Ankit Gupta, President, ASPA (Authentication Solution Providers' Association)
India’s healthcare industry is expanding rapidly, but a growing threat is hiding in plain sight. Counterfeit medicines and healthcare products are becoming harder to identify because the first thing consumers see often looks completely legitimate. The real vulnerability may begin with the packaging.
This article explores how counterfeiters are exploiting gaps in healthcare packaging and supply chains. It examines why traditional safeguards are no longer enough and how digital authentication, track-and-trace systems and smarter packaging could help rebuild trust from manufacturer to consumer.
Picture a retail chemist restocking a shelf with antibiotics that arrived through the usual channel. The carton looks unremarkable: correct logo, correct font, a hologram that glints the way it should. There is no reason to suspect anything, because nothing about the box gives him one. This, roughly, is how a meaningful share of counterfeit healthcare products are believed to enter India's supply chain, close to the scenario that played out when Delhi Police's Crime Branch raided a manufacturing unit in Ghaziabad this past December and recovered more than 7,500 fake ointments bearing well-known brand names.
That case was not built on advanced pharmaceutical know-how. It was built on the ability to replicate what a healthcare product looks like from the outside, and it points to where the real vulnerability in the supply chain sits: not in the product, but in the wrapper around it. The stakes are considerable. According to Grand View Research, as cited in a MoFPI report, India's nutraceuticals market was valued at USD 30.37 billion at the end of 2024 and is expected to grow at a CAGR of 13.6% from 2025 to 2030, while the pharmaceutical market, as per CRISIL, is estimated at close to USD 23 billion in FY26 and is projected to reach around USD 25 billion by FY27.
Packaging was long treated as a functional afterthought, never designed to withstand deliberate, sustained forgery. That assumption is now badly out of date. According to the ASPA-CRISIL "State of Counterfeiting in India 2025" report, counterfeiters typically source cheap, substandard active ingredients and, in documented cases, have used tap water to manufacture eye drops and vaccines, industrial solvent for paracetamol syrup, turmeric for antibiotics, and wheat flour for contraceptive pills. In medical devices, counterfeiters replicate syringes, diagnostic kits and implants using inferior materials with no adherence to sterility standards and sometimes relabel expired devices as new. High-volume OTC categories such as pain relievers and cold remedies face the same threat, often with incorrect or absent active ingredients.
The retailer survey in the same study asked where counterfeit products enter the supply chain. Distributors were named the largest point of entry, cited by 44% of retailers, followed by retailers themselves at 32%, wholesalers at 20%, and manufacturers at just 4%, suggesting the leak happens well after the factory gate, precisely where verification tends to be visual rather than digital. Price compounds the problem: counterfeit products were, on average, reported to be around 18% cheaper than genuine ones, with 38% of consumers reporting an 11-20% discount and 12% reporting a 41-50% discount, margins wide enough to sustain an entire informal network.
The stakes involved are categorically different from other counterfeited goods. A fake antibiotic can fail to treat an infection or actively harm the patient taking it. That asymmetry, a low cost of counterfeiting against a catastrophic cost of failure, is why this loophole deserves structural attention rather than incremental fixes.
Officially, the picture looks contained: the CDSCO's countrywide survey found that of 47,012 samples tested, only 0.025% were outright spurious, and 3.16% were not of standard quality, well below the 10% incidence the WHO associates with developing countries generally. But industry participants interviewed for the ASPA-CRISIL study placed real prevalence at 15-20%, considerably higher than official sampling suggests. Most respondents expected counterfeiting to be lower in the organized sector, where GST-linked invoicing and ERP-managed distribution leave a documented trail.
Consumer perception tells a starker story still. Eighty percent of consumers believe counterfeiting has increased over the past twelve months, and on average, they perceive 28% of healthcare products in the market to be counterfeit, more than triple the CDSCO's sampled figure. That perception varies by city, from 15% in Jaipur to 22% in Kolkata and 38% in Indore. Encouragingly, 73% of consumers said they would never knowingly buy a counterfeit product; 23% admitted they might if unaware of it, and 4% would if the genuine version was simply unavailable.
