Posted by: davidjolson | 07/19/2011

Access to HIV drugs: The good, the bad and the unmet need

This is a guest blog by Meredith Mazzotta of Science Speaks, the blog of the Center for Global Health Policy.

ROME  — Drug companies are excluding middle-income countries – such as Brazil, Thailand, India, Columbia and China – from HIV drug discount programs where drug prices can be as much as ten times higher, according to a press release and information from a new report by Medecins Sans Frontieres (MSF) released Monday at the 2011 International AIDS Society Conference.

The 14th edition of the MSF report “Untangling the Web of Antiretroviral Price Reductions” analyzes the prices of 23 ARVs with information provided by 19 drug manufacturers and shows the trend of decreasing prices among unpatented antiretroviral drugs mainly in the last year but also what has happened over the last decade. For example, over the past five years the price of generic tenofovir has dropped from $195 to $76 per patient per year as the number of generic manufacturers increased.

“Prices fall as the number of generic competitors increases – securing generic competition has therefore been essential to bringing the cost of drugs down to affordable levels,” according to the MSF report.

The report release comes on the heels of the striking of an agrement last week between Gilead Sciences and the Medicines Patent Pool (MPP) that increased access to antiretroviral (ARV) drugs for poor in many countries, but also excluded many countries with a high number of HIV infected persons. MSF made clear at a press conference Monday that even if these countries are currently receiving funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program, or the Global Fund to Fight AIDS, Tuberculosis and Malaria, they are still excluded.

The agreement with Gilead does cover tenofovir as well as new drugs still in the development pipeline – cobicistat (designed to improve the efficacy of other ARVs by boosting their availability in the blood), elvitegravir (an ARV used to prevent a step in the AIDS virus’ replication cycle), and a combination pill of tenofovir, emtricitabine, cobicistat and elvitegravir known as the “Quad.” This could help alleviate drug regimen and availability inequities between rich and poor countries for new drugs, MSF noted in its release.

Michelle Childs, policy and advocacy director at MSF’s Campaign for Access to Essential Medicines, expressed concern in the press release that Gilead’s announcement was lacking and might serve as a template for future agreements with other pharmaceutical companies.

MPP also announced today that negotiations have started with drug companies Boehringer-Ingelheim and Bristol-Myers Squibb for several HIV medicines on the MPP’s list of 19 drugs prioritized as especially critical to public health.

These efforts are seen as critical by the United Nations, which set a goal of putting 15 million people on treatment by 2015 at the UN High Level Meeting on AIDS in New York in June. Widely accessible, effective and affordable drugs must be available to those that need them in order to achieve that goal, the MPP made clear in a press release.

“It is morally wrong that 9 million are waiting for treatment and that 5,000 people are dying every day of AIDS-related illnesses,” said UNAIDS Executive Director Michel Sidibe in the MPP press release. “Sharing innovation and patents will drive down the price of medicines and bring antiretroviral treatment to millions more people.”

The MPP press release also called out drug companied Johnson & Johnson, Merck and Abbott for being the only three pharmaceutical companies not currently participating in negotiations with the Pool and inviting them to join the effort.

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