Boehringer cuts nevirapine price for developing world

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Boehringer-Ingelheim is to cut the price of its antiretroviral drug nevirapine (Viramune) by 50% in low-income countries, the company’s chairman said today. However, the concessionary price offered by Boehringer will still be four times higher than the price offered by Indian generic manufacturers through the Clinton HIV/AIDS Initiative’s purchasing consortium.

Boehringer-Ingelheim is to cut the price of Viramune from $438 a year to $219 a year in low income countries, and by up to 90% in 67 middle-income countries, to $438 a year.

The Clinton HIV/AIDS Initiative announced last week that new prices negotiated with Indian generic manufacturers will mean that nevirapine can be offered at $45 a year, while a fixed dose combination of AZT, 3TC and nevirapine will be available at $174 a year in low-income countries.

Glossary

low income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. While the majority of the approximately 30 countries that are ranked as low income are in sub-Saharan Africa, many African countries including Kenya, Nigeria, South Africa and Zambia are in the middle-income brackets. 

generic

In relation to medicines, a drug manufactured and sold without a brand name, in situations where the original manufacturer’s patent has expired or is not enforced. Generic drugs contain the same active ingredients as branded drugs, and have comparable strength, safety, efficacy and quality.

middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are around 50 lower-middle income countries (mostly in Africa and Asia) and around 60 upper-middle income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

fixed-dose combination (FDC)

Two or more drugs contained in a single dosage form, such as a capsule or tablet. By reducing the number of pills a person must take each day, fixed-dose combination drugs may help improve adherence.

second-line treatment

The second preferred therapy for a particular condition, used after first-line treatment fails or if a person cannot tolerate first-line drugs.

Nevertheless the Boehringer-Ingelheim price cut will result in substantial savings for some countries that continue to purchase originator products rather than generics due to patent restrictions.

A recent survey of prices paid by Global Fund grantees for antiretroviral drugs by Brenda Waning of Boston University revealed a variation of up to sixfold between countries in the prices paid for nevirapine. Recent procurement of Viramune by the Zambian government resulted in expenditure of $2.7 million more than a comparable purchase at the global median price for nevirapine.

Boehringer chairman Alessandro Banchi also disputed that differential pricing and voluntary licensing had any impact on the ability of research-based companies like Boehringer-Ingelheim to invest in new research and development.

"Preferential pricing is the only way how we can meet both conflicting needs in the fight against AIDS. We can refinance our high research and development costs for innovative, new treatments by the established price system in industrialised countries and can offer affordable medicines to patients in poor countries who otherwise cannot afford antiretroviral medication," he said

His view differs from complaints expressed by Merck and Abbott. Both companies have seen their highest-earning antiretroviral products subjected to compulsory licensing in middle-income countries this year (in Thailand and Brazil). Merck complained earlier this month that pharmaceutical companies would not continue to invest in diseases that affect developing countries if their intellectual property was not respected.

“Research and development-based pharmaceutical companies like Merck simply cannot sustain a situation in which the developed countries alone are expected to bear the cost for essential drugs in both least-developed countries and emerging markets,” a company spokesman said.

French foreign affairs minister Philippe Douste-Blazy yesterday said that France supported Brazil's use of a compulsory license to reduce the cost of efavirenz. M. Douste-Blazy is also president of UNITAID, the international drug purchase fund supported by taxes on airline travel. UNITAID is funding purchase of second-line antiretroviral drugs for 27 countries.