Immunotherapy Cost Comparison: All Approved Medicines in India

Indicative per-vial costs range roughly from ₹18,000 for the nivolumab biosimilar to over ₹3,00,000 for ipilimumab, as of August 2026. Per-cycle cost depends on vial strength, whether dosing is by body weight or a flat dose, and how many vials one dose needs. The table below sets every checkpoint inhibitor approved and marketed in India side by side.

Cemiplimab, avelumab, tislelizumab and newer PD-1 medicines such as toripalimab and sintilimab are used in some other countries; their India availability and published pricing are limited or unconfirmed as of August 2026, so they are left out of the table above rather than estimated.

Full-course cost is the per-cycle figure multiplied by however many cycles your protocol runs, and cycle count — not just per-vial price — is what actually drives the total. A biosimilar nivolumab course of 12–24 cycles works out to an indicative ₹4–17 lakh. A similar-length Keytruda course can run several times higher, both because its per-cycle cost is higher and because no Indian biosimilar exists yet to bring it down. Ipilimumab is typically capped at four doses, so despite the highest per-vial cost in the table, its full course often lands in a narrower total band than a year of a cheaper drug given continuously.

These are illustrative multiplications built from the table above, not quotes for any individual patient — actual cycle count depends on cancer type, stage, response and your oncologist's protocol, and can stop earlier or run longer than any general figure suggests.

By per-vial and per-cycle cost, the Indian nivolumab biosimilar (Tishtha) is currently the most affordable approved checkpoint inhibitor, priced at roughly a quarter of the originator Opdyta since its January 2026 launch. No other molecule in the table has a domestic biosimilar yet, so the rest sit closer together in cost, with ipilimumab highest per vial and durvalumab/atezolizumab in a middle band.

Affordability only matters, though, if the drug is actually an option for your cancer. Most people reading this comparison are not, in practice, choosing freely across all six molecules — the approved indication for your specific diagnosis and biomarker results decides which one or two drugs even apply, long before price becomes a factor your oncologist weighs.

The same molecule can be quoted very differently across hospitals for reasons that have nothing to do with the medicine itself. An originator versus a biosimilar brand changes the base price. A dose calculated by body weight versus a flat dose changes how many vials one cycle needs. Each hospital's own negotiated procurement rate with the manufacturer or distributor shifts the number again. Bundled day-care admission, nursing time, monitoring bloodwork and pre-treatment scans are sometimes folded into a quote and sometimes billed separately, which is why two "per-cycle" figures from two hospitals are not always comparing the same thing.

Ask any hospital for an itemised quote — drug cost, day-care charge, monitoring tests — rather than a single bundled number, so you can compare it fairly against the ranges in the table above.

Coverage varies by scheme, by hospital empanelment, and by the specific protocol prescribed — there is no single answer that applies to every patient. Where a government scheme such as Aarogyasri sets a ceiling for a given protocol, that ceiling does not automatically stretch to cover a full course of a higher-cost originator medicine like pembrolizumab or ipilimumab. Private insurance policies also differ on sub-limits for injectable oncology drugs, and cashless approval can take longer for newer immunotherapy protocols than for standard chemotherapy.

Never assume full coverage from a general comparison like this one. Take the specific drug and protocol your oncologist has proposed to your insurer or the scheme desk directly, and get the applicable ceiling or sub-limit in writing before treatment starts.

Not immediately, on current information — nivolumab is the only molecule in this table with an approved Indian biosimilar as of August 2026. Pembrolizumab's patent protection is not expected to begin lapsing in India until around 2028-29, so its cost picture has not moved the way nivolumab's has since Tishtha's January 2026 launch. Atezolizumab, durvalumab and ipilimumab currently have no announced Indian biosimilar timeline either.

As genuine biosimilars enter the market ahead of patent expiry on some products, counterfeit checkpoint inhibitors have also been reported reaching Indian patients chasing a lower price. Sourcing any of these medicines only through a licensed hospital pharmacy with documented cold-chain handling is a patient-safety matter, not just a cost-saving one — a lower price outside that channel is a warning sign, not a bargain.

If cost is only part of why you're comparing options, Why Did My Oncologist Choose This Drug and Not the Other One? explains the clinical reasoning behind a specific prescription. For two of the molecules in this table side by side in more depth, see Pembrolizumab vs Atezolizumab. If lung cancer is your specific diagnosis, Durvalumab vs Pembrolizumab in Stage 3 Lung Cancer narrows this same cost-and-indication comparison to that setting. And for the full picture of this section — checkpoint inhibitors, biosimilars, comparisons and more — return to Immunotherapy Medicines Explained.