AstraZeneca, Bayer, Eli Lilly: Why global pharma giants are betting big on India’s healthcare revolution

A FEW MONTHS AGO, British pharmaceuticals major GlaxoSmithKline (GSK) completed 100 years in India. The company, which started as H. J. Foster & Co. Ltd. in 1924, has undergone a series of name changes since then. Foster & Co. became Glaxo Laboratories, then Glaxo India and later GlaxoSmithKline Pharmaceuticals. In 2022, the global consumer healthcare business was hived off, but GSK remains one of the top pharmaceutical MNCs in India with market-leading products such as Augmentin in anti-infectives, Calpol in pain management, T-Bact in dermatology and paediatric vaccines Infanrix Hexa and Boostrix. “Over the century, we have played an instrumental role in addressing the evolving healthcare needs of India, right from introducing penicillin to life-saving vaccines and essential medicines,” says Bhushan Akshikar, managing director, GlaxoSmithKline Pharmaceuticals. “Today, we can say that we are a company in India, for India, and a key proponent of the ‘Make in India’ story,” he says.

GSK is not alone. The U.S.-based Abbott has been in India since 1910, one of the first countries outside the U.S. where it established a presence. “Today, we’re one of the largest healthcare companies in India, offering medicines, nutrition products, medical devices and diagnostic (tools). Our healthcare solutions impact one in six lives in India,” says Ambati Venu, vice president, Abbott India. Germany’s Bayer has been in India for 127 years. U.S.-based Pfizer will soon complete 75 years here. Swiss pharma major Novartis has had a significant footprint in the country since 1947. German Merck established its India office in 1967. Denmark’s Novo Nordisk, a global major in diabetic care, has been supplying insulin in India since 1935; it set up a local subsidiary in 1994. The list is incomplete.

Pharmaceutical MNCs have been serving Indian patients long before the Patent Act 1970 — which allowed Indian companies to make generic versions of patented medicines through a different process — gave a push to domestic manufacturing. The Act, along with the government’s decision to control prices of medicines and their raw materials through the Drugs Price Control Order 1970, made MNC pharmaceutical firms cede dominance to domestic players. The situation remains the same even though the government returned to the product patent regime in 2005. Home-grown firms have 80% share of the ₹2.55 lakh crore domestic pharmaceutical market.

Pharmaceutical MNCs’ India story, though, is not just about selling medicines. They are, in fact, shaping Indian healthcare by introducing innovative technologies, groundbreaking medicines and patient-centric programmes on their own as well as through partnerships with Indian firms. They are also deepening their India presence through research and development hubs, clinical trials and skill development. Almost every MNC pharmaceutical major has set up or is setting up a global capability centre (GCC) in India. “These centres of excellence (CoEs) play a significant role in generating jobs, upskilling the workforce and increasing the country’s knowledge base. They provide employment to over 90,000 people across India,” says Anil Matai, director general, Organisation of Pharmaceutical Producers of India (OPPI), the association of research-based global pharmaceutical companies in the country. A recent report by BCG and OPPI says 70% global pharmaceutical companies expect over 10% annual growth in India over the next five years, while 85% OPPI member companies plan to invest over $20 million on an average over the next five years. OPPI says India’s pharmaceutical market can touch $120 billion by 2030, which means big headroom for growth. Can the MNCs grab this opportunity?

Collaboration Is Key

The year 2025 marks two decades of product patent protection for medicines in India. This was expected to expand the market share of foreign MNCs but domestic companies continue to grow fast. Market intelligence firm IQVIA’s July-September 2024 quarter business insights report says revenues of domestic pharmaceutical firms grew 8% while that of MNCs grew 7% in Q3 2024. There are several factors behind this. First, new products from global pharmaceutical companies are a small part of the Indian market. Second, these MNCs cannot match the distribution network of domestic drug makers. Third, India is a price-sensitive market that prefers affordable alternatives launched by the domestic players. All this has forced global pharmaceutical companies to build their strategy around collaboration with local firms to launch India-specific brands with differential pricing for the domestic market. “Bayer has always focused on strengthening its presence in India by bringing innovative therapies to the Indian market faster, improving access to these therapies through tiered pricing & strategic partnerships, and accelerating R&D,” says Shweta Rai, managing director, India and Country Division Head South Asia, Bayer Pharmaceuticals. “We successfully innovated therapies in India, including Kerendia for chronic kidney disease, Verquvo for heart and Nubeqa for prostate cancer shortly after their global launch. We have entered into partnerships with Indian companies for enhanced reach and affordability,” says Rai.

Another example is the Covid-19 collaboration between U.K.’s AstraZeneca and Serum Institute of India. “Our vaccine, developed with the University of Oxford, was manufactured by Serum Institute of India post a technology transfer in India. We offered the vaccine at zero profit. We delivered three billion doses and saved over six million lives all over the world between December 8, 2020, and December 8, 2021,” says Sanjeev Panchal, country president & managing director, AstraZeneca Pharma India Ltd.

“Collaborations can help foreign firms navigate regulatory complexities, reduce costs and expand reach,” says OPPI’s Matai. India’s healthcare market, projected to double by 2030, presents significant opportunities, he says. “MNCs are poised to tap this expanding market by investing in R&D, digital healthcare and patient support programmes tailored to local needs. With the Indian government working towards making India a ‘Vishwaguru’ in drug discovery and healthcare, global companies have an opportunity to play a crucial role in this transformation by contributing innovative therapies and advanced technologies,” says Matai.

