Costa Rican PWAs Seek Treatment Access - No Success in Roche Negotiations

Treatment activists in Costa Rica are trying to get access to protease inhibitors and other AIDS treatments. In Costa Rica, saquinavir (Invirase(TM)) costs about $800 per month while the average salary is $250. The country has 1,100 diagnosed AIDS cases, of which about 70% are in the gay community.

While negotiating with the government to get antiretrovirals approved in the national health system, a coalition representing 200 persons with AIDS also sought from Hoffmann-La Roche a temporary compassionate access program for saquinavir for 50 people. On March 23 the group announced that after months of negotiation, Roche had refused to provide free or significantly discounted medication -- that the company's director in Costa Rica said that he did not have authority to make the decision.

Richard Stern, Ph.D. health coordinator of the Costa Rican gay and lesbian group Triangulo Rosa, noted that in rich countries, governments find that protease inhibitors are cost effective because they reduce the expense of hospitalization. But in Costa Rica, hospitals cost only about $200 a day, a fraction of the rate in the U.S. Since the drug's price is about the same in the two countries, it is hard to make the case that much of the drug's cost will be offset by savings elsewhere. The Costa Rican government has told the Coalition that it would cost three to four times more to provide the drugs than to keep patients in the hospital. Only AZT is regularly available in Costa Rica, and only for pregnant women.

[Note on international prices: ACT UP/Golden Gate, in San Francisco, has checked international prices on some AIDS drugs. The saquinavir prices (average wholesale price, per year, in U.S. dollars) are: $5966 U.S.; $4484 Canada; and $5760 in Germany, Italy, and Spain. In Costa Rica, $800 per month retail would be $9600 per year; we do not know the wholesale price in that country.]

Comment

The issue is not just Roche and saquinavir, but how modern medical care can be made available to the great majority of the worlds' people who are currently denied access.

While only Roche knows the reasons for its reluctance, a likely possibility is that the company does not want to single-handedly take on responsibility for the whole world -- most of which will need medication free or at a greatly reduced price. They may have decided that it would be easier to say no in the beginning than at any other time.

No single company can assume the responsibility alone. But industry must share responsibility for creating a system that people can live with. It has the resources. In the U.S., "From 1988 through 1995, the pharmaceutical industry surpassed all other Fortune 500 industries in profit rates, and it has ranked either first or second in 31 of the past 39 years," according to Peter Arno, Ph.D., a health economist at Montefiore Medical Center in New York.

There are already distribution channels for other drugs -- for example, companies donate drugs or provide them at greatly reduced cost to international agencies such as the World Health Organization, which then take the responsibility of distributing to governments and non-governmental organizations that need them and are able to use them. Another approach is to license countries to manufacture drugs at prices the countries can afford. As with patient assistance programs in the U.S. -- which many pharmaceutical companies maintain to provide free drugs to those with absolutely no way to pay for them -- no sales would be lost, since these programs are carefully designed to provide only for those who otherwise would go without.

Why are AIDS drugs often priced comparably in countries with vastly different incomes, while many other medications are priced to be affordable locally? Companies may fear that low-cost drugs will be smuggled back into rich countries. But this problem is likely to be far less than it may seem, since almost all antiretrovirals consumed anywhere are paid for either by government programs or by private insurance or HMOs. These large organizations can certainly be prevented from using smuggled drugs on any significant scale.

There are workable solutions for providing basic medical care -- for AIDS and for other conditions -- to those now denied it. The first step is to raise the issue and agree that it is intolerable to abandon most people in the world. Individuals and institutions must work ceaselessly until access is greatly improved.

For More Information

For more information on treatment access in Costa Rica and how you can help, contact: Asociacion Triangulo Rosa, Apartado 1619-4050, Alajuela, Costa Rica; fax 506-223-3964, email rastern@sol.racsa.co.cr.