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Predictable price control key to success in healthcare

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Prime Minister Narendra Modi announced the Make in India initiative from the ramparts of the Red Fort on 15 August 2014, encouraging international and domestic investors to set up shop and manufacture in India for consumption here and for the rest of the world. It was meant to remedy the low contribution of the manufacturing sector to Indian GDP compared to other similarly placed developing countries.

The initiative was received well by the investor community and has seen a steady increase in investment flows in order to support the government’s bid to expand the manufacturing sector in India. State governments, on their part, developed investment regions, embarked on road shows and provided infrastructure support as well as performance linked incentives to potential investors. The initiative focused on 25 sectors with healthcare as a key sector for building up domestic manufacturing, with a focus on pharmaceuticals and medical devices. India’s healthcare industry comprises hospitals, medical devices and equipment, health insurance, clinical trials, telemedicine and medical tourism. The Government of India is making structural reforms to strengthen the healthcare sector and encouraging Foreign Direct Investment (FDI). In fact, India’s FDI regime has been liberalised extensively. Currently, FDI is permitted to up to 100% under the automatic route in the hospital sector and in the manufacture of medical devices. In the pharmaceutical sector, FDI is permitted up to 100% in green field projects and 74% in brownfield projects under the automatic route.

Despite all these efforts, healthcare has comprised just 1.36% of total FDI flows until March 2021. Why then is the investing community shy of making aggressive investment decisions to set up green field plants to make pharma APIs (active pharmaceutical ingredient) or medical devices in India? Why are investors unwilling to produce in India despite huge domestic and global demand? The answer lies in the uncertain regulatory environment, unpredictable price control policies and a lack of sustainable policies over a period of time. Any investment decision will need to consider returns on the investment and the payback period. For API or medical device manufacturing, ROI and payback period depends on the end prices of the final drug or device, which are under price controls.

The Department of Pharmaceuticals under Ministry of Chemicals & Fertilizers revised the Drug Price Control Order (DPCO) in 2013 to increase the ambit of price control for drugs. The DPCO 2013 has scheduled and non-scheduled drugs. The scheduled drugs are those which are part of National List of Essential Medicines (NLEM) and prices are fixed by the government. The manufacturers are allowed to fix the prices for non-scheduled drugs; however the prices cannot be increased more than 10% annually which includes the inflation rate.

Medical devices are regulated under the Drug and Cosmetic Act 1940 and treated as a drug by definition. By virtue of this anomaly, medical devices can be brought under price control using similar criteria as pharmaceuticals. In 2016, for example, coronary stents were categorized as essential drugs and brought under price control. The knee implants (though these are not under essential category) were brought under price control using special powers under of para 19 of the DPCO 2013. This decision was never revisited by the regulators.

Even those drugs which are “non-scheduled”, can be brought under price control. Any drug which becomes economically unviable, goes off the shelves of the chemists. API manufacturers also fear a return of price controls on the API’s themselves as was the case until 2013. The price control mechanism has been made perpetual, which means, price control on any drug or device can be imposed at any time. The pharmaceutical industry has made India proud as the “pharmacy of the world”. Best-in-class generic drugs produced by Indian and global companies have contributed to affordable healthcare in India and abroad. The likes of Sun, Cipla, Dr Reddy Lab, Lupin and Glenmark are some of the Indian multinationals contributing to the vision of make-in-India for the world. While we produce world class generic drugs, we continue to have significant dependence on China for the APIs and key raw material for APIs. The pharma sector’s dependence on imports is significant and any shortage can have serious impact on India’s pharma industry.

Medical devices are the backbone of the healthcare infrastructure as these are the tools that help in diagnosing diseases and support the most advanced treatments for the evolving health concerns. India also supports the patients from other countries with specialized treatments in our modern hospitals, we call it medical tourism. India is competing with Singapore and Dubai in the expanding healthcare tourism pie.

However, we continue to be dependent on the imports of high-tech medical devices. As per Government of India’s own assessment, this situation is not going to change much in the next five years. While we are able to make and export syringes, masks, PPE, stents and some more, we will still depend on imports for sophisticated advanced medical devices like pacemakers, heart valves etc. This situation, unless corrected, will not provide predictable regulatory environment for the investors. The Drug and Cosmetic Act and DPCO–2013 do not represent a future-ready outlook for new investments.

