This study employs an observational and analytical design to compare the prices of medicines listed under the Jan Aushadhi Scheme (JAS) with equivalent branded formulations used for Eye and Ear, Nose, and Throat (ENT) conditions. The dataset comprised 696 branded medicines, including both single and combination formulations manufactured by different companies across these therapeutic areas.

The decision to focus on Eye and ENT medicines was informed by their public health relevance. According to Global Burden of Disease (GBD) estimates, hearing impairment is among the top three causes of disability worldwide, while uncorrected vision impairment and cataracts remain leading contributors to avoidable blindness. Despite this burden, affordability assessments of these therapeutic categories in India remain scarce, which justifies their selection as the core scope of the present analysis.

Data on branded drug prices were obtained from the Current Index of Medical Specialties (CIMS) for the period September–November 2021, while prices of generics supplied under JAS were sourced from the Pharmaceuticals & Medical Devices Bureau of India (PMBI) (25, 26). Both datasets report prices in Indian Rupees (INR). Medicines absent from either source were excluded.

Additional datasets were used to strengthen the scope of the analysis: Cross-country data on generic availability and pricing were drawn from the World Health Organization (WHO) Global Health Observatory (15). Information on the expansion of Jan Aushadhi Kendras (2018–2022) was obtained from official PMBJP reports. State-level distribution of Kendras was compiled from PMBI sources.

The Cost Ratio (CR) was defined as the ratio of the highest-priced branded version of a formulation to the lowest-priced version. The Cost Variation (CV) was calculated as:

CV = HBP − LBP LBP × 100 .

where HBP = highest branded price and LBP = lowest branded price. These measures capture both the dispersion of branded prices and the relative affordability of JAS generics.

Affordability was assessed using the WHO/HAI benchmark, expressed as the number of daily wages of the lowest-paid unskilled worker required to purchase a full treatment course.

Pearson’s correlation was used to test the relationship between the number of brands and cost variation. Multiple regression models were also estimated with cost variation as the dependent variable, and number of brands, formulation type (single vs. combination), and therapeutic category (Eye vs. ENT) as explanatory variables. This framework enabled testing whether greater brand competition reduces or amplifies price variation.

Time-series analysis was used to track the expansion of Jan Aushadhi Kendras between 2018 and 2022. State-level analysis identified the top five and bottom five states by Kendra distribution in 2022. To examine equity, population-adjusted ratios (Kendras per million population) were also calculated. Cross-country comparisons placed India’s generic availability and pricing alongside comparator countries using WHO datasets.

All data handling, descriptive statistics, and visualization were performed using Microsoft Excel (2019). Results are reported in tables, graphs, and geographic maps for clarity and comparability.

To extend generalizability beyond Eye and ENT, three high-burden chronic medicines were included in supplementary analysis in Appendix Table A2: Metformin 500 mg, Amlodipine 5 mg, and Human Insulin 40 IU/mL. For each, branded prices (lowest, highest, and median) from CIMS were compared against JAS prices from PMBI for identical pack sizes. The cost ratio, cost variation, and savings versus the median branded price were calculated. Monthly affordability was then estimated under standard dosing assumptions (Metformin: 60 tablets/month; Amlodipine: 30 tablets/month; Insulin: 2 vials/month), expressed as days of wage using the WHO affordability parameter.

To capture the role of formulation differences in shaping price disparities, we compiled illustrative comparisons across dosage forms for selected Eye and ENT medicines (e.g., eye drops versus ointments). For each formulation, branded price ranges (highest, lowest, and median) were compared against JAS prices, and cost ratios and price variations were computed. This supplementary analysis in Appendix Table A3 highlights how packaging, storage, and dosage form contribute to price dispersion beyond brand competition.

Several methodological limitations should be acknowledged. First, CIMS does not capture all marketed brands, while PMBI data are restricted to JAS-listed drugs, which may underestimate the full extent of market variation. Second, affordability estimates are based on national wage averages and do not capture regional disparities in income levels. Third, WHO cross-country datasets differ in survey years and data collection methods, which may affect comparability. Finally, while the study primarily focuses on Eye and ENT medicines, supplementary analysis of chronic drugs was limited to three illustrative examples and may not fully represent all therapeutic categories.

Figures 1, 2 present an updated cross-country comparison of the availability and pricing dynamics of generic and branded medicines using data from 2018 to 2021. This evidence provides a clearer understanding of India’s relative position in the global pharmaceutical landscape.

Figure 1 shows a striking disparity in the availability of generic medicines across countries. India records a median availability of only 1.4 percent, far lower than its regional neighbors such as Bangladesh (22 percent), Nepal (18.5 percent), and Sri Lanka (25 percent). Emerging economies outside South Asia perform even better, with Brazil (45 percent), South Africa (35 percent), and Thailand (32 percent) reporting far higher levels of generic availability. These findings underscore a structural imbalance in India’s pharmaceutical market, where reliance on branded medicines continues to dominate despite policy initiatives to expand generics.