What happens after detection may be the most revealing data point. Sixty-four percent of consumers who identify a counterfeit product simply discard it; only 36% report it to any relevant body. Every unreported fake is a signal that never reaches a brand-protection team or regulator. ASPA's own tracking shows the scale that does surface: between 2018 and 2025, ASPA recorded 521 media-reported instances of healthcare counterfeiting nationally, peaking at 136 in 2021 amid pandemic-era demand for PPE, masks and Covid-related medicines. Uttar Pradesh recorded the highest instances, followed by Bihar, Uttarakhand, Rajasthan and Delhi. In 2025, ASPA reported 52 instances, nearly double the 27 recorded in 2018.
Certain markets carry a particular reputation in this trade, among them Bhagirath Palace, located in Chandni Chowk, alongside hotspots in Bihar, Uttar Pradesh, West Bengal and Gujarat. On where these products actually reach consumers, local retail outlets accounted for 63% of channels through which consumers reported receiving a counterfeit product, closely followed by online aggregators at 60%, with multi-brand stores and social media ads run by sellers making up the remainder, a reminder that the loophole now spans e-commerce as much as the neighborhood chemist.
India's legal framework rests on the Drugs and Cosmetics Act, 1940, and Rules, 1945, with a 2022 amendment (Rule 96) requiring machine-readable codes, including QR codes, batch numbers and expiry dates, at each level of packaging. The Pharmacy Act, 1948, the Food Safety and Standards Act, 2006, and the Medical Devices Rules, 2017, round out the framework governing dispensing, nutraceuticals and devices, respectively. In 2023, on the Drugs Technical Advisory Board's recommendation, QR or barcodes became mandatory at the primary packaging level for the top 300 pharmaceutical brands, or at the secondary level where there isn't enough space on the primary packaging. It is meaningful, but narrow: it leaves the far larger universe of mid-sized manufacturers, generics, devices and nutraceuticals outside its scope, precisely where the data suggests risk is highest.
The way out of this is not a better hologram, but a shift toward systems where authenticity can be actively verified rather than passively assumed. Manufacturers have begun deploying layered defenses: tamper-evident labels, security tape, holographic tagger foil, security blister packs, and smart authentication via QR codes or NFC tags, Mankind Pharma's NFC-enabled packaging with Forge Stop being one live example.
ASPA's model rests on the same layered principle. Phygital authentication pairs a physical marker with a digital one, so a counterfeiter must defeat two systems rather than one; a hologram tied to a QR code verifiable in real time is a far harder target than a hologram alone. Serialized track-and-trace infrastructure gives every unit a trackable identity from production to the pharmacy counter, addressing the exact weak point retailers flagged, the 44% and 32% of counterfeit entry attributed to distributors and retailers, respectively. Blockchain-based verification adds a tamper-resistant audit trail that regulators and brand owners can rely on with far more confidence than a conventional database. And at the consumer end, QR codes, barcodes and holograms remain what people actually use: 66% of consumers check packaging quality, 61% assess look and feel, and 40% specifically look for a QR code, showing consumers are already primed to engage with these tools if manufacturers make them available.
Authentication cannot remain the preserve of large manufacturers or the 300 brands currently covered by the DTAB mandate. It needs to become a baseline expectation across mid-sized players and the nutraceutical, cosmetic and device segments, which the data shows are just as exposed. Regulatory consistency matters equally: a single, nationally standardized framework extending coding requirements beyond the current brand list would remove much of the fragmentation counterfeiters currently exploit.
Consumer awareness deserves more attention than it gets. The finding that 64% of consumers who spot a counterfeit simply discard it rather than report it is a signal the industry cannot ignore; closing that gap is as much a public health priority as any packaging upgrade. And finally, none of this holds without sustained collaboration. The enforcement action seen through 2025, together with ASPA's own tracking of 521 instances since 2018, shows agencies are willing to act on credible intelligence. What industry owes them in return is a steady, structured flow of exactly that.
The packaging loophole persists because packaging was, for too long, an afterthought in the trust equation: the last box ticked on the way to market rather than the first safeguard against those determined to exploit it. As India's healthcare products industry expands its global footprint, what wraps around the product will need to earn the same scrutiny as what's inside it.
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