The government of India has rolled out incentives for making API’s and medical devices in India, including performance-linked incentives, allowing 100% FDI in medical devices and medical device parks in some states. At the same time, the government is making local value addition a necessary condition for the medical devices being procured by central government agencies. This carrot-and-stick approach will not be effective in attracting investments at pace to meet the government’s self-reliance goals by 2030. Investors need more predictability in the imposition of price control and visibility on policy going forward. Investors are not really looking for fiscal incentives to expand, but a predictable regulatory environment and ease of doing business. The industry works with multiple agencies—the Ministry of health and family welfare, the department of pharmaceuticals, Niti Aayog, and the ministries of external affairs and commerce as direct stakeholders. A more streamlined vision and predictable policy environment can ensure that the industry and the government can achieve their goals together.

Rakesh K. Chitkara is the Senior Director of Global Government Affairs, South Asia of Abbott.

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Tesla eyes India market as Elon Musk makes bold AI prediction

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In a recent X Spaces session with Nicolai Tangen, CEO of Norges Bank Investment Management, Tesla CEO Elon Musk emphasized the importance of electric vehicles (EVs) in India, stating that it’s a natural progression for every country to embrace them. Musk highlighted India’s status as the most populous country globally and stressed that electric cars should be accessible to Indian consumers like they are in other parts of the world.

Musk’s comments coincide with Tesla’s intensified efforts to expand its presence in the Indian market. Sources reveal that the state governments of Maharashtra and Gujarat have extended enticing land offers to Tesla for the establishment of a cutting-edge EV manufacturing plant. The proposed investment for this venture ranges between USD 2 billion to USD 3 billion, demonstrating Tesla’s commitment to both domestic and international markets.

This move aligns with India’s new EV policy, which aims to attract investments from global EV manufacturers and promote the adoption of advanced EV technology among Indian consumers. The policy emphasizes the importance of domestic value addition (DVA) and sets specific localization targets for manufacturers establishing operations in India.

To incentivize investment, the government has introduced measures such as customs duty exemptions and import quotas for EVs based on the level of investment made by manufacturers. These initiatives aim to position India as a preferred destination for EV manufacturing and contribute to the country’s Make in India initiative.

In anticipation of these developments, Tesla plans to dispatch a team of experts to explore suitable locations across India for the proposed manufacturing facility. Musk’s previous statement about visiting India in 2024 further underscores the company’s eagerness to enter the Indian market and collaborate with local stakeholders.

Tesla’s expansion into India represents a significant step forward in the global EV landscape and underscores the company’s commitment to sustainable transportation solutions. With India poised to become a key market for electric vehicles, Tesla’s entry is expected to drive innovation and accelerate the adoption of EVs in the country.

As the electric vehicle market continues to evolve, Tesla’s entry into India holds the potential to reshape the automotive industry and contribute to India’s transition towards a greener and more sustainable future.

Tesla’s entry into the Indian market not only signifies a pivotal moment for the country’s automotive industry but also presents an opportunity for Tesla to capitalize on India’s growing demand for electric vehicles. With the Indian government’s focus on promoting clean energy initiatives and reducing carbon emissions, Tesla’s electric vehicles align perfectly with India’s sustainable development goals.

Moreover, Tesla’s presence in India is expected to stimulate job creation and economic growth, particularly in the manufacturing sector. The establishment of a state-of-the-art manufacturing plant will not only provide employment opportunities for local residents but also foster the development of ancillary industries and supply chains.

In addition to manufacturing, Tesla’s entry into India is poised to catalyze advancements in EV infrastructure and technology. As Tesla vehicles become more accessible to Indian consumers, there will be a corresponding need for charging infrastructure and support services. This presents opportunities for collaboration with local businesses and government agencies to build a robust EV ecosystem.

Furthermore, Tesla’s entry into India could spur competition and innovation in the domestic automotive market, encouraging other manufacturers to invest in electric vehicle technology. This competition could lead to advancements in battery technology, vehicle performance, and affordability, ultimately benefiting consumers.

Overall, Tesla’s decision to establish a manufacturing presence in India reflects the country’s growing importance in the global automotive industry and underscores India’s potential as a key market for electric vehicles. As Tesla’s footprint expands across the country, its impact on India’s economy, environment, and technological landscape is expected to be profound.

