HIV/AIDS Drugs for Sub-Saharan Africa: How Do Brand and Generic Supply Compare?

Abstract

BackgroundSignificant quantities of antiretroviral drugs (ARVs) to treat HIV/AIDS have been procured for Sub-Saharan Africa for the first time in their 20-year history. This presents a novel opportunity to empirically study the roles of brand and generic suppliers in providing access to ARVs.Methodology/Principal FindingsAn observational study of brand and generic supply based on a dataset of 2,162 orders of AIDS drugs for Sub-Saharan Africa reported to the Global Price Reporting Mechanism at the World Health Organization from January 2004-March 2006 was performed. Generic companies supplied 63% of the drugs studied, at prices that were on average about a third of the prices charged by brand companies. 96% of the procurement was of first line drugs, which were provided mostly by generic firms, while the remaining 4%, of second line drugs, was sourced primarily from brand companies. 85% of the generic drugs in the sample were manufactured in India, where the majority of the drugs procured were ineligible for patent protection. The remaining 15% was manufactured in South Africa, mostly under voluntary licenses provided by brand companies to a single generic company. In Sub-Saharan African countries, four first line drugs in the dataset were widely patented, however no general deterrent to generic purchasing based on a patent was detected.Conclusions/SignificanceGeneric and brand companies have played distinct roles in increasing the availability of ARVs in Sub-Saharan Africa. Generic companies provided most of the drugs studied, at prices below those charged by brand companies, and until now, almost exclusively supplied several fixed-dose combination drugs. Brand companies have supplied almost all second line drugs, signed voluntary licenses with generic companies, and are not strictly enforcing patents in certain countries. Further investigation into how price reductions in second line drugs can be achieved and the cheapest drugs can actually be procured is warranted.

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

“…6,7 The Global Fund and WHO databases can be used to monitor and examine the global ARV marketplace. Although some analyses of these databases have been carried out, [8][9][10][11] none has examined the global impact of the various ARV price-reduction strategies mentioned above. We used the Global Fund and WHO databases to test the following hypotheses on three different ARV price-reduction strategies: prices for high-volume ARV purchases are less than for low-volume purchases; prices for generic ARVs purchased within the CHAI consortium are less than for generic ARVs purchased outside the consortium; and prices for branded ARVs purchased under differential-pricing schemes are equal to or less than those for generic ARVs.…”

Compulsory Licensing Often Did Not Produce Lower Prices For Antiretrovirals Compared To International Procurement

“…16 Other scholars have used these databases to investigate international antiretroviral procurement costs and related issues. [23][24][25][26][27] We retrieved the price data corresponding to each compulsory licensing episode based on the following variables: drug product (irrespective of manufacturer), product strength (for example, 600 mg), calendar year of purchase, and the receiving or buying nation's Human Development Index category (low, medium, high, or very high). 28 Focusing on "peer countries" in the same Human Development Index category as the country of a compulsory license case study helped us control for variations that could affect procurement tactics, such as income and overall country development status, and gave us more conservative findings than would have otherwise been the case.…”

Temporal Trends in Generic and Brand Prices of Antiretroviral Medicines Procured with Donor Funds in Developing Countries

“…11,17 -18 In the early days of the GFATM, these procurement data were used to describe the relationships between ARV prices reported by manufacturers and ARV prices paid at country level. 19 More recently, these data were used to compare volumes of generic and brand ARVs procured in Sub-Saharan Africa, 20 to compare ARV prices in Brazil to prices in other low-and middle-income countries, 21 and to provide supporting data for analyses of ' conditional scholarships ' for health workers. 22 In this article, we utilize existing ARV procurement data to describe annual changes in ARV prices and comparisons of brand and generic ARV prices from 2002 to 2008, as well as variability in prices paid for equivalent ARVs over a 1-year time period, July 2007 -June 2008.…”