XVIII International AIDS Conference


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Antiretroviral purchase price negotiations and the sustainability of the policy of free universal access to treatment for people living with HIV/AIDS in Brazil

R. Burgos Filho, R. Luiz Scapini

Ministry of Health, STD/AIDS Department, Brasilia, Brazil

Issues: Brazil currently provides ARV treatment for 190,000 people living with HIV/AIDS. 72% of spending on ARV involves patent-protected ARV: 28.78% for third-line drugs provided to 3% of patients and 28% for first-line drugs for 70% of patients. The structuring measures used for price negotiations have guaranteed successive reductions in prices, making it feasible to incorporate new ARV and to include an annual increment of 25,000 patients without jeopardising the policy of sustainability.
Description: Making best use of key information like: international prices for pre-qualified generic drugs; international policy on access to ARV of companies holding patents in Brazil; accurate planning of procurement based on consistent data on consumption and future consumer demands; centralised purchasing; and annual negotiation of the contracts, are all fundamental to the success of negotiations.
The table I shows the impact of negotiations on expenditure by ARV/patient/year, by % of the GNP and by Current Spending of the Ministry of Health CS-MH.

Calendar YearNº PatientsExpenditure US$ ARV/Patient/Year% Expenditure ARV/GNP% Expenditure ARV/CS-MH
[Table I]

Lessons learned: Therapeutic guide indicating sequential therapy and the rational use of medicines, price negotiations and the application of flexibility rules as per the TRIPS agreement show that it is possible to guarantee the sustainability of a policy of free and universal access to ARV.
Next steps: Upgrade the pharmaceutical industrial park for the production of the new ARV.

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