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Air India, BIAL Partner to Create South India’s Top Aviation Hub

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Air India and Tata Group airlines will partner with BIAL to improve airport services and connectivity at Bengaluru’s Kempegowda International Airport, including setting up an exclusive lounge for premium passengers.

Air India and Bangalore International Airport Limited (BIAL) have entered into an agreement aimed at bolstering Bengaluru’s status as a premier aviation hub for southern India. The collaboration seeks to enhance air travel connectivity to and from India over the next five years.

Under the agreement, Air India, along with other Tata Group airlines such as AIX and Vistara, will work closely with BIAL to improve international connectivity, operational efficiency, and passenger experience at Kempegowda International Airport, Bengaluru (KIAB or BLR airport). This includes plans to strengthen the group’s presence at the airport and establish a dedicated domestic lounge for premium and frequent travelers of Tata Group airlines.

Furthermore, Air India has signed a memorandum of understanding (MOU) with the Government of Karnataka to develop maintenance, repair, and overhaul (MRO) facilities at the Bengaluru airport. This partnership aims to stimulate the MRO ecosystem and create over 1,200 new job opportunities in the state.

Campbell Wilson, CEO and MD of Air India, emphasized the importance of airline-airport synergy in enhancing customer experience and operational efficiency. He expressed enthusiasm for strengthening Air India’s relationship with BIAL and expanding its presence at the airport, as well as establishing a major MRO center.

Hari Marar, MD and CEO of Bangalore International Airport Limited, highlighted the BLR airport’s commitment to becoming the international gateway in Southern and Central India. He stated that the collaboration with Air India aligns with the Ministry of Civil Aviation’s vision of developing Indian airports as hubs and aims to enhance the passenger experience. Marar also expressed ambitions to capture a significant share of long-haul routes from Bengaluru Airport over the next five years.

In related news, Air India announced the appointment of Jayaraj Shanmugam as its Head of Global Airport Operations, effective April 15. Shanmugam, who previously served as the chief operating officer (COO) at BIAL, brings extensive experience to his new role.

The collaboration between Air India and BIAL represents a significant milestone in the transformation of Bengaluru into a key aviation hub in the region. By leveraging each other’s strengths and resources, the partnership aims to not only enhance air connectivity but also contribute to the economic growth of Karnataka by generating job opportunities through the establishment of MRO facilities.

Jayaraj Shanmugam’s appointment as the Head of Global Airport Operations further solidifies Air India’s commitment to optimizing its airport operations and providing a seamless travel experience for passengers. His extensive experience in airport management, coupled with his previous role at BIAL, positions him well to drive operational excellence and efficiency within the airline.

As the aviation industry continues to evolve, alliances between airlines and airports are becoming increasingly vital to meet the growing demands of travelers and enhance overall competitiveness. The strategic collaboration between Air India and BIAL sets a precedent for future partnerships in the aviation sector, emphasizing the importance of cooperation and synergy to achieve common goals.

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March sees strong growth in Indian pharma market, up by 9.5%

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The Indian pharmaceutical market (IPM) experienced a notable 9.5 percent increase in sales in March, reflecting robust value growth across various therapy segments, except for respiratory. According to data from research firm Pharmarack, all therapies demonstrated positive value growth, contributing to the overall expansion of the market.

Sheetal Sapale, Vice President-Commercial at Pharmarack, noted that while many pharmaceutical companies showed double-digit value growth, unit growth remained a challenge. The growth in sales during March was primarily driven by value growth and new introductions, particularly in the anti-diabetic segment.

Several factors contributed to the uptick in sales, including new product introductions and patent expiries. For instance, there were multiple launches in the hematinic market following the loss of exclusivity rights for iron supplement Orofer FCM in October 2023. Additionally, patent expiries for drugs like Linagliptin and Dulaglutide further fueled competition in the anti-diabetic segment.

In March, Alkem emerged as one of the few companies reporting positive unit and value growth, with a 15.1 percent increase in value and an 11.3 percent increase in units sold. Other key players such as Cadilla, Fourrts, and Natco Pharma also witnessed double-digit value and unit growth during the month.

