Quantify launch-to-access lags and affordability for recent FDA-approved neurological therapies across South Asian low- and middle-income countries (LMICs). 

In the last decade the FDA approved multiple high-impact neurological therapies. In South Asian LMICs, their entry has been delayed, and prices far exceed median household income, limiting accessibility and clinical integration.

We audited six therapies (ocrelizumab, risdiplam, onasemnogene abeparvovec, lecanemab, donanemab, tenecteplase). We recorded FDA approval year, first visible LMIC regulatory action, retail or hospital acquisition prices (USD), and number of tertiary centers offering advanced neurology services. Affordability was benchmarked against household income per capita from CEIC: Pakistan (USD 587, 2019), Bangladesh (USD 996, 2022), Sri Lanka (USD 1,377, 2019), and GDP per capita proxy for India (USD 2,301, 2022). Data sources included CEIC, World Bank, and regulatory announcements.

Latest therapies approved showed access delays of 3–8 years before LMIC registration. Ocrelizumab is priced at USD 13,000–15,000 per year, representing six times India’s and more than twenty times Pakistan’s annual household income. Risdiplam (USD 83,000 per year) and onasemnogene abeparvovec (USD 2.1 million, one-time U.S. list) remain beyond affordability benchmarks, even if registered. Anti-amyloid antibodies remain absent from all four LMIC as of October 2025. For stroke, tenecteplase (USD 550 per dose) is marketed in India and Bangladesh, yet thrombectomy infrastructure is sparse: India has 361 EVT-capable centers, Pakistan 4, Bangladesh 2, Sri Lanka 3. Access is therefore limited to patients in major cities.

Recent neurological breakthroughs remain inaccessible for most LMIC patients. When present, therapies are limited to a few tertiary hospitals and remain unaffordable relative to household means. Closing this gap requires LMIC-specific reforms: pooled procurement, tiered pricing, subsidy schemes for time-critical drugs, and hub-and-spoke expansion neurological services. Without these LMIC-specific reforms, advances in neurology risk remaining scientific milestones for the few, rather than lifelines for the many.