Russian Patients Asked for Cheaper Drugs, and Big Pharma Listened

Russia saw a rare feat in health care this week:  Patients spoke out about high medication prices, and a drug company listened.

Last Friday, the Moscow-based organization Community of People Living with HIV drew attention to a failed tender by the Russian Ministry of Health in May to purchase the antiretroviral medication combination of abacavir and lamivudine. The drug, better known in Europe by its brand name Kivexa, last year was used to treat about 3,500 Russians living with HIV at $17.50 per dose. Recognizing that demand for Kivexa was rising rapidly, the Russian Ministry of Health had said it would procure more than 2 million tablets of Kivexa, but that it was prepared to pay no more than $7.70 per dose—a price already five times higher than in several other countries, according to Médecins Sans Frontières data.

When ministry officials launched their auction, however, Kivexa’s sole producer in Russia, ViiV Healthcare, a joint venture of pharma giants GlaxoSmithKline and Pfizer, refused to participate. Although the drugmaker had already agreed to reduce its price for Kivexa by 40 percent in 2009, it would not accept the tender’s lower price, putting nearly 5,700 HIV patients’ access to Kivexa in Russia at risk.

Community of People Living with HIV and its partners  struck back. They called on ViiV Healthcare to lower its price and restore the supplies of the drug.

“It is obvious that the need for antiretroviral drugs produced by the company will continue to grow each year, and such a behavior can hardly be described as justified in terms of market strategy," Andrey Zlobin, chairman of the patient group’s board, said in a press release. “There is an inescapable feeling that the producer of the drug is trying to extract maximum benefit to the detriment of patients’ interests.”

In a surprising turn, ViiV Healthcare agreed. The company announced in a statement yesterday it will accept a lower price for Kivexa—50 percent lower, in fact—and the Ministry of Health has said it will launch a new tender on June 23.

Meeting with Community of People Living with HIV and other organizations yesterday, Deputy Minister of Health Veronika Skyvortsova acknowledged the community’s monitoring, thanking the groups for saving the government millions of rubles.

Announcing the victory, Zlobin declared, “We will not allow anyone to ignore our interests, health, and lives.”

Yet Kivexa, a second-line treatment, already represents a Hobson's choice for Russian HIV patients.  Even at $2,700 for treatment annually, Kivexa’s price is more than twice as much as Russia paid for first-line therapy under Global Fund to Fight AIDS, Tuberculosis and Malaria procurement in 2010.  Abacavir and lamivudine also must be prescribed in combination with a third medication, adding to the total price of treatment. Moreover, it is not recommended for those patients who also have hepatitis C, as many Russians living with HIV do.

Ultimately, to provide universal access to all Russians who require antiretrovirals, prices must fall significantly across the board and supply chains strengthened—an outcome requiring the commitment of both drug companies and the Ministry of Health.

Indeed, in its meeting with Ministry officials Wednesday, the Community of People Living with HIV raised the postponed tender of another antiretroviral produced by ViiV Healthcare called Combivir (zidovudine and lamivudine). That delay could put at risk treatment for 47,000 patients.

Patient groups suspect the Combivir auction, expected to start at 2 billion rubles ($71 million) and originally scheduled for late April, has been scuttled for similar reasons as the Kivexa tender. If so, one can only hope for the same outcome.

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