Multicountry collaboration: The Andean negotiations November 2002 June 2003

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Multi-country collaborationThe Andean
negotiations November 2002 June 2003

• Inter-country Meeting on Antiretroviral Drugs
  Pricing, Procurement and Supply Management
• Cairo, Egypt, 5-7 April 2005

Peter Graaff WHO Aids Medicines and Diagnostic
Service Geneva
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Andean (Lima) Negotiations begin November 2002

• November 2002 Joint meeting of Ministers of
  Health from Andean Countries and Ministers from
  Southern Cone
• Resolution to execute regional negotiations with
  manufacturers of ARV, brand and generics, as well
  as laboratory diagnostics adopted jointly by
• Bolivia, Chile, Colombia, Ecuador, Peru,
  Venezuela
• Argentina, Mexico, Paraguay, Uruguay
• Coordinated by regional institutions for economic
  integration (CAN / ORAS) and supported by PAHO
  and UNAIDS

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Open Competition Negotiation Model

• Rejection of the principles of the Accelerated
  Access Initiative
• Prices to be negotiated on price and volume, and
  not based on any other condition
• Countries would pre-qualify companies to ensure
  that the manufacturer and product conform with
  quality criteria
• Quality criteria based on WHO standards (GMP
  certification and bioequivalence)

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Development of the Negotiation Model

• Nomination by the Minister of Health of a
  Technical Commission, with members from each
  country (10)
• Development of a status report on HIV/AIDS in the
  Andean region, focusing on treatment access and
  pricing
• Regional meetings (3) of the Technical Commission
  to
• Review the Status Report
• Define prequalification criteria (coherent with
  WHO criteria)
• Identify manufacturers meeting criteria
• Define the Basis for the negotiation (one
  regional price, no external conditions)
• Briefing of the negotiators (Ministers of Health)
• Organize the negotiation

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ARV Manufacturers Prequalified for Negotiation

• 1. ABBOTT LABORATORIES 9.KAMPEL MARTIAN S.A.
• 2. BOEHRINGER INGELHEIM 10.LAZAR
• 3. BRISTOL MYERS SQUIBB 11.MERCK SHARP DOHME
• 4. CIPLA LTD 12.RANBAXY
• 5. COMBINO PHARM S.L. 13.REFASA S.A.C.
• 6. ELEA S.C.I.F.Y.A. 14.RICHMOND
• 7. FILAXIS S.A. 15.PRODUCTOS ROCHE S.A.
• 8. GLAXO SMITH KLINE 16. RONTAG S.A

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HIV Diagnostic Manufacturers Prequalified for
Negotiation
1. ABBOTT LABORATORIES 2. BAYER 3. BECKMAN 4. BECT
ON DICKINSON 5. BIOMERIEUX 6. BIORAD 7. CROMOION
PROMED 8. INNOGENETICS, N.V. 9. ROCHE
DIAGNOSTIC
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Outcomes of the Andean NegotiationLima, Peru,
June 2003

• Signing of Statement of Intent between 8 ARV
  manufacturers, and 5 HIV diagnostics
  manufacturers, and the countries
• Of the ARV Manufacturers 7 Generic Companies and
  1 Originator
• Of 37 items negotiated, price reductions were
  obtained for 15 items, compared to the lowest
  reference price in any of the countries prior to
  the negotiation

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Results
New
No
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2. Outcomes of the Lima Negotiation Peru, June
2003
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2. Outcomes of the Lima Negotiation, Peru, June
2003
Latin Americans lead price-cut drive AIDS
DRUGS Countries in Latin America have been
taking an increasingly aggressive stance towards
the pharmaceuticals industry over patented Aids
treatments, which could set a pattern for other
developing nations. "The prices they have
achieved are in some cases lower than in
sub-Saharan Africa," says James Fitzgerald, a
drug procurement specialist at the Pan American
Health Organization in Washington.
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Take home messages

• Development of a regional negotiation process
  requires significant political commitment and
  technical input from countries (and partners)
• Joint action by the EMR countries in addressing
  the determinants of access to ARVs can result in
  important direct benefits (price reductions) and
  indirect benefits (sharing of information, policy
  development, advocacy, coordination of efforts,
  intercountry cooperation)
• Negotiations have to be followed by procurement
  
• Impact should be monitored
• AND
• Working together works (to deal with technical
  and political issues)
• ??? GCC model
• ??? Council of Arab Ministers of Health

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An example of countries working togetherPrices
paid for ARVs as reported to the GFATM
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For further information

• James Fitzgerald of PAHO not only assisted the
  Andean countries with their negotiation process,
  but also me with the preparation of this
  presentation.
• Contact details
• graaffp_at_who.int
• amds_at_who.int
• http//www.who.int/3by5/amds/en/