Sample of ARV tiple-combination: stavudine (d4T) + lamivudine (3TC) + nevirapine (NVP). Lowest world prices per patient per year. Generic competition has shown to be the most effective means of lowering drug prices. During the last four years, originator companies have often responded to generic competition.
[1] To see previous editions, please consult www.accessmed-msf.org
[2] HIV/AIDS medicines and related supplies: Contemporary context and procurement. Technical guide. Chapter 2 and Annex B. World Bank, Washington, DC, 2004 http://siteresources.worldbank.org/INTPROCUREMENT/Resources/Technical-Guide-HIV-AIDS.pdf
[3] "Determining the patent status of essential medicines in developing countries", Health Economies and Drugs, EDM Series No. 17, UNAIDS/WHO/MSF, 2004
[4] "Drug patents under the spotlight. Sharing practical knowledge about pharmaceutical patents" MSF, June 2004
[5] Pediatric HIV/AIDS Factsheet, MSF, June 2005, www.accessmed-msf.org
[6] "Sources and prices of selected drugs and diagnostics for people living with HIV/AIDS". A joint UNICEF, UNAIDS Secretariat, WHO, MSF project. May 2004 (WHO/EDM/PAR/2003.2). http://www.who.int/medicines/organization/par/ipc/sources-prices.pdf
[7] Pilot Procurement, Quality and Sourcing Project: Access to HIV/AIDS drugs and diagnostics of acceptable quality, 23rd edition 4 April 2005. http://www.who.int/medicines/organization/qsm/activities/pilotproc/pilotproc.shtml
[8] Other generic manufacturers known to be producing one or more ARVs but not included in this document are: Richmond Laboratorios, Panalab, Filaxis (Argentina); Pharmaquick (Benin); Far Manguinhos, FURP, Lapefe, Laob, Iquego, IVB (Brazil); Apotex, Novopharm (Canada); Shanghai Desano Biopharmaceutical company, Northeast General Pharmaceutical Factory (China); Biogen (Colombia); Stein (Costa Rica); Zydus Cadila Healthcare, SunPharma, EAS-SURG, Mac Leods, IPCA(India); LG Chemicals, Samchully, Korea United Pharm Inc. (Korea); Protein, Pisa (Mexico); Andromaco (Spain); Aspen (South Africa); T.O. Chemecal (Thailand); Laboratorio Dosa S.A. (US), Varichem (Zimbabwe). This list is not exhaustive.
[9] Incoterms are standard trade definitions most commonly used in international sales contracts, as published by the International Chamber of Commerce, http://www.iccwbo.org/index_incoterms.asp
[10] "GAO Report to Congressional Requesters. GLOBAL HIV/AIDS EPIDEMIC. Selection of Antiretroviral Medications Provided under U.S. Emergency Plan is Limited", page 24, GAO, January 2005. "In some cases a manufacturer's prices include costs that other manufacturers do not include - such as shipping and insurance charges. We note where these differences exist, and have determined that they do not undermine the essential comparability of the prices presented in our report"
