(2003; 30 pages) [French] [Spanish]
Background and experiences with voluntary agreements
The most prominent of the formal arrangements to facilitate voluntary price reductions for pharmaceutical products for developing countries is the Accelerating Access Initiative (AAI).
The AAI was launched by UNAIDS in a partnership with several UN agencies and five pharmaceutical companies (Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Merck & Co and Hoffman-La Roche5). Responsibility for this initiative was transferred to WHO at the end of 2001. The main AAI goal is to provide developing countries with access to ARV medicines at reduced prices.
5 Abbott has now joined, so there are now 6 participating companies.
The launch in 1997 of the UNAIDS Drug Access Initiative, which antedated the AAI, resulted in participating research-based firms dropping their prices for triple ARV therapy from US$ 12 000/year to US$ 7 000/year. With the launch of the AAI in May 2000, the cost of triple drug combination regimens sourced from the participating companies quickly fell to about US$ 1 200/year. After the Indian Generics industry entered the scene, prices for first line regimens decreased further. Currently, four Indian generic companies offer first line triple combination regimens at less than half the price offered by the lowest priced companies participating in the AAI. A recent check of offers found the following prices: Cipla at US$ 350, Hetero at US$ 347, Aurobindo at US$ 289, and Ranbaxy at US$ 2956. These prices (not only those of the generic ARVs, but also those of the R & D industry) continue to drop and increasingly the quality of generic ARVs is being documented: both CIPLA and Ranbaxy obtained WHO prequalification of their first line ARVs7.
6Untangling the WEB of price reductions – a Pricing Guide for the Purchase of ARVs for Developing Countries, MSF, June 2002.
7 Pilot Procurement Quality and Sourcing Project: Access to Antimalarial, Anti-tuberculosis and HIV/AIDS Drugs and HIV/AIDS Diagnostics of Acceptable Quality (http://www.who.int/medicines/organization/qsm/activities/pilotproc/pilotprocmain.shtml).
Since the launch of the AAI, 80 countries have expressed their interest in the Initiative. In 39 of these 80 countries, national plans to improve access to care have been or are being developed. These plans have been used as a framework for dialogue with the pharmaceutical companies. Nineteen countries8 have concluded agreements with individual companies participating in the Initiative9.
8 Barbados, Benin, Burkina Faso, Burundi, Cameroon, Chile, Cote d’Ivoire, Gabon, Honduras, Jamaica, Mali, Morocco, Republic of Congo, Romania, Rwanda, Senegal, Trinidad and Tobago, Uganda, and Ukraine.
9UNAIDS, Accelerating Access Initiative, Widening access to care and support for people living with HIV/AIDS. Progress report. June 2002.
Despite the broad country interest, the actual number of patients receiving ARVs through AAI remains disappointingly low - less than 1% of the HIV population currently needing ARV treatment. As of December 2001, about 27,000 people had gained access to ARV therapy in the 19 participating countries. That number has now increased, but not by an order of magnitude.