South Africa struggling to pay for new medicines

According to the South African health service, even after a price cut, a newly developed anti-HIV injectable will still cost three times as much as the country can afford to pay for it.

The pharmaceutical company ViiV Healthcare, which is based in the United Kingdom, has reduced the price of the shot from 729 rand (or 32 pounds) to between 540 and 570 rand (or 23.66 to 24.97 pounds).

If the drug is taken as directed once every eight weeks, there is virtually little possibility that a person will become infected with HIV as a result of sexual activity. It includes the antiviral medication cabotegravir, which is released gradually over the course of two months. This medication is referred to as CAB-LA, which is an abbreviation for long-acting cabotegravir.

The HIV epidemic in South Africa is the worst in the world, with more than 13 percent of the population living with the virus. In 2022, it was anticipated that there were 164,200 people afflicted with the virus throughout the country.

The non-profit pricing of CAB-LA is significantly lower than the price in the United States, which is approximately $3,700 (£2,975) for a shot; nonetheless, this price is still four times higher than the price that South Africa’s health department pays for a daily HIV prevention tablet, which is £2.85 for a month’s supply for each patient, according to the health department.

“In order for the South African government to find CAB-LA to be economically viable, the price would have to fall within a tolerable range of oral PrEP [the daily tablet], which currently costs 129 rand [£5.68] for a supply that lasts for two months. According to Khadija Jamaloodien, the chief director of procurement for the National Health Department, “We cannot afford to pay double or thrice the price, especially not within the context of the budget cuts our department has faced.”

Jamaloodien continued by saying, “What’s more is that ViiV’s non-profit price does not include distribution costs, so it will be even higher than the currently quoted 540 to 570 rand per vial.”

Donors, such as those who contribute to the President’s Emergency Plan for Aids Relief of the US government, could be asked to cover the cost of CAB-LA. This would be one approach of overcoming the prohibitive cost of the drug. Pepfar has contributed the greatest money of any government donor to the provision of antiretroviral therapy in Africa, and it is also responsible for funding oral PrEP in a number of African nations.

According to Mitchell Warren of the Coalition to Accelerate Access to Long-Acting PrEP, ViiV has already sent Pepfar-sponsored supplies to Malawi, Zambia, and Zimbabwe, and they are expected to arrive in late November. It is anticipated that between the years 2023 and 2025, Malawi will be given 10,000 jabs, Zimbabwe will receive between 10,000 and 12,000, and Zambia will receive between 8,000 and 10,000.

Warren and several other South African HIV researchers have said that Pepfar has informed them that South Africa is on the list for donations in the beginning of 2024, despite the fact that Pepfar has not confirmed this information.

However, the department of health claims that it has not yet made a decision about whether or not it will accept donations from CAB-LA. Jamaloodien stated that the nation needs to make sure that its programs are sustainable and that relying on contributions means that the rollout would have to halt if the funding came to an end. Jamaloodien also stated that the nation needs to guarantee that its programs are sustainable. When it comes to HIV treatment, South Africa is responsible for footing the bill for its antiretroviral medications.

Jamaloodien stated, “It’s certainly not something we will flat-out refuse, but we also need to look at sustainability.” “It’s not something we will outright refuse.”

In March, ViiV licensed three Indian drugmakers to build cheaper generic copies of CAB-LA in partnership with the Medicines Patent Pool, an organization supported by the United Nations that assists less developed nations in gaining access to necessary medications. Cipla, which is one of the firms, already has a plant in Durban, and it intends to use that unit to produce the medicine.

However, Cipla must first acquire the necessary technology, construct the necessary facilities, and then conduct tests to demonstrate that its product is functionally equivalent to the branded product.

According to Warren, this means that the earliest that generic versions will become available is in the year 2027.

ViiV has indicated that as volumes go up, and they get orders from large buyers like Pepfar, the Global Fund, and governments like South Africa, the [non-profit] price could drop considerably,” said Warren. “ViiV has indicated that as volumes go up, and they get orders from large buyers like Pepfar, the Global Fund, and governments like South Africa.” “We believe that within the next couple of years, the branded product could cost closer to $100 or $120 for a year’s worth of injections [as opposed to the current price of $175].”

However, even at that price, it would still be more than double what it costs the South African government to purchase a daily medication for HIV prevention. The department argued that this would make the treatment unaffordable because it would not be cost effective.

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