[11] Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach, WHO, 2003 Revision. http://www.who.int/hiv/pub/prev_care/en/ARVGuidelinesRevised2003.pdf
[12] Global Fund Price Reporting Mechanism. http://www.theglobalfund.org/en/
Table 1: 1st and 2nd category of prices offered by manufacturers for the different countries (yearly and unit prices)
| |
Unit |
|
|
|
|
|
|
|
|
abacavir |
|
Cipla |
GSK 1st categ |
GSK 2nd categ |
Hetero Drugs Ltd |
Ranbaxy |
|
|
|
300mg, tablet |
tab |
584 (0.8) |
887 (1.215) |
n/a |
773 (1.058) |
664 (0.91) |
|
|
|
20mg/ml, oral solution |
ml |
292 (0.1) |
382 (0.131) |
n/a |
|
|
|
|
|
didanosine |
|
Aurobindo 1st categ |
BMS 1st categ |
BMS 2nd categ |
Cipla |
Hetero Drugs Ltd |
Ranbaxy |
|
|
100mg, tablets |
tab |
197 (0.135) |
310 (0.212) |
n/a |
234 (0.16) |
280 (0.192) |
321 (0.22) |
|
|
250mg, enter-coated caps |
cap |
|
198 (0.543) |
n/a |
106 (0.29) |
|
146 (0.4) |
|
|
400mg, enteric-coated caps |
cap |
|
279 (0.764) |
n/a |
142 (0.39) |
|
219 (0.6) |
|
|
2g powder for reconstitution with water and with antiacids |
g |
39 (2.160) |
133 (7.370) |
n/a |
|
|
|
|
|
efavirenz |
|
Aurobindo |
Cipla |
Hetero Drugs Ltd |
Merck 1st categ |
Merck 2nd categ |
Ranbaxy |
|
|
50mg |
cap |
|
|
|
169 (0.116) |
311 (0.113) |
|
|
|
200mg |
cap |
438 (0.4) |
372 (0.34) |
316 (0.289) |
500 (0.457) |
920 (0.840) |
405 (0.37) |
|
|
600mg |
tab |
472 (1.292) |
347 (0.95) |
355 (0.917) |
347 (095) |
766 (2.1) |
358 (1.17) |
|
|
30mg/ml suspension |
ml |
227 (0.069) |
|
|
309 (0.094) |
496 (0.151) |
|
|
|
emtricitabine |
|
Gilead 1st categ |
Gilead 2nd categ |
|
|
|
|
|
|
200mg |
cap |
n/a |
n/a |
|
|
|
|
|
|
indinavir |
|
Aurobindo |
Cipla |
Hetero Drugs Ltd |
Merck 1st categ |
Merck 2nd categ |
Ranbaxy |
Strides |
|
400mg |
cap |
432 (0.296) |
321 (0.220) |
217 (0.149) |
400 (0.274) |
686 (0.470) |
336 (0.23) |
453 (0.31) |
|
lamivudine |
|
Aurobindo |
Cipla |
GSK 1st categ |
GSK 2nd categ |
GPO |
Hetero Drugs Ltd |
Ranbaxy |
Strides |
150mg |
tab |
66 (0.09) |
73 (0.1) |
69 (0.095) |
n/a |
171 (0.234) |
53 (0.073) |
69 (0.095) |
73 (0.10) |
300mg |
tab |
|
85 (0.233) |
n/a |
n/a |
|
|
69 (0.19) |
|
10mg/ml oral solution and syrup and dry syrup |
ml |
61 (0.021) |
58 (0.02) |
82 (0.028) |
n/a |
76 (0.026) |
|
|
|
lamivudine + efavirenz + didanosine |
|
Cipla |
|
|
|
|
|
|
|
150+600+250 (EC) |
3 cap |
766 (2.1) |
|
|
|
|
|
|
|
150+600+400(EC) |
