Budget 2026: Customs duty relief on high-cost cancer drugs to aid access

A customs duty exemption on select high-cost cancer and rare disease therapies is expected to lower treatment costs for patients while supporting demand for multinational and domestic pharma companies

A customs duty exemption on 17 high-cost cancer drugs and therapies for seven rare diseases is set to ease access to some of the most expensive treatments in India, while offering a demand tailwind to global and domestic drugmakers with largely imported portfolios. By cutting the duty incidence from 5–10 per cent to zero with immediate effect, the measure lowers landed costs for manufacturers and distributors and is expected to translate into modest but meaningful price relief for patients who pay largely out of pocket.

 

Who benefits on the company side

 

The move is positive for multinational innovators that dominate oncology and rare-disease therapeutics in India. Novartis stands to gain from duty-free imports of ribociclib (Kisqali/Kryxana), a CDK4/6 inhibitor used widely in hormone receptor-positive breast cancer. Eli Lilly similarly benefits through abemaciclib (Verzenio/Ramiven), another mainstay in the same indication. AstraZeneca gains from tremelimumab (Imjudo), used in advanced liver cancer, while Roche-linked portfolios benefit via venetoclax for chronic lymphocytic leukaemia.

 

Other global players with products on the list include AbbVie (ibrutinib), Blueprint Medicines/Ariad (ponatinib), Bayer (darolutamide) and Bristol Myers Squibb (ipilimumab), alongside multiple immune checkpoint inhibitors that are predominantly imported. With customs duties removed, companies can either recalibrate prices to improve affordability or maintain pricing while expanding patient access through hospital tenders and assistance programmes — both outcomes supportive of volumes.

 

A notable domestic beneficiary is ImmunoACT, whose talicabtagene autoleucel (NexCAR19) — India’s first indigenously developed CAR T-cell therapy — also qualifies for the exemption. While CAR-T therapies remain expensive even by Indian standards, the duty relief improves overall treatment economics and strengthens India’s position as a manufacturing and clinical hub for advanced cell therapies.

 

In the rare disease segment, Alnylam Pharmaceuticals benefits from the exemption on lumasiran (Oxlumo) for primary hyperoxaluria type 1, while makers of C1 esterase inhibitors for hereditary angioedema and suppliers of intravenous immunoglobulin (IVIG) for primary immunodeficiency disorders (PIDDs) stand to see steadier demand as affordability improves.

 

What it means for patients

 

For patients, the immediate impact is a reduction in the final cost of therapies that often run into lakhs per month. CDK4/6 inhibitors such as ribociclib and abemaciclib — used for long-term disease control in breast cancer — are expected to see price softening at the margin, easing continuity of care. High-ticket immunotherapies like tremelimumab, which can cost several lakhs per vial, become incrementally more accessible, particularly in private hospitals where import costs are directly passed on.

 

The inclusion of NexCAR19 is significant for patients with relapsed or refractory B-cell cancers. Although priced far below global CAR-T therapies, a Rs 25–30 lakh one-time treatment remains prohibitive for most families. Duty-free imports reduce ancillary costs around the therapy and can complement philanthropic and insurer support.

 

The rare disease exemptions offer even clearer relief. Patients with primary hyperoxaluria type 1 require repeated doses of lumasiran over a lifetime; removing customs duty lowers cumulative treatment costs. Those with cystinosis — who rely on named-patient imports of cysteamine therapies — benefit from reduced prices on both systemic and ophthalmic formulations. For hereditary angioedema, where emergency treatments can cost several lakhs per vial, the relief can be life-saving by improving availability during acute episodes. PIDD patients, dependent on regular IVIG infusions costing tens of thousands per session, also stand to gain from lower per-dose costs.

 

Time-bound but targeted

 

The rare disease exemption will remain valid until March 31, 2029, aligning with patient assistance frameworks and providing predictability to suppliers and hospitals. While the duty cut does not eliminate the affordability challenge — many therapies still exceed insurance limits — it narrows the gap between clinical need and financial access.

 

Overall, the measure supports innovators with imported portfolios and signals policy intent to prioritise oncology and rare diseases. For patients, it offers tangible, if incremental, relief on some of the most expensive treatments in modern medicine, improving adherence and outcomes in conditions where delays or interruptions can be fatal.