Treatment Expansion Focus

Meeting the Global Need

for Our Medicines

Disclaimer: The views expressed in this paper/presentation are the views of

the author and do not necessarily reflect the views or policies of the Asian
Development Bank (ADB), or its Board of Governors, or the governments they
represent. ADB does not guarantee the accuracy of the data included in this
paper and accepts no responsibility for any consequence of their use.
Terminology used may not necessarily be consistent with ADB official terms.

Our Model of Treatment Expansion

Tiered Pricing

Generic Licensing

Branded drugs available

at deeply discounted prices

Partnerships with generic manufacturers

to produce high-quality, low-cost medicines

Drug Registration
Working with network
of business partners
to submit regulatory
dossiers on a country
by country basis

Relevant Data
Broad clinical trials across
broad patient populations;
local clinical trials where
appropriate; key
demonstration projects

Partnerships &
Health Systems Strengthening
Agreements with non-profit
service providers and on the
ground medical education and
training

Product Donations
Targeted donations enabling
treatment initiation for key
underserved populations
2

Generic Competition Has Reduced Prices

Driven by competition among licensed generic manufacturers, the
cost of Gilead HIV medicines has fallen by 80%

$17.00

Lowest Price (Per Patient/Month)

$12.42

8,700
Patients Reached (Thousands)

7,300
$12.42
5,400
$8.25
$6.50

2,400
1,400

30

133

2006

2007

413

2008

2,900

$5.50
$4.49

703

2009

2010

2011

2012

$4.00

2013

$4.00

2014

$3.50

2015

Year

Patient Access to ARVs

More than 60% of patients on antiretroviral therapy in the
developing world are now receiving Gilead medicines

Generic drug
manufacturers account
for 98% of Gilead HIV
medicines prescribed in
developing countries

Includes patients receiving Viread for hepatitis B. Viread is approved for both HIV
and chronic hepatitis B virus infection

Explore new models to expand access

Wealthy

Emerging
Middle Class

Poor
(Base of the Pyramid)

Potential Funders:

Private
Patient pays entirely out of
pocket or has private health
insurance (HMOs)
Private/Funder
Patient pays a portion out of pocket;
external funder pays remainder to
make therapy more affordable to more
patients
Public (with or without Funder)
Treatment is covered by public program
with or without subsidy from external
Funder

Potential Out-of-Pocket Funding Mechanisms

Micro-giving
Micro-saving
Micro-credit
Mobile Money

HCV in Mongolia: Financing Options

Majority of patients are in middle class and can afford to pay through loan
program
Two bank options available, providing flexibility and access
XAC Bank
High

~10% of population
Can afford $400 / month

Has existing salary loans with 1.5-2.2% interest rates

Agreed to launch health loans at 1.2%/month

because stakeholders agreed to use Xac bank with
no interest on holdings

Middle class

~70% of population
Can afford $ 50-70 / month

TDB Bank
Second largest bank with wide spread
Interest rate at 1.7%/month and a maximum of 24 months

Below poverty line

Cannot afford at
any subsidy

Don't require any groups (i.e. HCV stakeholders) to

deposit funds at the bank

Bond / trust model

Are
Patients
Cured?

3rd party monitor

Government
4
Yes

3
Treatment
results are
verified

For every cured

patient, government
pays $xx for xx years
into the trust

Govt
guarantees the
debt

Trust
No

Bonds
1

Proceeds deposited
into the Trust

(or revolving credit facility

if investment grade bonds
cannot be issued)

Bond Holders/
Investors/Funders
2
Treatment
provided to
patients

Drug
Manufacturer

World
Bank

Islamic
Develop
ment
Bank

Other
investors/
funders

Access in Action: Brazil

An estimated 3 million people in Brazil are chronically
infected with HCV but only 10% are currently diagnosed.

The partnership:
Reached an agreement with the Brazilian Ministry of Health to
enable availability of branded Sovaldi through the national
public health system
Ministry of Health has committed to scaling up treatment
nearly threefold

Sovaldi also an integral component of Brazils new HCV

treatment guidelines
Gilead also implementing medical education programs to
familiarize Brazilian healthcare providers with the latest HCV
treatment options

Brazilian Ministry of Health

press conference launching new
treatment guidelines,
July 2015