The top-selling medicine brands in March included Glaxo Smith Kline’s Augmentin and USV’s Glycomet GP, with Augmentin achieving sales of Rs 73 crore. Despite facing challenges in unit growth, Augmentin reported a 10 percent increase in value sales. Mankind’s Manforce condom brand retained its position as the third top-selling brand, despite negative unit and value growth.

Cipla’s Foracort inhaler maintained its fourth position in the respiratory segment, with sales totaling Rs 50 crore. Abbott’s Type 2 diabetes/weight management drug Rybelsus demonstrated remarkable growth, with a double-digit value growth rate of 7 percent and a staggering 75 percent increase in units sold in March.

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McDonald’s buys all Israeli franchise restaurants amid boycotts

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Aljazeera said that McDonald’s announced it will purchase its 30-year-old Israel franchise from Alonyal Ltd., taking back control of 225 outlets that employ more than 5,000 people. After US fast-food business Alonyal announced that it would be giving free meals to the Israeli soldiers in response to the October 7 bombing by Palestinian group Hamas, there were protests and boycotts. While McDonald’s is a global corporation, its franchises are typically locally owned and operate independently. Its CEO, Chris Kempczinski, said previously that the company had seen “meaningful business impact” in several markets in the Middle East and some outside the region due to the Israel-Hamas conflict, as per Aljazeera.

“For more than 30 years, Alonyal Limited has been proud to bring the Golden Arches to Israel and serve our communities,” Omri Padan, CEO and owner of Alonyal, said in a statement on Thursday. According to Aljazeera, McDonald’s added that it “remains committed to the Israeli market and to ensuring a positive employee and customer experience in the market going forward.” Following the transaction’s completion in the coming months, McDonald’s will assume ownership of Alonyal’s outlets and operations, maintaining its current workforce. However, the terms of the transaction were not disclosed by the companies involved. In February, Kempczinski said that the war had had a “disheartening” effect on sales in Middle Eastern countries and other Muslim-majority nations such as Malaysia and Indonesia. “So long as this conflict, this war, is going on, we’re not expecting to see any significant improvement in this,” Kempczinski said in a conference call. “It’s a human tragedy, what’s going on, and I think that does weigh on brands like ours.”

During October–December, sales growth for the fast-food chain’s Middle East, China, and India division was only 0.7 percent, significantly lower than market projections of 5.5 percent. This decline follows calls for a McDonald’s boycott by customers in Muslim countries, prompted by Alonyal’s announcement. Consequently, franchisees in nations like Egypt, Jordan, and Saudi Arabia distanced themselves from the donations, collectively pledging millions of dollars in aid to Palestinians in Gaza.

While Chicago-based McDonald’s is known as one of the United States’ most iconic brands, most of its restaurants worldwide are locally owned and operated. Another prominent Western fast-food chain, Starbucks, has also faced boycott campaigns due to its perceived pro-Israeli stance and alleged financial ties to Israel. CEO Laxman Narasimhan told journalists in February that Starbucks saw a “significant impact on traffic and sales” in the Middle East but also in the US, where protesters campaigned against the Seattle-based company, calling for it to take a stand against Israel.

Domino’s, a US-based pizza maker with franchises around the world, also faced blowback after posts on social media claimed without evidence that it had also given free food to Israeli soldiers. The brand’s same-store sales dipped by 8.9 percent in Asia in the second half of 2023, mainly because consumers in Malaysia associated it with the US, an Israeli ally, a company official said.

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Disney CEO targets password-sharing, following Netflix

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Disney CEO Bob Iger has revealed plans to tackle password-sharing on the company’s streaming platform, set to commence in June. Iger stressed in a CNBC interview the importance of consolidating the streaming industry, with the initiative aimed at boosting subscriber growth and improving profitability. He articulated aspirations for achieving double-digit margins for the business.

This move mirrors actions taken by streaming giant Netflix, which experienced a substantial surge in subscribers after cracking down on password-sharing, surpassing Wall Street’s expectations by adding nearly 22 million subscribers in the latter half of last year.

Iger’s announcement closely follows a proxy battle against Disney’s activist investors, including Nelson Peltz, who had criticized Disney’s performance in the streaming-television sector. Reflecting on the outcome of the proxy vote, Iger expressed satisfaction with the resounding endorsement of the board’s strategies, particularly concerning CEO succession. Moreover, Iger has also hinted at ongoing plans regarding partnerships for ESPN.

