Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases

Abstract

Objective To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment. Methods We estimated the impact of global strategies to reduce ARV prices using data on 7253 procurement transactions (July 2002-October 2007 from databases hosted by WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Findings For 19 of 24 ARV dosage forms, we detected no association between price and volume purchased. For the other five ARVs, high-volume purchases were 4-21% less expensive than medium-or low-volume purchases. Nine of 13 generic ARVs were priced 6-36% lower when purchased under the Clinton Foundation HIV/AIDS Initiative (CHAI). Fifteen of 18 branded ARVs were priced 23-498% higher for differentially priced purchases compared with non-CHAI generic purchases. However, two branded, differentially priced ARVs were priced 63% and 73% lower, respectively, than generic non-CHAI equivalents. Conclusion Large purchase volumes did not necessarily result in lower ARV prices. Although current plans for pooled procurement will further increase purchase volumes, savings are uncertain and should be balanced against programmatic costs. Third-party negotiation by CHAI resulted in lower generic ARV prices. Generics were less expensive than differentially priced branded ARVs, except where little generic competition exists. Alternative strategies for reducing ARV prices, such as streamlining financial management systems, improving demand forecasting and removing barriers to generics, should be explored.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries

“…Pooled procurement of anti fungals would increase availability and secure com petitive prices, through eff ective coordination of regional governments, global health organisations and funders, and pharma ceutical companies and distributors. 78 Drug funding and distribution could be integrated with existing antiretroviral therapy programmes to provide antifungals alongside antiretrovirals, antituberculous drugs, and co-trimoxazole.…”

Countries Where HIV Is Concentrated Among Most-At-Risk Populations Get Disproportionally Lower Funding From PEPFAR

“…Instead, the analysis included per capita income as a control, on the assumption that, in general, countries with lower incomes paid less for med- ications than countries with relatively higher incomes. 37 In addition, this analysis focused only on men who have sex with men and people who inject drugs. Data on sex workers were scarce and further complicated by the antiprostitution pledge in the legislation establishing and reauthorizing PEPFAR, which hampered programming and data collection for this group.…”

Indian Manufacture of New Generic Antiretrovirals: Implications for Global Access to Anti-Hiv Drugs

“…Three strategies that have already been developed to expand access to generic ARVs include proARVs include pros include procurement arrangements to increase purchase volumes, third-party consultation and price negotiation with generic ARV suppliers, and differential pricing (also referred to as price discrimination or tiered pricing) [16]. Newer strategies to further reduce ARV costs include the further removal of institutional barriers for generic entry, improved forecasting of future ARV demands in order to avoid emergency drug shipments, technology transfer to generic manufacturers and publicly accessible procurement databases to guide evidence-based drug policies.…”