E-drug: Historical ARV negotiations of 10 Latin American countries
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Dear friends:
Yesterday, 10 Latin American countries (Mexico, Colombia,
Venezuela, Ecuador, Peru, Bolivia, Argentina, Uruguay, Paraguay
and Chile) reached a final agreement with ARV producers on pricing.
It has taken one year of technical and political discussions to define
the terms and conditions of the agreement.
The ten countries invited producers to help them respond to the
HIV epidemic. HIV is a health problem without borders and is
demanding more resources than available in each of them. ARV
prices is not the only problem, but significant reductions in their prices
is part of the solution.
The producers defined a "maximum reference price" for each ARV
product, which will be valid for all ten countries. Individual countries
are allowed to accept lower prices in tenders or purchases, but not
higher ones. Producers also made price offers to the ten countries for
each product. This price offer was fully independent of any future
purchase, exclusivity, or minimal purchase volumes. Differential
prices for quantities were also not allowed. Only the "maximum
reference price" was agreed.
The results are spectacular. 37 drugs were negotiated, and in 15 of
them the reference price is lower than the lowest price paid earlier in
any one of the ten countries. For the first line treatment protocol
(ZDV, LMVD, NVP) the price per year was reduced from US$ 1100
(lowest) and US$ 5000 (highest) to US$ 365. The price of the second
line protocol (with EFV) went down from US$ 3000 to US$ 1100.
If all savings would be used for first line treatment, some 150.000
extra PLHIVs could be treated.
Negotiations also included test kits, for which price reductions from 9
- 90% have been achieved.
Except for Abbot, the multinational firms who participated in the
"Accelerated Access Initiative" initially stuck to their policy of
differential pricing based on per capita income and extend of the
epidemic in each of the ten countries. Despite insistence of the
Ministries of Health, the multinationals refused to make a single
pricing proposal. However, producers of India and Argentina, who
have GMP certificates and had satisfactory bioequivalence studies
carried out, made a large number of price offers for all ARVs. Thanks
to the price offers of these firms, the results mentioned above were
reached.
The agreement does not mean that the multinational firms will
withdraw for the ten countries, or that governments and NGO's will
not buy from them. It only means that they did not agree on a
"maximum reference price", and hence did not accept the call of the
Ministries of Health to fight together with them against the HIV
epidemic. They will go on making their products available at the usual
prices.
Francisco A. Rossi
Advisor
Ministerio de Protecci�n Social, Colombia
Carrera 13 No 32-76
tel +57-1-3365066 ext 2229
fax +57-1-3360165
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