Figure 2 highlights the extent of price differentials between generics and branded medicines. India’s price ratio of 59.7 indicates that generics are comparatively more expensive relative to their branded counterparts when benchmarked against other countries. By contrast, countries such as Brazil (8.0), South Africa (10.3), and Bangladesh (12.5) demonstrate significantly lower ratios, reflecting more efficient adoption of generic alternatives. Even within South Asia, India lags, as Nepal (15.0) and Sri Lanka (14.2) show far narrower price gaps.

Taken together, the updated figures reveal that India continues to face a dual challenge of low availability and high relative prices for generic medicines. This reinforces the country’s heavy dependence on branded drugs and highlights the barriers that persist in fostering widespread adoption of affordable alternatives. Given the high burden of out-of-pocket expenditure on medicines in India, the Jan Aushadhi Scheme (JAS) assumes even greater importance. By improving both the supply and affordability of generics, JAS has the potential to reduce financial stress on households and to realign India’s pharmaceutical market with global best practices.

In summary, the expanded cross-country evidence demonstrates that India remains an outlier in generic medicine adoption, lagging well behind both regional neighbors and middle-income comparators. These insights strengthen the argument for strategic interventions, including regulatory reforms, prescriber sensitization, and scaling up of the Jan Aushadhi network, to ensure that generics fulfill their promise as a cost-effective healthcare solution.

An in-depth analysis was conducted on the prices of both generic and branded Eye medicines, encompassing a total of 26 generic pharmaceuticals and 559 branded Eye drugs, each with varying packaging units. Notably, the majority of the analyzed drugs were single entities (refer to Appendix Table A1). Cost variation was calculated using the formula suggested by literature (21). Among the Eye medications, specific drugs exhibited diverse patterns. For instance, Ofloxacin Eye Drops had the highest number of branded counterparts (131), followed by Tobramycin (80) and Timolol Maleate (73). In contrast, Olopatadine Hydrochloride had only one branded counterpart. Timolol Maleate 3 mL stood out with the highest cost ratio of 21.6, signifying its status as the most expensive drug in comparison to the least expensive drug, Olopatadine Hydrochloride. The range of cost variation spanned from 7.1 percent for Gentamicin 0.3 mL to a substantial 2055.9 percent for Timolol Maleate 3 mL.

Simultaneously, the analysis extended to ENT medications, considering seven drugs from the Jan Aushadhi Scheme (JAS) drug list and their 137 branded counterparts. The analysis revealed intriguing findings. Paradichlorobenzene, Benzocaine, Chlorbutol, and Turpentine Oil at 10 mL demonstrated the highest price variation of 500 percent, while Fluticasone Propionate Nasal Spray exhibited the lowest variation at 8.5 percent. Paradichlorobenzene, Benzocaine, Chlorbutol, and Turpentine Oil at 10 mL also recorded the highest cost ratio at 6.0.

Figures 3, 4 visually represent the cost variation between the minimum branded price and the Jan Aushadhi Scheme (JAS) price for Eye and ENT drugs, respectively. The comparative analysis indicates that not all generic drugs are uniformly cheaper than their branded counterparts. Specifically, the JAS price for eye medications was found to be 69 percent higher than branded drugs. Remarkably, substantial variations were observed, with the highest differences noted for Latanoprost (419 percent) and Xylometazoline (294 percent). Cipla emerged as the leading manufacturer, producing the highest number of Eye and ENT medications (28), followed by Intas (19), Allergan (18), and FDC (18). Notably, Timolol Maleate eye drops exhibited a notable cost variation, despite having a limited number of brands in the market. The correlation between cost variation percentage and the number of brands was moderately strong at 56 percent.

Table 1 provides a detailed cost comparison for selected ENT medicines, presenting information on JAS price, maximum and minimum prices per unit, average price per unit, cost ratio, and cost variation percentage.

First: Fluticasone 50 mcg + Azelastine 140 mcg Nasal (Corticosteroids). The analysis covers 14 brands, primarily in 70 MD and 120 MD packaging units. JAS Price ranges from 189.0 to 434.9, with an average price of 333.6. The cost ratio indicates a variation of 2.3, suggesting some brands are 2.3 times more expensive than others. Cost variation is substantial at 130.1%, highlighting notable price diversity among brands.

Second: Fluticasone Furoate Nasal Spray 27.5 mcg (Corticosteroids). 18 brands are analyzed across different packaging units. JAS Price ranges from 350.0 to 434.9, with an average price of 415.5. Notably, one brand in 100 MD packaging has the same maximum, minimum, and average price, resulting in a cost ratio of 1.0 and zero cost variation. For the rest, the cost ratio varies, with a notable 59.3% cost variation.

Third: Fluticasone Propionate Nasal Spray 50 mcg (Corticosteroids). The analysis includes 27 brands with varying packaging units. JAS Price ranges from 304.4 to 533.0, averaging at 341.9. The cost ratio varies significantly, indicating substantial price diversity among brands. A notable 193.5% cost variation underscores the wide-ranging prices within this category.

