US Pharmaceuticals Uniquely Yakachengetedzwa kubva Mukumikwikwi
Vashomanana vanogona kukakavara nekuti mishonga yeHIV inodhura. Zvechokwadi, maererano neCenters for Disease Control and Prevention (CDC), munhu anogara neHIV anotanga kurapwa mangwanani achasangana nemararamiro emararamiro anosvika madhora 250 000, uye izvi ndezvemapiritsi avo oga. Izvo zvinodhura hazvigoni kushamisika zvichipiwa kuti muitiro wechitatu-mu-imwe sarudzo, saTurumeq , ine mari yakawanda yepamusoro $ 2 600 pamwedzi.
Zvimwe kusanganiswa zvakanaka zvakanyanyisa izvozvo .
Pasinei neizvi, haunowanzonzwa zvakawanda munzira yekuchema kwevanhu pamusoro pemutengo wemishonga iyi. Uye izvi ndezvekuti vazhinji vanowana mishonga yavo yeHIV inobhadharwa, pamwe nechepakati, kubva kune inshuwarisi kana hurumende dzakasiyana-siyana uye rubatsiro rwevamwe.
Mukufema kwakafanana, vamwe vanonetseka kuti ma antiretroviral mishonga inogona sei kutakura mutengo wakakura kudaro muAmerica patinonzwa kuti zvinyorwa zvechi generic hazviwanikwi kune dzimwe nyika asi zvinodhura zvakanyanya se2000 muzana kudarika zvatinobhadhara pano.
Zvikonzero zvekusavapo kwehutachiona hweHIV huri muUnited States panguva imwe chete iri nyore uye yakavhiringidza, inosanganisira sayenzi, zvematongerwo enyika, uye zvakanaka, pfuma yakare-kare. Nokuparadzanisa nyaya idzi dzakaparadzana, tinogona kujekesa zviri nani matambudziko anotarisana nevatengi vane HIV nehuwandu hwehutano hwakakura.
Apo Kufambira mberi kweScience kunowedzera Generic Drug Development
Kazhinji kutaura, apo purogiramu yezvinodhaka inopera (kazhinji makore makumi maviri pashure pekuti patent yaive yakatanga kuiswa), kodzero yekukopa iyo mishonga ichave yakazarurirwa kune ani zvake anosarudza kuumba shanduro ye generic.
Chinangwa chemauto ndechekukwikwidzana nechigadzirwa chepakutanga pamutengo, nevatambi vakawanda vanowedzera kukwikwidza kukuru uye, kakawanda kupfuura kwete, kuderedza mari.
Saka sei tisati taona izvi nemishonga yeHIV? Pashure pezvose, zvivako zverwendo rurefu rwema-antiretrovirals zvingazopera kana kuti zvichange zvichangopera, kusanganisira izvo zvekare zvakadai se " Susstar" (efavirenz) uye tenofovir (TDF).
Asi kana iwe uchitarisa mabhuku eDaily and Drug Administration (FDA), maitiro ekugadzira anowanikwa uye anogamuchirwa kune vatanhatu vezvinodhaka. Pakati idzi, chetatu chinowanzoshandiswa pakurapa HIV muUnited States (stavudine uye didanosine), asi vose asi vaviri (abacavir ne lamivudine) vari kuwira kunze.
Uye imomo mune imwe yenhamo inotarisana nevatori vemazuva ano munharaunda yeHIV: Kufambisa-kushandura sayenzi kunogona kuita kuti vamwe vashandisi vezvinodhaka vasashandise.
Kuda Kuda Kunoda Kuderedza Kupikisana Kwechizvarwa
Tora, somuenzaniso, Rescriptor (delavirdine) uye Aptivus (tipranavir), mishonga miviri yakanaka yeHIV iyo mabhizimisi ayo akazopera muna 2013 uye 2015, pamwe chete. Kunyange zvose zviri zviviri zvichiri kushandiswa mukurapa kweHIV, imwe, mitsva yechizvarwa chemishonga (kunyanya integrase inhibitors) yakapiwa nzvimbo yakasarudzwa. Iyi mishonga, panguva iyo, yakaderedzwa kune imwe nzvimbo.
Somugumisiro, Rescriptor neAptivus zvinowanzoshandiswa se "kugumburwa-shure" apo dzimwe mishonga dzinokundikana. Izvi chete zvinoderedza zvinokurudzira vakugadziri kuti vauye muzvinhu zvinowanzoitika kana pasina vimbiso shoma yekutengesa kwekutengesa.
