In India or the US - MS Treatment is Still Costly

I’m not sure which part of a recent news story I want to share first because both aspects make me angry, and again I feel frustration at knowing treatment for Multiple Sclerosis is available, but not all people are given the opportunity to put up a fight due to costs.

The story comes from India, where it is estimated that 100,000-200,000 people have MS, but most of them are never offered treatment. The reason seems to be two-fold - one is the cost and the other is the lack of medical information literacy.

First the article points out that there is a lack of knowledge about treatment options and the Disease Modifying Therapies (DMTs), among both physicians and the people with MS. The stories say that DMTs have been available in India for 15 years, which puts it behind the US and the Western world by just a few years.  The newer oral MS drugs have not yet been approved for use in India, but appear to be poised for approval in the next year or two.  The same stories go on to say that the majority of people with MS in India never receive treatment for their disease.

India is known as one of the leading manufacturing sites in the world for pharmaceutical drugs and is also a leader in the biotech industry, but unable or unwilling to treat this large MS population. India is positioned as the 4th largest economy in the world, and it is just wrong that 100-200,000 people in India are not offered the chance to slow the progression of this disease.

It is no surprise that the per capita income in India is quite low, even though it has risen much faster than other places in the world, thanks to its strong economic growth rate.  The per capita income in India is now estimated at just short of  6,000 Rupees per month. Before you get excited about that large number for income, do the currency conversion and you will find it equals about $90 US a month. That means the per capita income for a family of 4 would be less than $400 a month, but the reality is an even great percentage of people live on much less than that.

It appears that India is also known for its anemic or often non-existent health insurance and people without good coverage or who have none at all, usually go without treatment for Multiple Sclerosis.  The typical cost of the injectable treatments for MS in India is around 27,000R per month, about $400 US. The income of the average Indian family of four would have to all be used to treat the person with MS and it is unlikely that a family would use all of its resources to get treatment, when they would still need the basics of food, clothing and shelter.  Hence most of the MS population in India remains untreated.

I don’t believe the pharmaceutical company patient assistance plans we have here in the United States exist in India. I’m not sure about other countries, but I’m thinking the US market is a special situation. We  also can’t buy any of the current DMT’s approved for use in the United States for $400 – our prices are easily ten times that amount.

The escalating costs of DMTs in the United States are also out of proportion to what the average income might be.  Recent estimates of the average income in the United States for a family of four is approximately $52,000.  Current annual pricing for a few of our MS drugs includes Aubagio at $48,000, Tecfidera costs $55,000, and Gilenya for $60,000. Copaxone, one of the oldest MS drugs in use is now running about $50,000 a year. If a person in the US has to choose between treatment at these costs or the basics of food, clothing and shelter, we are no better off than the people in India with Multiple Sclerosis.

Because these are averages that use the income of the super-rich as part of the numbers, I would venture a guess that so many people with MS, both in the US and India, live on incomes well below these averages.

I started this blog with two points in mind – the first being the lack of knowledge about MS in India is hurting the patients there.  The second was going to be about how the people in India can get these drugs for about $400 and why is that so much less than what is charged in the United States.

The more I wrote and researched the numbers, a third point slowly emerged – when it comes to comparing costs in India versus the United States, is there really such a difference after all? How do we get these essential treatment drugs to people with MS, no matter where they live, without forcing them into spending their entire income in exchange for their health?   It seems to be a universal question – now we need to find an answer.

wishing you well,


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