Fourth: Oxymetazoline Nasal Drops (0.5 mg/mL; Sympathomimetic Agents). 8 brands are assessed in 10 mL packaging units. JAS Price ranges from 24.3 to 79.6, averaging at 53.1. The cost ratio is high at 3.3, reflecting considerable price differences. A significant cost variation of 227.2% highlights notable diversity in pricing.

Fifth: Paradichlorobenzene, Benzocaine, Chlorbutol, and Turpentine Oil Ear Drops (Analgesic). This category includes 25 brands primarily in 10 mL packaging units. JAS Price ranges from 22.0 to 132.0, with an average price of 57.4. The cost ratio is notably high at 6.0, indicating substantial price disparities. A substantial cost variation of 500.0% underscores the significant diversity in pricing.

Sixth: Saline Nasal Drops (Sodium Chloride 0.65% w/v; Sympathomimetic Agents). 29 brands are evaluated across 10 mL, 15 mL, and 20 mL packaging units. JAS Price ranges from 15.0 to 60.0, with an average price of 36.0. The cost ratio varies, indicating diverse pricing structures. A significant cost variation of 300.0% highlights the considerable price diversity in this category.

Seventh: Xylometazoline 0.1% W/V Nasal Drop (Sympathomimetic Agents). This category includes 16 brands in 10 mL packaging units. JAS Price ranges from 30.0 to 50.6, averaging at 40.1. The cost ratio indicates diverse pricing structures among brands. A notable cost variation of 69.0% underlines the variability in pricing within this category.

The analysis reveals substantial variations in pricing among different brands within each therapeutic category. The cost ratios and variation percentages highlight the complexity and diversity in the pricing of ENT medicines, emphasizing the need for strategies to promote affordability and accessibility, especially through initiatives like the Jan Aushadhi Scheme. In conclusion, the findings from this comprehensive analysis shed light on the intricate pricing dynamics of generic and branded medications for Eye and ENT conditions in India. The observed variations in cost, coupled with the impact of the Jan Aushadhi Scheme, underscore the complexity of pharmaceutical pricing and the potential avenues for enhancing affordability and accessibility.

The combined statistical analysis provides further insights into the dynamics of drug pricing under the Jan Aushadhi Scheme. As shown in Table 2, the correlation between the number of available brands and the extent of cost variation was strong and positive (r = 0.79). This finding indicates that higher brand proliferation is associated with greater variation in pricing, contrary to the expectation that competition necessarily drives prices downward. Regression analysis reinforced this relationship, with the coefficient for brand count (15.86, p < 0.01) suggesting that, on average, each additional brand in the market increases the cost variation by approximately 16 percent (Table 3). The model explains around 62 percent of the variation (R² = 0.62) in drug cost disparities, highlighting brand count as a significant driver of price differences in both Eye and ENT medicines. Affordability analysis (Table 4) based on the WHO/HAI method demonstrates that Jan Aushadhi medicines generally meet global benchmarks for affordability. For example, Ofloxacin eye drops (INR 10.7) and Xylometazoline nasal drops (INR 30.0) cost less than 0.1 days’ wage, reflecting high affordability. However, some medicines such as Latanoprost (0.55 days’ wage) and Fluticasone Propionate (0.81 days’ wage) approach or exceed half a day’s wage, suggesting a relatively higher burden for low-income households.

To extend the analysis beyond Eye and ENT conditions, we examined three widely prescribed chronic disease medicines—Metformin, Amlodipine, and Human Insulin. The results (Appendix Table A2) reveal substantial brand-driven price variation, with cost ratios ranging from 3.2 (Insulin) to over 7.0 (Metformin). In all three cases, Jan Aushadhi formulations were consistently among the most affordable options. The savings were particularly notable for oral medicines such as Metformin and Amlodipine, where JAS prices were significantly lower than the branded median. However, for insulin, JAS formulations were cheaper than premium brands but not always the absolute lowest-cost option available. These findings demonstrate that patterns of wide price dispersion and affordability advantages for JAS drugs extend beyond the study’s core focus on Eye and ENT medicines, underscoring the broader policy relevance of the scheme for chronic disease management in India.

Figure 5 provides a visual representation of the distribution of Jan Aushadhi Kendras (JAS Kendras) across different Indian States and Union Territories. Geographical distribution is crucial in assessing the accessibility and availability of affordable generic medications provided by Jan Aushadhi. Several insights emerge from this analysis.

First, the figure highlights significant regional disparities. Uttar Pradesh stands out with the highest concentration, suggesting greater accessibility to Jan Aushadhi medicines, while Andaman and Nicobar Islands have only a handful of Kendras, indicating constrained access. Second, while concentration in populous states such as Uttar Pradesh and Bihar may suggest scale, the population-adjusted figures reveal much lower access than smaller states and union territories. Third, the overarching aim of Jan Aushadhi—providing cost-effective alternatives to branded medicines—is likely influenced by this uneven distribution, as equitable state-level coverage remains a challenge. Fourth, policymakers can use such geographic evidence to identify “high-demand, low-coverage” areas where future Kendras should be prioritized. Finally, awareness-building is particularly important in states with fewer Kendras to maximize uptake of available facilities.