Merck Offers to Reduce Price of Antiretroviral Efavirenz in Thailand, Provide No-Cost Efavirenz, Testing, Treatment Access to Children

Merck has offered to reduce the price of its antiretroviral drug Efavirenz in Thailand, Vichai Chokewiwat, chair of the Government Pharmaceutical Organization and the Ministry of Public Health's Committee on Compulsory Licensing, said on Saturday, Thailand's Nation reports (Nation, 6/3). The Thai government in November 2006 issued a compulsory license to produce a lower-cost version of Efavirenz. Since then, the government and Merck have continued negotiations. Thai Health Minister Mongkol Na Songkhla last month announced the government was considering revoking its compulsory license for Efavirenz following recent talks with Merck (Kaiser Daily HIV/AIDS Report, 5/24).

According to Vichai, Merck's subsidiary in Thailand, MSD Thailand, has agreed to sell Efavirenz for 767 baht, or about $23, per patient monthly, about half of the original price of 1,400 baht, or about $43, per patient monthly (Nation, 6/3). Merck previously had offered to reduce the price of Efavirenz to $23 per bottle, but the government can purchase a generic version of the drug from India-based drug makers for about $20 per bottle (Kaiser Daily HIV/AIDS Report, 4/16). In addition, Merck offered to provide a liquid version of Efavirenz at no cost to 2,500 HIV-positive children in Thailand and to sponsor HIV testing and treatment programs for children. The new price was "offered verbally" to Siriwat Thiptaradol, GPO secretary-general, according to Vichai. Merck has until June 12 to submit the offer in writing to the health ministry, Vichai added.

Reaction
Merck's offer was welcomed by HIV/AIDS advocates, according to the Nation. Vichai said that the offer is about 5% higher than generic versions of Efavirenz but added that the ministry likely will accept the offer because the inclusion of no-cost Efavirenz and treatment for children made the package "interesting" (Nation, 6/3). Siriwat, who also serves as secretary-general of Thailand's Food and Drug Administration, said he will discuss Merck's offer to provide treatment access to HIV-positive children with Thai medical experts (Kultida, Bangkok Post, 6/2). Jiraporn Limpananont, a lecturer at Chulalongkorn University's Faculty of Pharmacy, said Merck's new offer proves that the "original drug price does not reflect the real cost of drug development and investment" (Nation, 6/3).

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