3 cap |
839 (2.3) |
|
|
|
|
|
|
|
lamivudine/zidovudine/abacavir |
|
GSK 1st categ |
GSK 2nd categ |
Hetero Drugs Ltd |
Ranbaxy |
|
|
|
|
300 + 150 + 300mg |
tab |
1241 (1.7) |
n/a |
992 (1.358) |
1095 (1.5) |
|
|
|
|
lamivudine/stavudine |
|
Aurobindo |
Cipla |
Hetero Drugs Ltd |
Ranbaxy |
Strides |
|
|
|
150 + 30mg |
tab |
72 (0.099) |
79 (0.108) |
74 (0.101) |
124 (0.17) |
113 (0.155) |
|
|
|
150 + 40mg |
tab |
80 (0.109) |
85 (0.117) |
81 (0.111) |
131 (0.18) |
120 (0.165) |
|
|
|
lamivudine/stavudine/nevirapine |
|
Aurobindo |
Cipla |
GPO |
Hetero Drugs Ltd |
Ranbaxy |
Strides |
|
|
150 + 30 + 200mg |
tab |
144 (0.198) |
175 (0.24) |
341 (0.467) |
147 (0.201) |
219 (0.3) |
168 (0.23) |
|
|
150 + 40 + 200mg |
tab |
152 (0.208) |
182 (0.25) |
375 (0.514) |
161 (0.221) |
234 (0.32) |
175 (0.24) |
|
|
lamivudine/zidovudine |
|
Aurobindo |
Cipla |
GSK 1st categ |
GSK 2nd categ |
GPO |
Hetero Drugs Ltd |
Ranbaxy |
Strides |
150 + 300mg |
tab |
204 (0.28) |
182 (0.25) |
237 (0.325) |
n/a |
426 (0.584) |
190 (0.260) |
197 (0.27) |
204 (0.280) |
lamivudine/zidovudine/nevirapine |
|
Aurobindo |
Cipla |
Hetero Drugs Ltd |
Ranbaxy |
|
|
|
|
150 + 300 + 200mg |
tab |
257 (0.352) |
255 (0.35) |
281 (0.385) |
292 (0.4) |
|
|
|
|
lopinavir/ritonavir |
|
Abbott 1st categ |
Abbott 2nd categ |
Hetero Drugs Ltd |
|
|
|
|
|
133.3 + 33.3mg |
cap |
500 (0.228) |
n/a |
1898 (0.867) |
|
|
|
|
|
80 + 20mg/ml oral solution |
ml |
152 (0.139) |
n/a |
|
|
|
|
|
|
nelfinavir |
|
Aurobindo |
Cipla |
GPO |
Hetero Drugs Ltd |
Roche 1st categ |
Roche 2nd categ |
|
|
250mg (3) |
tab |
1533 (0.42) |
1423 (0.39) |
1599 (0.438) |
1217 (0.333) |
978 (0.268) |
2211 (0.606) |
|
|
50mg/g oral powder |
g |
|
|
|
|
1962 (0.224) |
2243 (0.256) |
|
|
nevirapine |
|
Aurobindo |
Boehringer 1st categ |
Boehringer 2nd categ |
Cipla |
GPO |
Hetero Drugs Ltd |
Ranbaxy |
Strides |
200mg |
tab |
112 (0.153) |
438 (0.6) |
n/a |
73 (0.1) |
255 (0.35) |
77 (0.106) |
84 (0.115) |
80 (0.11) |
10mg/ml suspension |
ml |
411 (0.075) |
400 (0.073) |
n/a |
137 (0.025) |
82 (0.015) |
|
|
|
ritonavir |
|
Abbott 1st categ |
Abbott 2nd categ |
Aurobindo |
Cipla |
Hetero Drugs Ltd |
Strides |
|
|
100mg |
cap |
83 (0.114) |
n/a |
336 (0.46) |
339 (0.464)) |
196 (0.269 |
438 (0.6) |
|
|
80mg/ml oral solution |
ml |
79 (0.93) |
n/a |
|
|
|
|
|
|
saquinavir |
|
Hetero Drugs Ltd |
Roche 1st categ |
Roche 2nd categ |
|
|
|
|
|
hard caps 200mg (5) |
cap |
1022 (0.28) |
989 (0.271) |
1327 (0.606) |
|
|
|
|
|
stavudine |
|
Aurobindo |
BMS 1st categ |
BMS 2nd categ |
Cipla |
GPO |
Hetero Drugs |
Ltd Ranbaxy |
Strides |
15mg |
