Remdesivir and favipiravir, two of the most prominent drugs for treatment of covid-19, present up to ₹220 crore in sales for pharmaceutical firms in the Indian market for current financial year, with additional sales in low and middle income countries, international brokerage Sanford Bernstein said in a report.
“We estimate this to be a ₹2.0-2.2 billion market in India in FY21. Sales in other LMICs will be an upside. Assuming a steady decline in cases and no second wave, we expect the upside to be largely limited to FY21 and FY22,” Bernstein analyst Nithya Balasubramanian said.
The total figure includes around ₹70-80 crore in sales from remdesivir and the rest from favipiravir, with the latter being a variable number due to cutthroat competition and pricing war for the drug since Glenmark Pharmaceuticals’ launch, Balasubramanian said.
Both drugs have received emergency use authorisation from the Drug Controller General of India’s office to treat covid-19 patients, with Gilead Sciences Inc’s intravenous drug remdesivir used for moderate-to-severe disease and favipiravir used against mild-to-moderate symptoms.
While the price of remdesivir has largely been constant between ₹4,000 per vial for Cipla’s Cipremi and Hetero Drugs’ Covifor at ₹5,400 per dose, that of favipiravir has varied, primarily because it is a generic drug and also due to lesser complexity involved in its production. Gilead has signed a pact with six Indian companies, including Cipla and Hetero Drugs, for licensing the generic of its novel drug and for its sale in 127 low- and middle-income countries, including India.
Glenmark launched favipiravir under the brand ‘Fabiflu’ in late June at ₹103 rupees per tablet, but has also slashed its price to ₹75 per tablet in early July amid criticism that it was too expensive for treating mild-to-moderate covid-19. A full course of favipiravir for mild-to-moderate course involves up to 122 tablets over two weeks, and at ₹103 per pill, it cost more than ₹12,000.
Since Glenmark slashed its price, over half a dozen companies have come out with their own brands at a cheaper price, the latest being Sun Pharma’s ‘FluGuard’ and Lupin’s ‘Covihalt’. Sun Pharmaceutical’s brand is the cheapest, cost less than half of Glenmark’s FabiFlu at ₹35 per tablet.
The jury is still out on whether favirpiravir can treat covid-19 effectively as there is not enough research to establish that. Even Glenmark’s 150-patient phase 3 clinical trial, the only one completed so far in India, showed 40% faster recovery compared to those on standard supportive care in terms of how doctors perceived symptoms, but the primary outcome of viral clearance, an objective metric for evaluation of recovery, showed a lower rate.
With less than 2 million patients diagnosed with covid-19 so far against a population of more than 1 billion, Balasubramanian said that vaccines could provide a much higher upside but did not give an estimate for its market size as companies developing it, like Serum Institute of India, Zydus Cadila and Bharat Biotech, are not covered by the brokerage.
On an overall front, the Bernstein analyst said the pharmaceutical industry is at an inflection point after four years of torrid performance due to a $22 billion opportunity in the next 5 years from expiry of patents on various drugs, and also because Indian companies’ investments in specialty drugs and biologics portfolio in the US starts maturing. The third factor for the optimism is the growth of the Indian market from $33 billion in 2019 to $59 billion by 2023, driven by prescription branded generics.