Ellen Campbell-Grizzle - PHARMACY TODAY CONSUMERS OFTEN complain about medication prices. In the case of HIV/AIDS medicines, the situation assumes greater poignancy. One solution is for pharmacists to offer a less-expensive but equivalent generic option, if one exists.
However, these less expensive options remain unaffordable to many. The World Health Organisation (WHO) estimates that only one per cent of the global population is able to afford the treatment that they need to combat HIV/AIDS. Also the management of many chronic diseases requires adherence to treatment rates of 85 per cent while rates exceeding 95 per cent are crucial for the successful control of HIV/AIDS. No matter how good a drug is, if people can't afford it or do not take it properly, treatment will fail.
The burden caused by the price of a drug is not eased by any explanation of pricing formulae. Yet, a question that is asked so frequently deserves attention. Pharmaceutical manufacturing companies explain that prices reflect the enormous cost of research and development involved in bringing lifesaving antiretrovirals (ARVs) to the market. This process can take seven years or more moving through highly-regulated pre-clinical to clinical stages. The drug is the intellectual property of the originator company and it is estimated that the recovery of the cost of investment takes four to five years.
The latest ARV is a structurally-complex molecule made through a highly- sophisticated process of 100 production steps. A new class of ARV is presently sold at US$21,000 per year to each patient in the U.S. Each new drug is most expensive at the earliest stages of the market cycle. Later competitive forces and patent expiration tend to drive the price downward. In Jamaica, the exchange rate, fees, charges and mark-ups also are a part of the pricing
formula.
In the case of AIDS, the challenge is much deeper than providing less expensive medicines. Comprehensive therapy requires the regular use of antibiotics, nutritionals along with the 'cocktail' of drugs used to treat the virus. The cost burden is increased by the need to monitor progress with the requisite lab tests; measure drug levels in the blood to avert toxicities and manage side effects. Stigma adds to the bill as well. In Jamaica, patients fear breach of privacy. Many travel long distances from home to preserve anonymity and incur transportation costs to buy medication.
Why are HIV/AIDS medicines so expensive? The reasons are many and multifactorial including the following:-
medicines are the result of large investments in research and development that the drug originator claims the right to recover
they attract fees, taxes and mark-ups along the distributive chain
they are used in conjunction with several other drugs and nutritionals for effective treatment
adherence is crucial. Non-adherence will lead to drug resistance and the precribing of more expensive alternatives
stigma can add to cost in many ways.
There are some important things that you can do to control the price of your HIV/AIDS medication:-
take your medication as prescribed and follow nutritional advice
seek help from your healthcare provider to manage side effects
wear a condom during sexual intercourse to prevent contraction of other sexually transmitted infections (STIs), other strains of HIV or passing on STIs to your partner.
The rationale for the pricing of medication offers no salve to the patient who cannot afford to buy treatment. Remember, prevention is the least-expensive option. Abstinence and condom use do work. If you need greater detail about the costing of your HIV/AIDS medicines, ask your pharmacist, you have the right to know!
Ellen Campbell Grizzle, President, The Caribbean Association of Pharmacists (CAP) and Director, Information & Research, National Council on Drug Abuse (NCDA).
