Are daratumumab (Darzalex), lenalidomide (Revlimid), dexamethasone, and bortezomib available in Nepal, and what are their costs?

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Last updated: October 24, 2026 • View editorial policy

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Availability and Cost of Multiple Myeloma Drugs in Nepal

Based on the most recent evidence from 2025, daratumumab (Darzalex), lenalidomide (Revlimid), bortezomib, and dexamethasone are available in Nepal, but access is severely limited in the public sector, forcing most patients to purchase these medications privately at high out-of-pocket costs. 1

Drug Availability in Nepal

Public vs. Private Sector Access

The 2025 South Asian treatment accessibility study provides the most current data on Nepal's multiple myeloma drug landscape 1:

  • Lenalidomide and bortezomib: Available in public institutions in 75% of South Asian countries studied, which includes Nepal
  • Daratumumab: Largely restricted to private institutions in 62.5% of countries, meaning public sector access in Nepal is extremely limited
  • Dexamethasone: Widely available as a generic corticosteroid in both sectors

Critical Access Barriers

Patients in Nepal face an average out-of-pocket expenditure of 70% of total medical costs for multiple myeloma treatment 1. This represents one of the highest financial burdens in the region and creates a significant barrier to accessing these life-saving medications.

Cost Information

Price Variation Data

A 2020 study examining anticancer medicine prices in Nepalese hospital pharmacies revealed substantial price variations 2:

  • Bortezomib 2 mg injection: Price variation of 241% between different brands available in Nepal
  • The study documented that the majority of anticancer medicines in Nepal remain unregulated by the government, leading to wide price disparities

Practical Cost Implications

The lack of government price regulation for most anticancer drugs means that patients purchasing daratumumab, lenalidomide, and bortezomib in Nepal will encounter:

  • Highly variable pricing depending on the brand and pharmacy
  • Substantially higher costs in private institutions where daratumumab is primarily available
  • Limited or no financial assistance programs (only India in the South Asian region has a dedicated myeloma patient support group) 1

Infrastructure Limitations

Beyond drug availability, Nepal faces critical diagnostic and treatment infrastructure gaps 1:

  • Diagnostic tools: Serum protein electrophoresis, immunofixation, and free light chain assays are unavailable in public hospitals in 62.5% of South Asian countries
  • Stem cell transplantation: While autologous stem cell transplant centers exist in 75% of studied countries, cryopreservation facilities are limited to only 25%
  • Advanced imaging: PET scans remain cost-prohibitive even where available

Clinical Recommendations for Nepali Providers

When prescribing these regimens in Nepal, prioritize:

  1. First-line for transplant-ineligible patients: VRd (bortezomib-lenalidomide-dexamethasone) is the most commonly used regimen in public institutions across South Asia at 50% 1, making it the most accessible option
  2. If daratumumab is financially feasible: DRd (daratumumab-lenalidomide-dexamethasone) shows superior outcomes with median time to next treatment of 32.6 months versus 17.7 months for DVd 3, and is preferred by current guidelines 4, 5
  3. Cost-conscious alternatives: Consider bortezomib-based regimens when daratumumab is unaffordable, as bortezomib has better public sector availability

Common Pitfalls to Avoid

  • Do not assume public sector availability of daratumumab - verify access before prescribing, as most patients will need private purchase
  • Screen for financial toxicity early - with 70% out-of-pocket costs, many patients cannot complete planned therapy
  • Verify brand pricing - with 241% variation in bortezomib prices alone, shopping between pharmacies can significantly reduce costs 2
  • Plan for diagnostic limitations - minimal residual disease monitoring and advanced response assessment may not be feasible in public settings 1

The harsh reality is that while these evidence-based regimens are technically available in Nepal, the combination of limited public sector access, lack of price regulation, and 70% patient cost burden means that optimal multiple myeloma treatment remains out of reach for most Nepali patients without substantial private resources.

References

5
Guideline

multiple myeloma, version 2.2024, nccn clinical practice guidelines in oncology.

Journal of the National Comprehensive Cancer Network : JNCCN, 2023

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.