In her Budget speech Tuesday, Finance Minister Nirmala Sitharaman said, “To provide relief to cancer patients, I propose to fully exempt three more medicines from customs duties,” she said, referring to trastuzumab deruxtecan, osimertinib and durvalumab, three targeted therapy drugs with effective treatment outcomes that work by precisely identifying and inhibiting the growth of cancer cells.
At present, these patented drugs, which are imported, are prohibitively expensive, costing around Rs 5 lakh a month, keeping it out of reach for most patients. Which is why, Sitharaman’s announcement – of slashing customs duty on the three drugs from 10% to zero – holds out hope for cancer patients, bringing the cost of a vial to under a lakh.
These drugs have proved to be lifesavers for many, including a 60-year-old woman from Delhi’s Saket area. Two years ago, when she was diagnosed with Stage IV lung cancer, doctors gave her between two and nine months to live. With the targeted therapy drug osimertinib, she has outlived her doctor’s prognosis. Same is the case of two other women with the same cancer — a 77-year-old woman from CR Park and a 53-year-old who was being treated at AIIMS for gastrointestinal complaints but was diagnosed with the cancer and put on the osimertinib therapy.
Osimertinib — sold as Tagrisso — is a medication that helps in treating certain types of lung cancer by blocking the action of a protein that leads to the cancerous cells multiplying. It costs around 1.5 lakh for a strip of ten pills. Trastuzumab deruxtecan — sold as Enhertu — is a monoclonal antibody that is used for the treatment of breast and stomach cancers.
The drug was first approved by the US Food and Drug Administration for gastric and gastrointestinal cancers in 2021. Earlier this year, the US regulator approved the drug for all cancers with HER-2 receptor, including breast cancers.
The cancerous tissues grow quicker when there are HER-2 receptors. Patients have to shell out around R1.6 lakh per vial of the medicine. Durvalumab — sold as Imfinzi — is used for the treatment of certain lung and bladder cancers. It trains the body’s immune system to look for a PD-L1 protein that is found on cancer cells and attack it. This drug costs around R 1.5 lakh for every 10ml vial.
Even an exemption of 10 per cent duty on these expensive drugs is a significant one given the financial burden these long-term therapies place on patients.
Dr Abhishek Shankar, oncologist from the All India Institute of Medical Sciences (AIIMS), explains, “The drugs are still under patent, which means we do not make them here, and hence cost a lot as they have to be imported. These cost typically over a lakh. But these are all targeted immunotherapy drugs which give much better results than other available therapies for certain types of cancers. This is the reason we prescribe these therapies to even patients at AIIMS and they shell out huge amounts. Any reduction in the prices will help patients.”
There was a time when the family of the 77-year-old lung cancer patient from Delhi’s C R Park had to make a hard decision before the treatment protocol.
“We first chose a second-generation drug called Afatinib but then she had severe side effects like diarrhoea, itching and toe infection. We were told osimertinib, the third -generation drug, could give her up to three years, improve her quality of life and have fewer side effects. But we signed up for osimertinib only when its manufacturer, Astrazeneca, put us on a patient programme that allowed us to get three strips of ten pills each for Rs 1.5 lakh. Otherwise, each strip costs Rs 1.5 lakh. Still, we ran out of money and then got the drug from the grey market at lower prices,” says her daughter.
Dr Ankur Bahl, senior director of medical oncology at Fortis Gurugram, who is treating the 60-year-old patient of lung cancer, says he prescribes osimertinib to two or three patients every week.
“I have prescribed it for a particular type of lung cancer which accounts for 25 to 30 per cent of incidence in non-smoking women. I know patients who have survived with this medicine for four years. But many have to either sell their assets to get the therapy or opt for two other drugs — knowing that they are not as good — because they cannot afford osimertinib. Any reduction in the costs will help,” he says.
Dr C S Pramesh, Director, Tata Memorial Hospital, says that after the customs duty cut, the pharma industry should ensure that the tax benefit is passed on to patients.
“These three drugs have all been shown to improve outcomes in breast, lung, and some other common cancers, and the customs duty cut will make these drugs more affordable for patients with these cancers,” he says.
With inputs from Rupsa Chakraborty
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