cap |
|
n/a |
n/a |
0.04 |
0.058 |
|
|
|
20mg |
cap |
|
0.094 |
n/a |
0.045 |
0.07 |
|
|
|
30mg |
cap |
14 (0.019) |
48 (0.066) |
n/a |
36 (0.05) |
60 (0.082) |
21 (0.029) |
36 (0.049) |
35 (0.048) |
40mg |
cap |
31 (0.043) |
55 (0.075) |
n/a |
39 (0.054) |
77 (0.105) |
25 (0.035) |
47 (0.064) |
46 (0.063) |
1mg/ml powder for syrup |
ml |
|
358 (0.048) |
n/a |
153 (0.021) |
80 (0.011) |
|
|
|
5mg/ml powder for syrup |
ml |
|
|
|
|
23 (0.016) |
|
|
|
tenofovir disoproxil fumarate |
|
Gilead 1st categ |
Gilead 2nd categ |
|
|
|
|
|
|
300mg |
tab |
301 (0.824) |
n/a |
|
|
|
|
|
|
tenofovir disoproxil |
|
Gilead 1st categ |
Gilead 2nd categ |
|
|
|
|
|
|
fumarate/emtricitabine |
|
|
|
|
|
|
|
|
|
300 + 200mg |
tab |
362 (0.991) |
n/a |
|
|
|
|
|
|
zidovudine |
|
Aurobindo |
Cipla |
Combino Pharm |
GSK 1st categ |
GSK 2nd categ |
GPO |
Hetero Drugs Ltd |
Ranbaxy |
100mg |
cap |
|
|
|
241 (0.33) |
n/a |
|
|
|
250mg |
cap |
|
|
|
117 (0.16) |
n/a |
|
|
|
300mg |
tab |
140 (0.192) |
131 (0.18) |
285 (0.39) |
212 (0.29) |
n/a |
277 (0.38) |
134 (0.183) |
161 (0.22) |
10mg/ml syrup and 50mg/5ml oral solution |
ml |
|
93 (0.015) |
130 (0.021) |
223 (0.036) |
n/a |
130 (0.021) |
|
|
n/a = discounted price not available.
Price of products pre-qualified by WHO (23rd edition of WHO Pre-Qualified List) appear in bold.
BMS sells ddI in other doses (per mg price remains the same).
The daily dose referred to is 800mg IDV twice daily with ritonavir 100mg twice daily as booster as recommended by WHO. The prescribing information given by the manufacturer is 800mg three times daily (price US$ 600/year).
The daily dose referred to is 1250 mg twice daily although the dosage of 9 tablets (3 tablets three times a day) can also be used. Cipla PMTCT a 0.080 ml en envase de 25 ml.
The daily dose referred to is 100mg twice daily, for use as booster medication. This dose is not indicated in the manufacturer's label.
Saquinqvir should be used in combination with low-dose ritonavir as Saquinavir/Ritonavir 1000mg/100mg twice daily.
Not possible to use stavudine 15 mg capsule for 15 kg patient.
Not possible to use zidovudine 100 mg capsule for 15 kg patient.
GPO, has AZT at 0.021 in 60 ml bottle.
According to WHO treatment guidelines, the pediatric dosage of NVP is 120 to 200 mg/m2/dose, twice daily. For these calcilations we considered 160mg/m2.
According to WHO treatment guidelines, the pediatric dosage of NfV is 55 to 65 mg/m2/dose, twice daily. For these calcilations we considered 60mg/m2.
Gilead 1st category price applies to some middle-income countries. See Table 2 for conditions.
