[Ip-health] (e-drug) Roche Viracept (nelfinavir) price breaks bank

[Mike Palmedo]

http://www.essentialdrugs.org/edrug/hma/e-drug.200210/msg00053.php

E-DRUG: Roche Viracept (nelfinavir) price breaks bank
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Dear e-Druggers,

We are wondering if others are faced with one drug eating an unfair
share
of ARV project budgets?

MSF runs several ARV treatment programs in developing countries and is
using Viracept (Roche's nelfinavir) as a second-line treatment. In most
cases generic formulations of the drug are not yet registered and
Roche's
product is our only option. Nelfinavir is recommended by WHO as part of
first or second-line ARV drug combinations.

In its ARV project in Guatemala, MSF needs 16,000 tablets of nelfinavir
250
mg per month: Roche gives us the preferential price of 1.10 USD/tablet.
The
bill amounts to 17,600 USD/month.

If indinavir were used instead MSF would need 9,540 400 mg tablets to
treat
the same number of patients. With the MSD published price of 0.286
USD/tablet, the protease inhibitor bill would be 2,728 USD/month. (Note:
this is six tablets per day, not four tablets with a booster dose of
ritonavir. The indinavir/ritonavir combination is not practical in this
project because most of our patients do not have refrigerators.)

In other words, for the same amount of money, MSF could treat almost 6.5
times more patients with indinavir.  The difference is even greater when
comparing the preferential price that Roche offers to Guatemalan
authorities: according to our sources, it is  2.30 USD/tablet, more than
twice the price offered to MSF.

If the drugs were interchangeable we would use indinavir but this is not
the case. Nelfinavir is easier for patients to take. Indinavir must be
taken either one-hour before eating or two hours after eating and
patients
need to drink large quantities of water to avoid kidney stones.

It is interesting to note that for least developed countries,
multinationals participating in the Accelerated Access Initiative
(UNAIDS)
have dropped prices (compared to French/Swiss prices) between 80-98% --
except for Roche. Roche's best price is only 40% less than their Swiss
price. In the absence of significant generic competition for this drug
we
think Roche has an obligation to lower their price.  If you agree please
let Roche know, we tried but like Marie Antoinette they have told us to
"eat cake."

Daniel Berman
Access to Essential Medicines
MSF
daniel.berman@geneva.msf.org
+41 79 286 9649