Make AIDS drugs affordable at home first

[Guest guest]

`Make AIDS drugs affordable at home first'

P.T. Jyothi Datta, New Delhi , Nov. 3

TWO years ago, pharma major Cipla had let the cat among the pigeons

when it made anti-AIDS drugs available at about a thirtieth of the US

price, forcing multinationals to follow suit in the interest of

patients in Africa.

A week ago, three Indian pharma companies tied up with the Clinton

Foundation to make anti-AIDS drugs or anti-retrovirals (ARV)

available at one-third current costs, to Africa and the Caribbean.

But for the estimated four million HIV/AIDS patients in India ARV

prices are still steep, thus putting the spotlight on domestic drug

companies and their role in making ARVs accessible at home, as they

do abroad.

" It is a human issue and drug companies have an ethical

responsibility to make ARVs inexpensive at home, besides reducing the

cost of infection monitoring. Drugs, used in the first line of

medication, are priced between Rs 1,500 and Rs 15,000 per month, per

person, depending on the combination of drugs. Medication is based on

infection monitoring which is undertaken twice a year and costs about

Rs 800 to Rs 5,000 per test. Only four lakh of 40 lakh patients may

need ARVs, but the exercise is expensive and drug companies need to

reduce drug and testing costs, " Mr K.K. Abraham, Indian Network of

People living with HIV/AIDS (INP+), told Business Line.

Similar sentiments are echoed by Ms Meenakshi Datta Ghosh, Project

Director, National Aids Control Organisation (NACO). Appreciative of

the pharma companies' role in driving down ARV prices, she however

admits: " ARV prices need to be brought down further. The current

prices quoted at $1 per day remain unaffordable. And this refers

merely to the base regimen of ARVs. HIV patients sometimes have

multiple co-infections — Tuberculosis (TB), pneumonia, cancers, etc. —

and the $1 per day immediately becomes irrelevant, because the

patient needs protease inhibitors, which are significantly more

expensive. "

The anti-AIDS cocktail costs a patient about $15,000 per year, two

years ago. But chemically-equivalent drugs from generic majors

brought down costs to $350 per year. However, even this works out to

about Rs 17,000 per year for a patient in India.

The Clinton Foundation's recent agreement with Cipla, Ranbaxy and

Matrix brings the combination therapy cost down to $140 per annum per

head and here lies a lesson for India.

" The agreement was structured on high-volumes and hence bulk rates

could be negotiated, " say observers.

Cipla's Mr S. Radhakrishnan concurs: " Currently, there is no purchase

system in India and ARVs are procured from trade channels. Cipla has

offered free technology to the Government for ARV manufacturing and

distribution, besides donating Nevirapine, a drug used in prevention

of mother-to-child transmission. Pricing in India depends on factors

such as import duties on bulk drugs and intermediates, local taxes

and levies, trade margins, etc. The recent agreement for ARV supplies

in Africa, through the Foundation, was possible since it ensured

availability of active pharmaceutical ingredients at low prices for

large volumes. Also, the Foundation undertook with respective

Governments to develop infrastructure for distribution of drugs to

patients. Similar efforts from the Indian Government will make drugs

accessible to patients in India. "

http://www.thehindubusinessline.com/2003/11/04/stories/200311040248010

0.htm