Investing For The Future

In February 2020, Switzerland’s Novartis announced the launch of Biome India in Hyderabad, its first digital innovation hub in Asia and fourth globally. The aim is to boost interaction between Novartis and partners from across the digital ecosystem, from start-ups and academia to the biggest players in the industry. Around 15 years ago, Novartis was among the pioneers when it set up a GCC in Hyderabad. It houses 18% of the 12,000-odd global development employees. The company says India has evolved to be an integral part of the development journey of many breakthrough medicines in therapeutic areas like cardiovascular, oncology, immunology, neurology and ophthalmology.

Another company whose India facilities are big contributors in finding solutions on a global scale is Roche. It has three CoEs in India. Roche Information Solutions at Pune is a digital CoE that plays an integral role in integrating patient data. The Offshore Development Centre in Chennai, in partnership with ZS Associates, consolidates data and analytics business operation services of all Roche Pharma affiliates. Roche Services and Solutions India brings expertise around technological advancements in healthcare through AI/ML. “Our GCC in Hyderabad is a hub for data analysis of all global clinical trials. The team is dedicated to advancing clinical data operations and AI & data science initiatives for Bayer worldwide,” says Bayer’s Rai. She says India is currently a part of Bayer’s 17 ongoing clinical Phase III & IV trials, involving nearly 4,000 participants. India is playing a crucial role in AstraZeneca’s global operations too, particularly in clinical trials, says Panchal. “We’re pioneering clinical innovation with new approaches to engaging with patients and trial teams in the clinic and beyond. At present, 60-plus global clinical trials are ongoing in India,” he adds.

Novo Nordisk India is also ensuring that the Indian population is well represented in global clinical trials. “Over 4,000 patients in India are participating in phase II-IV clinical trials. The company also has more than 40 ongoing trials involving diabetes and new therapy areas such as obesity, cardiovascular diseases, metabolic dysfunction-associated steatohepatitis or MASH (inflammation of liver caused by excess fat) and rare diseases like sickle cell disease, contributing to almost 10% of the global patient pool within Novo Nordisk,” says Vikrant Shrotriya, MD, Novo Nordisk India.

In keeping with the trend, India now has at least 38 pharmaceutical GCCs. “These companies are not only investing in India’s healthcare infrastructure but also creating a robust foundation for long-term growth and sustainability,” says OPPI’s Matai.

Huge Potential

The future looks bright for pharmaceutical MNCs. Digital transformation, including telemedicine, AI in diagnostics and data-driven healthcare solutions, is reshaping the industry. The companies seem to be well-positioned to capitalise on these trends by integrating their global expertise in technology with India’s growing digital healthcare ecosystem. There is also a growing emphasis on preventive healthcare, driven by rising incomes, ageing population and increasing awareness. This aligns with global pharmaceutical companies’ focus on lifestyle-related drugs and wellness programmes. The MNCs also have an advantage in complex drug development. “The shift to discovering drugs will require domestic players to collaborate with global companies in many aspects of the value chain from innovation, R&D and scaled-up manufacturing to data analytics and AI-led transformation,” says Matai. He adds this will build capability, skills and talent and ensure adoption of innovative methods to reduce the cost of delivering healthcare. “The push for universal health coverage and increased government spending on healthcare will provide a favourable environment for global pharmaceutical companies to expand reach and contribute to India’s healthcare ecosystem,” says Matai.

In fact, the government has taken several steps to make India a preferred destination for pharmaceutical MNCs. It has notified the list of countries (U.S., U.K., Japan, Australia, Canada, apart from the E.U.) under the New Drugs and Clinical Trials Rules 2019; this means waiver from local clinical trials for certain categories if the drug has been approved in those countries. Patent (Amendment) Rules 2024 have streamlined several operational matters. India has also signed the Trade and Economic Partnership Agreement with European Free Trade Association member states — Iceland, Liechtenstein, Norway and Switzerland.

The initiatives to improve healthcare access — including Ayushman Bharat, which provides financial protection and better access to quality care, the Pradhan Mantri Jan Arogya Yojana, the National Health Mission and the Pradhan Mantri Swasthya Suraksha Yojana — are encouraging developments for global pharmaceutical companies.

Bayer’s Rai says the pharmaceutical landscape in India is set to evolve significantly over the next five years. “There is emphasis on personalised medicine. We are committed to advancing this through robust research and development in critical therapeutic areas such as women’s health, kidney care, cardiology and diabetes,” she says. Bayer is investing in digital health technologies to improve patient interactions and streamline access to essential treatments through telemedicine and mobile applications. GSK’s Akshikar expects preventive healthcare to assume critical scale over the next few years due to rising incidence of lifestyle-related diseases. Interestingly, GSK is trying an Amazon-like marketplace model in India. “Our online vaccine ordering app, VaxiKart, allows healthcare professionals to place orders, manage inventory and access offers from preferred distributors,” says Akshikar. “The secret sauce is the 2Rs of Resilience and Reinvention. We are rooted in our purpose to drive innovation at scale.”

The coming years will show how many fellow MNC pharmaceutical companies are betting on resilience and reinvention to stay relevant. The efforts are certainly on.