HIV patients ask for one pill back

The Patient Control movement warned of a shortage of the most popular and most expensive combined drug (three drugs in one tablet) on the domestic market, the antiretroviral drug Eviplera. According to activists, some doctors explain the interruptions in the drug by introducing anti-Russian sanctions, but Patient Control is sure that the problem is the too high price set by the manufacturer – more than 300 thousand rubles. for the annual rate. Russians living with HIV asked Johnson & Johnson to halve the cost, but the company did not agree to this. As a result, Eviplera’s purchase volumes in 2022 decreased by 56% compared to 2021

Patient Control (which unites people living with HIV in Russia) reported a shortage of the ARV drug Eviplera (rilpivirine/tenofovir/emtricitabine) produced by the American Johnson & Johnson. Public activists specify that since the beginning of the year, Pereboi.ru has received reports from 12 regions about the shortage of the drug. According to patients and activists, the most difficult situation has developed in the Tver region, Komi and Crimea. The regional ministries of health could not comment on this data to Kommersant.

“Some of the patients are given the drug for a month, warning that the next time, most likely, they will have to change the therapy completely,” they say in Patient Control. “sanctions, frightening that the drug has left the Russian market and will no longer be. But we know it’s not.”

Eviplera is the most frequently prescribed and most expensive combination antiretroviral drug in Russia, according to government procurement monitoring data. Patients regularly talk about problems with it. So, in May 2020, Patient Control reported: due to the shortage of Eviplera, doctors are forced to change treatment regimens based on what drugs are available in AIDS centers, including those that were previously canceled for patients due to for the occurrence of adverse events.

As the representative of Patient Control, Yulia Vereshchagina, explains, the reason is the high price of Eviplera – more than 300 thousand rubles. in year. In September 2022, the Treatment Preparedness Coalition approached Johnson & Johnson with a request to reduce the price of Eviplera by at least half, to RUB 150,000. for the annual course (about 12 thousand rubles per pack). According to Ms. Vereshchagina, the price was reduced “very slightly”. But in a response letter, the company confirmed that the volume of purchases of Eviplera in 2022 decreased by 56% compared to 2021, and the application collected from the regions of the Russian Federation was satisfied only by 31%. “Indeed, over the past few years, we have observed that the actual volume of purchases of the drug rilpivirine + tenofovir + emtricitabine in the framework of the auctions held under the federal program is lower than the declared need,” representatives of Johnson & Johnson confirmed to Kommersant. that various additional measures are being taken to ensure the uninterrupted availability of vital medicines in the country.”

“According to information from the public procurement website, we observe that the regions tried to cover the shortage in Evipler at their own expense, but given the high price of the drug, this did not work,” says Ms. Vereshchagina. “We are preparing a request to the Ministry of Health of the Russian Federation with a request to accept urgent measures to solve the problem, as well as explain the reason for the cut in applications for Eviplera.

Earlier, Kommersant said that this year the Ministry of Health has significantly reduced purchases of expensive modern foreign drugs for the treatment of HIV, which have no analogues. If in 2021 they accounted for 67.3% of the total volume of purchases, then this year it is already 55%. The reduction in the share is due to the reduction in the cost of Eviplera from Johnson & Johnson. Last autumn, at the expense of the 2022 budget, this fund was purchased for 1.9 billion rubles, which is two times less than the previous volume of purchases. But the department increased purchases of more budgetary medicines. For example, 585.6 million rubles were allocated from the 2022 budget for a drug based on efavirenz (manufactured by a large number of companies), which is 21% more year-on-year. The volume of purchases of lopinavir + ritonavir (mainly supplied by the original Kaletra from AbbVie and the generic Kalidavir from Pharmasyntez) increased by 45% to RUB 5 billion.

Yulia Vereshchagina claims that these are one of the oldest drugs that cause many side effects in some patients. “Some of the patients who came to us about Eviplera said that the regimens were being changed to these drugs, despite the side effects,” continues Ms. Vereshchagina.

At the same time, as the Treatment Preparedness Coalition pointed out, this year experts estimated a shortage of the budget for the purchase of drugs for HIV patients at 10 billion rubles, and the Ministry of Health has already begun to purchase HIV drugs at the expense of the funds provided for in the budget for 2023 . According to Yulia Vereshchagina, the Ministry of Finance responded to a request from patients to the government that it was not worth waiting for a “special increase” in the budget (now it is about 30 billion rubles), and long-term purchases and price reductions by manufacturers can solve the problem of drug shortages. “But long-term purchases in 2021 didn’t particularly solve the problem, and prices for some drugs are not going down much,” Ms. Vereshchagina states.

The Ministry of Health reported to Kommersant that the federal budget for the purchase of therapy for people with HIV, including in combination with hepatitis B and C viruses, is 31.7 billion rubles. annually. According to the agency, four contracts for the supply of Eviplera have been signed. For two of them, deliveries have been made in full, for two more deliveries are ongoing. The remaining drugs will be used in 2023. “Issues of uninterrupted drug supply are one of the priorities of the Russian Ministry of Health and are under control,” the press service said.

Natalya Kostarnova