Evolution of ARV prices: observations fromthe Global Price Reporting Mechanism

Yves SouteyrandYves SouteyrandCoordinator, HIV/SIR UnitCoordinator, HIV/SIR Unit

9/12/109/12/10

Annual Consultation with Pharmaceutical Companies2 |

AMDS Clearing House SI

Price Information System

Controlled Medicines

ARV Market Intelligence

Inform Local Productionof ARVs

Market Forecast

PSM

Regulatory Status Database

API Sources and Prices

ARV production costing

Global ARV price reporting mechanism

Controlled Medicines

PSM Toolbox andConsultants Roster

M&E Indicators

http://apps.who.int/hiv/amds/en/

Annual Consultation with Pharmaceutical Companies3 |

The Global Price Reporting Mechanism[GPRM]

Annual Consultation with Pharmaceutical Companies4 |

Sources of procurement information

CHAI/UNITAIDCHAI/UNITAID

Crown AgentCrown Agent

IAPSO UNDPIAPSO UNDP

IDA HIV/AIDSIDA HIV/AIDS

MissionPharmaMissionPharma

UnicefUnicef

Global Drug FacilityGlobal Drug Facility

GPRM

Global FundGlobal Fund

JSI/DeliverJSI/Deliver

MSHMSH

SCMSSCMS

WHO CPSWHO CPS

UNFPAUNFPACountriesCountries

Annual Consultation with Pharmaceutical Companies5 |

GRPM captures around 75% of all public ARVGRPM captures around 75% of all public ARVtransactions in low and middle income countriestransactions in low and middle income countries

CHAI/UNITAIDCHAI/UNITAID

Crown AgentCrown Agent

IAPSO UNDPIAPSO UNDP

IDA HIV/AIDSIDA HIV/AIDS

MissionPharmaMissionPharma

UnicefUnicef

Global Drug FacilityGlobal Drug Facility

GPRM

Global FundGlobal Fund

JSI/DeliverJSI/Deliver

MSHMSH

SCMSSCMS

WHO CPSWHO CPS

UNFPAUNFPACountriesCountries

Annual Consultation with Pharmaceutical Companies6 |

Main partners in the GPRMHIV medicines (in Value - Dec 2009)

GFTAM

26.7%

UNITAID

8.4%

Mission

Pharma

10.7%

UNICEF

14.5%

PEPFAR

(SCMS,MS

H,JSI)

25.5%

CHAI

1.1%IDA

11.5%

Others*

1.7%

US$ 764 Millions

* UNDP, CPS, CHMP* UNDP, CPS, CHMP

Annual Consultation with Pharmaceutical Companies7 |

Weighted median price for first line regimensin LIC (comparisons 2006-2010 guidelines)

147

175

106

137143

0

100

200

300

400

2008 2009 2010

Med

ian

tran

sact

ion

pric

e (U

S$/p

py)

First Line based on 2010 recommendation with d4Tswitch of 50% to TDF and 50% to ZDV

First Line based on 2010 recommendation with d4Tswitch of 70% to TDF and 30% to ZDV

First Line based on 2006 recommendation

Annual Consultation with Pharmaceutical Companies8 |

Weighted median price for first line regimensin LIC (comparisons 2006-2010 guidelines)

106

147

279

248

364341

175143

137

0

100

200

300

400

2008 2009 2010

Med

ian

tran

sact

ion

pric

e (U

S$/

ppy)

First Line based on 2010 recommendation with d4Tswitch of 50% to TDF and 50% to ZDV

First Line based on 2010 recommendation with d4Tswitch of 70% to TDF and 30% to ZDV

First Line based on 2006 recommendation

Annual Consultation with Pharmaceutical Companies9 |

Weighted median price for secondline regimens in LIC

854

780

690

500

600

700

800

900

2008 2009 2010Wei

gh

ted

med

ian

pri

ce f

or

seco

nd

lin

e re

gim

ens

in

LIC

2nd Line based on uptake by countries

Annual Consultation with Pharmaceutical Companies10 |

Weighted median price for first line paediatricregimens in LIC (comparisons 2006-2010

guidelines)

170

868880

0

50

100

150

200

2008 2009 2010

We

igh

ted

me

dia

n p

ric

e f

or

firs

t li

ne

re

gim

en

s

First Line based on 2010 recommendation with 70% ZDV and 30% ABC based regimens and 15% on LPV/r

First Line based on 2006 recommendation

Annual Consultation with Pharmaceutical Companies11 |

Weighted median price for first line paediatricregimens in LIC (comparisons 2006-2010

guidelines)

88 8680

170

198198

0

50

100

150

200

250

2008 2009 2010

We

igh

ted

me

dia

n p

ric

e f

or

firs

t li

ne

re

gim

en

s

First Line based on 2006 recommendation

First Line based on 2010 recommendation with 70% ZDV and 30% ABC based regimens and 15% on LPV/r

Annual Consultation with Pharmaceutical Companies12 |

Weighted median price for secondline paediatric regimens in LIC

407

352

409

300

350

400

450

2008 2009 2010Wei

gh

ted

med

ian

pri

ce f

or

seco

nd

lin

e re

gim

ens

2nd Line based on uptake by countries

Annual Consultation with Pharmaceutical Companies13 |

Conclusions

Prices of ARVs drugs continue to decrease

But– Updated recommendations increase the median price of

first line regimens– This is especially true for pediatric regimens– Prices of second line regimens, even decreasing,

continue to be high

Prices continue to challenge scaling up ART

Thank you