UNITAID and the Clinton Foundation’s HIV/AIDS Initiative (CHAI) have just announced price reductions negotiated with generic companies for 41 adult and pediatric antiretroviral formulations to treat HIV/AIDS.  This is welcome news which must be interpreted with caution, says international medical humanitarian organization Médecins Sans Frontières (MSF).

Among the price drops, one of the more notable is the fall in the price of tenofovir (TDF).  In 2006, WHO guidelines suggested that countries start to move away from older regimens based on stavudine which cause significant side effects, to less toxic one-pill-a-day regimens that include TDF.  But the high price of tenofovir has, until now, been a significant barrier, meaning that many patients have gone without the better regimen.

“These new prices go a long way in removing one of the major barriers that was stopping countries from putting people on the best treatment possible,” said Janice Lee, pharmacist with MSF’s Access to Essential Medicines Campaign. “We challenge donors and governments to roll out this new treatment and urge WHO to speed up the prequalification process for easy-to-use three-in-one combination pills containing tenofovir.”

Also significant is the fact that the price of lopinavir/ritonavir (LPV/r) has been slashed to below $600 Cnd for one patient’s yearly treatment course. LPV/r is one of the protease inhibitors recommended by WHO for second-line treatment.  This latest move means that generic manufacturers are now pricing this crucial drug more affordably than the patent-holder, Abbott Laboratories, whose policies have in the past severely restricted access to LPV/r in developing countries.

“These falls in prices show, once again, that generic competition is the most effective way in driving the price of life-saving medicines down,” said Michelle Childs, director of policy and advocacy with MSF.

While CHAI announced the prices for these new discounted generic drugs are open to the 70 countries included in its consortium, in a number of them the drugs are actually patented by the originator company. This means that the generic versions of the drugs cannot enter the country unless there is a voluntary agreement, or the country issues a compulsory licence. As a result, patients in those countries will not be able to access the more affordable generic versions.  This includes countries like China, South Africa or Colombia.

“This announcement has a sting in its tail — for a number of countries included in the CHAI list, patent barriers mean that in reality these prices will be unavailable.  These discounts will remain paper promises unless there is a clear strategy from UNITAID and CHAI to find a way to overcome these barriers to affordable access. UNITAID’s proposal for a patent pool for HIV medicines could be one solution, provided all developing countries can benefit from it. In addition, policy and technical support should be given by WHO to those countries who may have to issue a compulsory licence.”

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