, Terumo has had to adjust how it approached the market. “Successfully navigating the complexities of the Indian healthcare market required a commitment to operational efficiency, the enhancement of commercial capabilities, and the establishment of a resilient organizational structure.”

Terumo is now fine-tuning its India strategy even further, says Agarwal. “Currently, our strategic focus revolves around scaling up operations, introducing innovative capabilities such as the establishment of partner R&D centres, and transitioning from a product-centric approach to delivering comprehensive solutions.”

Being able to adapt to the realities of the Indian market is also important for mid-sized international companies. “Flexibility is a valuable asset for midsize companies navigating the complexities of the Indian market,” says Menarini’s Kariangal and as a smaller company, Menarini is perhaps better placed to do this. “Unlike larger multinational corporations, midsize firms often have the agility to adapt quickly to local nuances, which can be of significant advantage,” he claims.


Challenges of Affordability

While India’s business environment and healthcare landscape have evolved, access remains a challenge with affordability as a major roadblock for international innovators looking to introduce new therapies in a country where 95 percent of healthcare expenses are out of pocket for patients.

“The key to unlocking the market’s potential lies in enabling access to innovative therapies, drawing inspiration from models seen in countries like China, Taiwan and Korea,” says OPPI’s Pattathil.

Novo Nordisk’s Shrotiya supports a collaborative approach. “Navigating the challenge of affordability in a country like India, where healthcare priorities are shifting from infectious to chronic diseases, requires a collaborative approach,” Shrotiya maintains.  To do this, “Novo Nordisk actively engages with government initiatives, such as CDIC (Changing Diabetes in Children) and collaborations with Centres of Excellence,” he says. “The company acknowledges the government’s evolving focus on addressing non-communicable diseases (NCDs) and actively participates in programs to improve access to medications.”

The decentralized nature of India’s healthcare system also adds another layer of difficulty to access. “Despite national guidelines, treatment decisions often rest with individual doctors, influencing the trajectory of patient care,” claims Shrotiya, noting that this is particularly the case when it comes to insulin use. “Only a fraction of the diabetic population in India is currently taking insulin, highlighting the need for early insulinization. The absence of a centralized access system places treatment decisions in the hands of individual clinicians, contributing to delays in insulin initiation.”


Building Relationships and Education

To tackle these issues, international pharma companies strive to maintain strong relationships with doctors and healthcare providers, something Servier has been doing for over three decades. “In India, building strong connections with doctors and healthcare providers is crucial,” Pierre Perez, managing director of Servier India contends. “We have been operating in the country for 36 years and have built a robust reputation for scientific communication.” These relationships, Perez claims, have given the French company a competitive edge over local companies.

“The key differentiator lies not primarily in pricing but in scientific communication, and engaging with healthcare professionals, aiming to provide access to global scientific expertise, new data, and real-world evidence and most importantly, keeping patients’ wellbeing at the core,” Merck’s Reddy agrees.

Education is another important element for Perez. “Many patients struggle to afford their prescriptions and often discontinue their treatment, which is detrimental to their health. We offer added value through education, aiding patients in understanding the importance of adherence to their prescribed treatment.”