Tishtha: India's Nivolumab Biosimilar and What It Costs

Tishtha is a biosimilar version of nivolumab — a PD-1 immune checkpoint inhibitor — made by Zydus Lifesciences and launched in India on 22 January 2026 at prices the company put at roughly one quarter of the reference brand. This page sets out what it is, what the published prices do and do not cover, whether it is the same medicine as the originator, and how to check that a vial is genuine. It is a reference, not a recommendation.

Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026

Tishtha is Zydus Lifesciences' biosimilar version of nivolumab, a PD-1 immune checkpoint inhibitor given as an intravenous infusion. It received Indian regulatory approval in July 2024 and reached the market on 22 January 2026 — the first nivolumab biosimilar launched anywhere in the world. It is prescription-only and hospital-administered.

Nivolumab itself is not new. It blocks the PD-1 receptor on T cells, which some tumours use to switch off an immune response against them. Indications reported at the Indian launch include melanoma, non-small cell lung cancer, renal cell carcinoma and head and neck squamous cell carcinoma, among others. What is new is the price point — and that is why this molecule is suddenly a live conversation for families who had been quietly written out of it.

Regulatory status, as of August 2026: Tishtha holds Indian approval granted in July 2024, with a Phase IV post-marketing study attached as a condition, and has been marketed in India since 22 January 2026. Whether any individual hospital stocks it is a procurement matter for that hospital, not a regulatory one.

Indicative only, as of August 2026. Every figure here is a published manufacturer or reported price for the product — it is not a CION price for this molecule. List prices move, and hospital procurement rates, scheme ceilings and insurer settlements all differ from them.

Same active molecule, different manufacturer. Tishtha contains nivolumab, as the originator brand does, and holds Indian approval as a biosimilar to it. A biosimilar is not a generic copy of a tablet. It is a separately manufactured biologic that has to prove similarity to the reference product before a regulator will approve it.

That bar matters. Nivolumab is a large, complex antibody, so it cannot be reverse-engineered the way a small-molecule pill can once a patent lapses. The manufacturer must run its own analytical, non-clinical and clinical similarity studies and show no clinically meaningful difference from the reference product. Approval then applies only within the reference product's indication set. The Phase IV condition attached to Tishtha's 2024 Indian approval is a routine post-marketing requirement, not a caveat about the approval itself.

This page does not rank one manufacturer's product against another's. Which brand a hospital procures is driven by formulary agreements, scheme empanelment and price. Whether nivolumab of any brand suits a particular patient is driven by cancer type, stage, prior treatment and, in some cancers, a biomarker result — a clinical judgment for the treating oncologist.

Who Tishtha is not for

Most people with cancer in India are not candidates for a checkpoint inhibitor at all, and a lower price does not widen who it suits. Nivolumab is approved in India for a defined set of cancers — melanoma, certain non-small cell lung cancers, renal cell carcinoma and head and neck squamous cell carcinoma among them. Within those, eligibility turns on stage, on what treatment came before, and in some cancers on a biomarker result.

It is also not suitable, without specialist assessment, for people with active or uncontrolled autoimmune disease, people on high-dose immunosuppressive medicines, or organ transplant recipients. Checkpoint inhibitors work by lifting a brake on the immune system, which is why these situations need individual review rather than a general rule from a web page.

This page is not a price quote, not a statement that CION stocks or supplies this product, not a comparison of one manufacturer's quality against another's, and not a route to source vials. Those questions belong with a treating oncologist and the hospital's pharmacy and billing teams.

A vial price is not a course price. Nivolumab is dosed by protocol, often by body weight, and repeated every two to four weeks over months. The drug bill is vials per infusion multiplied by the number of infusions given. Day-care charges, monitoring blood tests and response imaging sit on top of that, billed separately.

Two things follow, and both are worth raising before the first cycle rather than after the third. A single infusion may need more than one vial, so a published vial price is a building block and not an answer. And the number of cycles is not fixed at the start — treatment is reviewed at intervals and may stop earlier than planned. A written per-cycle estimate from the hospital billing desk, covering drug, day care and monitoring together, is more useful than any figure on a web page.

Scheme cover is worth checking early. Aarogyasri, CGHS, ECHS, ESI and private insurers treat high-cost biologics differently, and empanelment can be specific to a brand rather than a molecule. Any scheme ceiling quoted to a family is indicative, as of August 2026, and should be confirmed in writing.

• Procure through the hospital pharmacy. Direct from the manufacturer or an authorised distributor. A vial bought around the hospital cannot be verified afterwards.
• Insist on a printed invoice. It should name the product, batch number, expiry date and supplier. Keep it — it is the paper trail if a batch is ever recalled.
• Match vial to carton to invoice. Batch number and expiry should agree across all three, and the carton seal should be intact.
• Cold chain, 2 to 8 degrees Celsius, unbroken. Nivolumab is a refrigerated biologic. A vial carried home in a bag, left out, or frozen is unsafe even if genuine.
• Refuse informal supply routes. No vial from an agent, a family contact or an overseas courier should be used before the hospital pharmacy has inspected and accepted it.
• Ask where this vial came from. A properly run oncology pharmacy answers that in one sentence, and no reasonable team takes offence.

This is general safety guidance about a high-value refrigerated biologic. It is not an allegation against any named manufacturer, distributor or hospital.

Probably more entrants, possibly lower prices, but nothing is settled. Reported nivolumab biosimilar pipelines as of 2026 include Reliance Life Sciences and Enzene in India, and Amgen, Sandoz, Biocon and others internationally. More approved entrants usually pushes biosimilar prices down over time. By how much, and how soon, is unknown.

The Indian sequence so far is unusual. The originator's Indian patent protection ran to May 2026, yet the biosimilar launched in January 2026 under court permission after a Delhi High Court division bench set aside an injunction, with the Supreme Court declining to interfere on 11 February 2026. Pembrolizumab, the other widely used PD-1 inhibitor, sits on a different clock — its protection is expected to begin lapsing around 2028-29, so no equivalent price effect should be assumed for that molecule yet. Our pages on when a pembrolizumab biosimilar might reach India and what the Keytruda patent expiry means for Indian patients follow that timeline.

One practical caution. A family budgeting for treatment starting now should budget on today's published prices, not an expected future fall. Delaying a treatment an oncologist has recommended, in the hope of a cheaper entrant, is a decision with clinical consequences and belongs in a conversation with that oncologist.

• Is a Nivolumab Biosimilar as Good as Opdyta? — the equivalence question in depth, and what a biosimilar approval does and does not establish.
• When Will a Pembrolizumab (Keytruda) Biosimilar Reach India? — the other PD-1 inhibitor families ask about, and why its timeline differs.
• What the Keytruda Patent Expiry Means for Indian Patients — how a patent lapse translates, and fails to translate, into a lower bill.
• Immunotherapy Medicines Explained — the reference section this page sits in, including how pricing and regulatory information is sourced.
• Immunotherapy at CION — the pillar guide to what immunotherapy is, who it suits, and how it is delivered as day care.

This page is editorial reference content, not an offer, a price list or a recommendation to use any named product. It makes no comparative quality claim between manufacturers. Prices come from the manufacturer's published launch announcement and subsequent reporting, dated January 2026 and indicative as of August 2026 — they are not CION rates, and CION does not state that it stocks or supplies this product. Whether nivolumab has a role in a particular patient's treatment is a decision for the treating oncologist.