The fourth edition of a pricing guide to the availability of antiretrovirals, setting out the discounts available to treatment providers in developing countries, has been published by the international NGO Médecins sans Frontières, working in partnership with WHO, UNICEF and UNAIDS. The report highlights continuing gaps, which were also identified recently in NAM’s newsletter HIV & AIDS Treatment in Practice, in providing for children with HIV who need affordable paediatric formulations.
"Children living with HIV/AIDS are one of the most neglected populations: paediatric formulations are lacking and/or formulations do not meet children’s and caregivers’ needs - unpleasant tasting syrup, tablets too big to swallow, need to refrigerate some products, unbreakable tablets, lack of fixed dose combinations (FDCs), and non-adapted dosages. For example there are currently no fixed dose combinations for paediatric use."
While affordability is not the only issue - for example, some important drugs remain unregistered in many countries that have registration systems - clear and accurate information on pricing is essential, and this report aims to provide it. All information has been checked with the companies concerned.
"Lack of clear information on pharmaceutical prices on the international market is a significant barrier to improving access to essential medicines in developing countries. The situation is particularly complex in the case of antiretrovirals (ARVs)."
"The data in this guide on ARV prices offered by originator companies and some generic companies in low- and middle-income countries are meant to provide potential buyers with clear verified data. This information is intended for use by government and non-profit procurement agencies, as well as other bulk purchasers of ARVs, including health facilities and non governmental organizations (NGOs)."
"This document includes both adult and paediatric formulations, and is meant to be used in tandem with the report of the Pilot Procurement, Quality and Sourcing Project: Access to HIV/AIDS Drugs and Diagnostics of Acceptable Quality, a project initiated by WHO and developed in collaboration with other United Nations Organisations (UNAIDS, UNICEF, UNFPA)."
While reporting continuing moves to reduce drug prices, including recent announcements by GlaxoSmithKline and Gilead Sciences, MSF argues that current arrangements are too dependent on individual companies, often too limited in their scope and complicated in the conditions that have to be met for people to get access to the treatment they need.
The report includes evidence that generic competition has helped drive down the prices of ARVs but MSF does not view this as a complete answer, since there are a number of important drugs for which generic versions are not available and are unlikely to become available soon.
“There is an urgent need to develop a more systematic, transparent approach to differential pricing of originator products in addition to stimulating generic competition," say the authors.
It is important to note that the prices quoted in the report may not reflect what individual patients or healthcare systems have to pay, since they do not include import taxes, distributor mark-ups and so on, which still apply in many countries to many of the drugs listed.
Further information on aidsmap
Untangling the web of price reductions: a pricing guide for the purchase of ARVs for developing countries, MSF, 2003, is available in English in pdf format here.
Sources and prices of selected drugs and diagnostics for people living with HIV/AIDS has been updated and will shortly be available here. [This site will also give access to the MSF report mentioned above, in English, French and Spanish.]