Table 2: Summary table for conditions
Company |
Eligibility (countries) |
Eligibility (body) |
Additional comments |
Delivery of goods[6] |
Abbott |
All African countries and LDCs outside of Africa |
Governments, NGOs, UN system organizations and other national and international health institutions |
|
FOB |
Aurobindo |
No restriction |
NGOs and Governmental Organizations |
Prices available for at least 1,000,000 units for each product per single shipment. |
Payment by letter of credit. FOB Hyderabad (India) |
BMS |
Sub-Saharan Africa, Haiti, Mauritius, Cambodia, Vietnam (For other developing countries, prices negotiated on a case by case basis with BMS local market representative.) |
Both private and public sector organizations that are able to provide effective, sustainable and medically sound care and treatment of HIV/AIDS are eligible. |
|
DDU to French Speaking Africa and CIF incoterm for English Speaking Africa (Kenya, Uganda, Tanzania, Ethiopia, Nigeria, Ghana, Eritrea) |
Boehringer-Ingelheim |
All World Bank low-income countries and sub-Saharan Africa. (Other countries on a case-by-case basis.) |
Governments, NGOs and other partners who can guarantee that the programme is run in a responsible manner. |
|
CIF |
Cipla |
No restriction |
No restriction |
No quantity related conditions. Prices are as per table 1 however for larger quantities the prices are negotiable. |
FOB Mumbai (India) or CIF - Freight charges separately on actual. |
Combino Pharm |
No restriction |
No restriction |
Delivery terms 120 days. No minimum order required unless any special labeling is required (standard labeling is in Spanish): order of a complete batch. Pack of 60 or 300 capsules available for ZDV. |
FOB Barcelona (Spain) |
Gilead |
95 nations including all of Africa and 15 other UN-designated 'least developed' countries. |
Organizations that provide HIV treatment in the 68 countries covered by the Gilead Global Access programme will be able to receive Viread at the access price. Applications will go through a review process. |
Gilead works with several distributors in Africa to facilitate low cost local distribution channels. |
FOB |
GlaxoSmithKline |
Least Developed Countries (LDCs) plus sub-Saharan Africa. All projects fully financed by the Global Fund to fight AIDS, TB and Malaria as well as projects funded by PEPFAR. (For middle income developing countries public sector prices negotiated on a case-by-case basis bilaterally through the AAI). |
Governments, aid organizations, charities, UN agencies, other not-for-profit organizations and international procurement agencies. |
In sub-Saharan Africa employers there who offer HIV/AIDS care and treatment directly to their staff through workplace clinics or similar arrangements are also eligible.
In sub-Saharan Africa employers there who offer HIV/AIDS care and treatment directly to their staff through workplace clinics or similar arrangements are also eligible.
All organizations must supply the preferentially priced products on a not for profit basis. Supply Agreement required (For NGOs requiring less than 10 patient packs per month, this requirement may be waived).
The manufacturer recommends that 'prescribers must ensure that patients are fully informed regarding hypersensitivity reaction to abacavir. Patients developing signs or symptoms must contact their doctor immediately for advice.'
|
CIP |
GPO |
No restriction |
Not-for-profit organizations and governments |
Payment by signed letter of credit. |
FOB Bangkok (Thailand) |
Hetero Drugs Ltd |
No restriction |
Private sector, public sector and NGOs |
Prices could be negotiated on individual basis according commercial terms. |
FOB Mumbai (India) |
Merck & Co. Inc |
First category of countries: Low Human Development Index (HDI) countries plus medium HDI countries with adult HIV prevalence of 1% or greater10.
Second category of countries: Medium HDI countries with adult HIV prevalence less than 1%10.
|
Governments, international organizations, NGOs, private sector organizations (e.g. employers, hospitals and insurers). |
Merck & Co. Inc does not rule out supplying ARVs to patients through retail pharmacies. Although Romania does not fall under these categories it also benefits from these prices due to a government commitment to a programme of universal access. |
CIP |
Ranbaxy |
No restriction |
NGOs and Governments or Programs supported by them |
Confirmed letter of credit or advance payment preferred for new customers |
FOB Delhi/Mumbai (India) |
Roche |
First category of countries: All countries in sub-Saharan Africa and all UN defined Least Developed Countries
Second category of countries: Low income countries and lower middle income countries - as classified by the World Bank.
|
Governments, Non Profit Institutional Providers of HIV care, NGOs. |
CAD (Cash Against Documents) 30 days at sight. Minimum order and delivery amount per shipment is CHF 10,000 (US$ 8,179) |
FCABasel (CH), |
Strides Arcolab Ltd |
No restriction |
Governments, non profit institutional providers of HIV treatment, NGOs |
Payment by signed letter of credit |
FOB Bangalore (India) |
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