The victory in the proxy battle strengthens Iger’s position as Disney endeavors to revitalize its film and television franchises, achieve profitability in its streaming division, and establish partnerships for ESPN’s digital expansion.

Last year, Netflix expanded its crackdown on password-sharing to over 100 countries, extending beyond the United States. As part of its efforts to address market saturation and explore new revenue avenues, the platform implemented restrictions on password-sharing and introduced a subscription option supported by ads.

Emails were sent out to customers in 103 countries and territories, including key markets such as the United States, Britain, France, Germany, Australia, Singapore, Mexico, and Brazil, in May 2023. These emails reiterated Netflix’s policy that accounts should only be used within a single household.

To ease the transition, Netflix provides paying customers with the option to add an extra member from outside their household for a supplementary monthly fee. In the United States, this fee amounts to $8 (Rs 660). Members are also given the ability to transfer a person’s profile to maintain their viewing history and personalized recommendations, ensuring a seamless experience.

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India’s Ayurveda market to reach Rs 1.2 trillion by FY28

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The Ayurveda product market in India is poised for substantial growth, with projections indicating a remarkable increase in market value to Rs 1,20,660 crore ($16.27 billion) by FY28 from the current Rs 57,450 crore ($7 billion), according to a study conducted by Ayurveda tech startup NirogStreet.

The surge in the Ayurveda product market can be attributed to several factors, including the escalating demand for natural and herbal remedies both domestically and internationally. Additionally, the rise in the number of Ayurvedic medical practitioners, coupled with government initiatives and the emergence of new entrepreneurs in the sector, has further fueled the market’s expansion.

NirogStreet’s survey revealed that the overall market for Ayurveda products and services is expected to grow at a Compound Annual Growth Rate (CAGR) of 15 percent from FY23 to FY28. Specifically, the product and service sectors are anticipated to witness growth rates of 16 percent and 12.4 percent, respectively, during this period.

The survey also shed light on the Ayurvedic manufacturing landscape in India, estimating its value at Rs 89,750 crore ($11 billion) in FY22. This figure encompasses the value of exports, amounting to around Rs 40,900 crore ($5 billion), with imports estimated at Rs 8,600 crore ($1 billion).

Participation in the survey was significant, with approximately 7,500 manufacturers from 10 states, including Uttar Pradesh, Bihar, Madhya Pradesh, Delhi, Haryana, Rajasthan, Punjab, Maharashtra, Jammu and Kashmir, and Kerala.

At a recent CII AYUSH Conclave, Padmashri Vaidya Rajesh Kotecha, Secretary, Ministry of AYUSH, emphasized the importance of positioning AYUSH products in global markets and fostering innovation within the ecosystem. He highlighted that the AYUSH sector has witnessed remarkable growth, reaching $24 billion in a span of 10 years.

In light of this exponential growth trajectory, NirogStreet underscored the significant potential of the Ayurveda product market to become a key contributor to India’s economy.

The recent surge in the Ayurveda product market underscores a broader global trend towards holistic and natural wellness solutions. As consumers increasingly prioritize health and well-being, Ayurveda’s ancient wisdom and emphasis on holistic healing are gaining traction worldwide.

India’s rich heritage in Ayurveda positions it as a global leader in this burgeoning industry. The country’s vast array of medicinal herbs, traditional knowledge, and skilled practitioners serve as key assets in driving the growth of the Ayurveda sector. However, amidst the promising growth prospects, challenges persist, including the need for stringent quality control measures, standardization of products, and greater awareness about Ayurveda’s efficacy. Addressing these challenges will be crucial in ensuring the sustainable growth of the industry and maintaining consumer trust.

The endorsement of Ayurveda by government authorities and the proactive role of industry stakeholders in promoting innovation and research are essential steps towards realizing the full potential of the sector. In conclusion, the projected growth of India’s Ayurveda product market signifies a transformative shift towards holistic wellness and natural remedies. With concerted efforts from both public and private sectors, the Ayurveda industry is poised to emerge as a significant driver of economic growth while enriching lives with its time-tested principles of well-being.

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