Kerala moves its spinal muscular atrophy patients to the generic Risdiplam, Natsmart, under KARE

29 October 2026

Kerala now supplies a generic form of the spinal muscular atrophy medicine Risdiplam to its patients, bringing the bill down from crores to lakhs. The generic, Natsmart, is made in India by Natco Pharma; the branded drug had been bought at a negotiated rate per bottle running into lakhs. All of this runs through the State's rare disease programme, KARE, short for Kerala United Against Rare Diseases. Health Minister K. Muraleedharan told the Assembly that orders have gone out for 2,159 bottles so that supply does not break. Treatment is given at the spinal muscular atrophy clinic in SAT Hospital, Thiruvananthapuram, along with physiotherapy, breathing support, devices, rehabilitation and surgery. Parents have questioned the absence of a bioequivalence study, while Natco points to its approval from the drug regulator and to World Health Organization guidance that exempts oral solutions. Courts in Delhi and Kerala have both ruled in favour of the generic being made and bought.