SOUTH AFRICA: New ARV tender halves drug prices
JOHANNESBURG, 20 December 2010 (PlusNews) – South Africa’s newly announced tender for antiretrovirals (ARVs) has halved the price the government will pay for the life-saving drugs; however, fixed dose combinations, which would decrease the pill burden, are still largely absent from the deal.
With estimated savings of about US$685 million from end-January, South African Health Minister Aaron Motsoaledi said the programme could now afford to treat twice as many HIV-positive patients as before. Few fixed dose combinations have been included in the new tender, however, due to continued registration delays with the Medicines Control Council (MCC).
As part of a campaign to test 15 million South Africans for HIV by April 2011, at least 4.8 million people had been tested as of June 2010. More than 900,000 people were diagnosed HIV-positive as a result; Motsoaledi said he hoped the savings earned through the new drug tender would help these new HIV patients.
South Africa has an HIV prevalence rate of about 18 percent, and is estimated to have the world’s largest ARV programme. In a budget speech made earlier this year, Motsoaledi stated that despite the country’s huge economies of scale in ARV procurement, it still paid significantly higher prices for its ARVs than other countries.
In 2008, the country paid about $23 for a month’s supply of a 300mg tablet of the ARV tenofovir; in 2011, the country will pay just less than $8.
While the tender’s prices are new, its drug suppliers are not as 10 long-standing pharmaceutical companies will continue to supply the national programme with ARVs although in different proportions. The increased competitiveness of the new tender was cited by Motsoaledi as one of the reasons behind new, lower drug pricing alongside advancements in the production and acquisition of ARV ingredients.
Registration delays
According to Andy Gray, a senior lecturer at the department of therapeutics and medicines management at South Africa’s University of KwaZulu-Natal, the tender has only included dual fixed-dose combinations, such as a tenofovir and emtricitabine, in limited amounts. The tender makes no provision for triple combination pills, including those that would add nevirapine to this combination to form South Africa’s first-line regimen.
According to a statement released by Section 27, a public interest legal centre, triple fixed-dose combinations were not included because most, while approved by agencies such as the US Food and Drug Administration, have not yet been approved by South Africa’s MCC.
Fixed-dose combinations have been shown to reduce pharmacy errors in dispensing and to ease treatment adherence.
Only half the battle
While activists from the South African AIDS lobby group, the Treatment Action Campaign (TAC), and Section 27 have welcomed the new tender, they continue to call for improvements in the tender’s terms and greater transparency.
According to a statement released by senior researcher and director of policy and research at Section 27, Jonathan Berger, the tender makes no provision for a reduction in drug prices should the prices of the active ingredients decline. He also added that, as in past tenders, the government has yet to release any documentation about the selection process or how the tender was allocated.
The statement also called for the speedy implementation of the newly established Central Procurement Authority, which was approved at a recent National Health Council meeting.
The new body is expected to draw on the lessons learned from the new ARV tender to push for lower prices on other health-related commodities and deal with issues of late payments to manufacturers that have been blamed for past shortages in ARVs, HIV testing kits and tuberculosis drugs, according to a department of health statement.
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