Finance Minister Nirmala Sitharaman’s Union Budget 2026-27, unveiled on February 1, presents a curious paradox in India’s healthcare priorities: a bold ₹10,000 crore Biopharma Shakti scheme championing domestic biologics and biosimilars innovation alongside customs duty waivers on 17 cancer drugs and seven rare disease therapies that could slash monthly treatment costs from ₹70,000-₹95,000—yet an overall healthcare allocation of ₹1.05 lakh crore representing merely 6% nominal growth that inflation effectively nullifies. Facing 15 lakh annual cancer diagnoses and 8 lakh cancer deaths, the duty relief on medications like ribociclib (Kryxana for breast cancer) and abemaciclib (Verzenio) offers genuine relief for desperate patients currently resorting to crowdfunding platforms.
However, Ayushman Bharat PM-JAY receives only marginal ₹9,500 crore whilst primary healthcare infrastructure languishes. Former IMA president Dr Ravi Wankhedkar‘s criticism cuts to the contradiction: “focus on pharmaceuticals at the cost of public health.” Meanwhile, Novartis MD Amitabh Dube hails duty relief as “strengthening the ecosystem around high-value treatments,” as India’s ₹4.72 lakh crore pharmaceutical sector pivots from generics dominance toward innovation leadership amid EU Free Trade Agreement opportunities worth $572 billion in medtech access.
Biopharma Shakti: Betting on Biologics Leadership
The Biopharma Shakti scheme’s five-year ₹10,000 crore outlay establishes three new National Institutes of Pharmaceutical Education and Research centres whilst upgrading seven existing facilities alongside chemical manufacturing parks. This infrastructure investment targets India’s strategic pivot from small-molecule generics—where the nation commands 20% global market share—toward complex biologics and biosimilars, including post-2028 patent cliff opportunities for blockbuster molecules like Humira and Keytruda clones addressing non-communicable diseases, particularly cancer. Chemicals Minister J.P. Nadda characterised the initiative as designed to “enhance domestic production and usher in a new era of growth and innovation,” whilst Minister of State Anupriya Patel emphasised the vision of a “Self-Reliant India” in pharmaceuticals.
Complementary regulatory reforms through NDCT 2026 amendments deliver 90-day R&D timeline savings by converting test licenses into intimations and expanding bioavailability/bioequivalence waivers that accelerate Section 3(d) patent validations. These changes support Indian pharmaceutical giants like Sun Pharma and Divi’s Laboratories pursuing €2 billion EU contract development and manufacturing organisation pipelines, building upon the existing ₹15,000 crore PLI Pharma scheme adjacency. The PIB blueprint emphasises “manufacturing scale, skilled human resources, and clinical trials infrastructure,” targeting a network of over 1,000 accredited trial sites beyond current Mumbai-Delhi-Bengaluru concentration. This follows the Economic Survey FY26‘s pharmaceutical success narrative documenting R&D investment growth from ₹1,250 million in FY94 to ₹209.8 billion in FY19 following India’s TRIPS Agreement compliance pivot, with exports reaching $30.5 billion in FY25.
Infrastructure components extend beyond pharmaceuticals proper into WHO’s Jamnagar Traditional Medicine Centre upgrades and three new All India Ayurveda Institutes, alongside scaled AYUSH pharmacies and testing laboratories. KPMG analysis frames this as India’s strategic “move from manufacturing strength to innovation leadership,” particularly benefiting MSMEs comprising 80% of the pharmaceutical sector through industrial clusters like Gujarat’s Mundra facility positioned to exploit EU FTA’s zero-duty access reducing current 11% pharmaceutical tariffs whilst generating an estimated one million jobs supporting Viksit Bharat 2047 objectives.
Cancer Drug Relief Amid Access Constraints
Complete customs duty elimination on 17 oncology medications—including ribociclib (Kryxana costing ₹70,000 monthly for breast cancer), abemaciclib (Verzenio at ₹95,000 monthly), ceritinib for lung cancer, and advanced CAR-T therapies like talcabtagene autoleucel for blood cancers—alongside seven rare disease treatments eliminates the 10% unregistered import levy that previously forced patients toward crowdfunding desperation. Novartis MD Amitabh Dube affirmed that “easing duty barriers helps innovative treatments reach patients more effectively,” building upon last year’s 36 life-saving medication exemptions with NPPA pass-through pricing mandates ensuring retail price reductions materialise whilst patient assistance programmes receive tax exemptions. Yet Tata Memorial’s 2022 research reveals that under 3% of eligible patients access immunotherapy despite 8 lakh annual cancer deaths, exposing systemic access barriers beyond pricing alone.
Ripple effects could prove substantial: Ayushman Bharat’s 1.4 billion coverage base should absorb cheaper monoclonal antibodies, whilst rural diagnostics benefit from the PLI Medtech scheme‘s ₹4,000 crore allocation targeting 60% domestic value addition by 2028. EU FTA provisions promise 10-15% landed cost reductions on oncology biologics compounding domestic duty relief. However, scope limitations persist—merely 24 medications total receive exemptions whilst crores-scale CAR-T therapies remain unaddressed, leaving the approximately ₹500 crore annual crowdfunding dependency substantially intact.
Primary Healthcare’s Budgetary Neglect
The Health Ministry’s ₹1.05 lakh crore FY27 allocation represents 6% nominal growth over FY26 that 6% inflation renders effectively stagnant in real terms. Ayushman PM-JAY‘s marginal ₹9,500 crore alongside National Health Mission primary care stasis signals what Dr Ravi Wankhedkar characterised as “lacking direction and benefiting corporate hospitals” rather than foundational public health infrastructure. A solitary ₹100 crore allocation for allied health professional training offers minimal horizon expansion, whilst geriatric care and non-hospital delivery models receive rhetorical acknowledgement without quantified commitments or medical tourism development tilts toward corporate beneficiaries.
Positive elements exist: the 1,000 clinical trial sites network democratises research participation beyond metropolitan concentration, whilst Biopharma Shakti’s NIPER expansion could skil 50,000 youth capitalising on EU Mode 4 visa provisions easing professional mobility. Yet fundamental infrastructure voids persist—India maintains merely 1.2 hospital beds per 1,000 population against WHO’s 3.5 recommendation, rural primary health centres remain chronically understaffed, and the Budget’s ₹10,000 crore pharmaceutical innovation tilt neglects public health scaffolding essential for equitable outcomes.
Budget 2026-27’s pharmaceutical provisions vault biosimilars innovation through ₹10,000 crore Biopharma Shakti and meaningful cancer drug duty relief exploiting EU FTA tailwinds, yet overall healthcare’s ₹1.05 lakh crore anaemia sidelines primary infrastructure whilst Ayushman stagnates. India’s pharmacy sector ascends value chains from 20% generics share toward biologics leadership, but public health’s hazy horizon demands urgent recalibration—oncology access partially provisioned whilst foundational care languishes unfunded.