Saizvozvowo, kunyange zvazvo mishonga yakafanana neTDF ichiri pakati pezvinonyanya kushandiswa munyika, shanduro yakagadzirwa-inonzi tenofovir alafenamide (TAF) -yakatangwa muna 2016 sezvo TDF's patent yakagadzirirwa kupera.
Rangano here? Kwete chaizvo, kupa kuti fomu idzva inopa zvakawanda zvishoma nemigumisiro uye yakakwirira, yakasimba-yehutano yehutano hwemazi (zvinoreva kuti mishonga inoramba iri mumutambo wako kwenguva refu). Pakupedzisira, TAF isiri mishonga inobatsira zvikuru iyo inofanira kutora TDF, kunyanya mumapiritsi matsva pamwe chete.
Saka, izvi zvinoreva here kuti hatizooni maitiro eTDF chero nguva pfupi? Vazhinji vanotenda kuti tichadaro. Kunyange mukutarisana kwekutsvaga kunoda, TDF generic inenge iine nzvimbo mune hutachiwana hutachiona hweHIV uye inogona kugumburwa nehasha nevanishuwarenzi nevamwe vanopa kuedza kuderedza mishonga yemishonga . Uye, pakupedzisira, varwi vanowanzove vari mumusika, iyo yakaderera mitengo ichaenda.
Izvo zvave zviri izvo zvakaitika nehuwandu hweEpizicom , imwe-in-imwe sarudzo ine bhacavir uye lamivudine. Nezvose zvinodhaka zvikamu zvinorayirwa zvekutanga-line remishonga, vatori vana vakagumbuka pamutambo we generic uye vakakwanisa kupa mari yekusvika kusvika makumi manomwe kubva pane iyo ye zita rezita.
Utachiona hweHIV Mishonga Vanodzivirirwa Kubva kuGeneric Price Pressures
Vashandisi vezvinodhaka veHIV vane US vari munzvimbo yakasiyana yekushamwaridzana kunokonzerwa nemakambani makuru angangodaro ari kuisa pazvitsitsinho zvavo.
Chokutanga, mutengi anoda imwe yepiritsi yakasarudzwa yakaita mahwendefa ega ega asingashamisi mune chimwe chinhu asi gare gare-shanduro yekurapa. Hazvishamisi kuti zvibvumirano zvezvizhinji zvezvipiritsi zvinosanganiswa hazvina nzvimbo pedyo nekuguma kweupenyu hwavo, pamwe nedzimwe saTruvada (TDF plus emtricitabine) chete nekuda kwekupera muna 2021.
Saka kunyange kana mumwe wemishonga yemishonga inowanika kune vanogadzira zvinogadzirwa, mutengi anowanzosarudza zita rechigadzirwa pamwe chete tablet (kunze kwekuti, chokwadi, inshuwarheni inovamanikidza kuti vasaita zvimwe).
Asi, kunyange kunze kwenyaya yekutsvaga kwevatengi, kukwikwidzana kwemitambo kuUnited States kwave kwenguva yakareba yakasimudzirwa mune zvinotungamirirwa nevasiri vemuropa zvinodhaka zvinodhaka. Izvi zvinokonzerwa nehurukuro yekuti hurumende yeUnited States ndiyo imwe yekutengesa zvinodhaka zvinodhaka mazuva ano.
Kuburikidza nehurumende inotungamirirwa neAIDS Drug Assistance Program (ADAP) , hurumende dzehurumende dzinoendeswa kunotenga zvinodhaka zveHIV zvakananga kubva kune avo vatengesi. Mitengo inotungamirirwa neHurumende 340B Drug Pricing Program, iyo inoderedza kuwandisa mutengo wekutengesa kune imwe nzvimbo kubva kune 60 kusvika ku70 muzana. Mushure mokunge uchitaura zvekuputsika, zita rechirwere zvinodhaka nguva dzose rinopedzisira risina kudhura kudarika vashandi varo.
Chimwe chikonzero chekuchengetedza mishonga yemishonga ndiyo nzira iyo mushonga unoparidzirwa. Kusiyana nehutano inshuwarhu yehutano, ADAP chirongwa chekurapa chinongorongedzerwa chete nemitemo yakabudiswa neDhipatimendi reHutano neHuman Services , iyo inowanzoisa yose-mu-imwe mahwendefa ekubatanidza-iyo mishonga inodzivirirwa nepamutemo-sechisarudzo chakanakidzwa murapi yekutanga .
Pakupedzisira, haisi "kusanganiswa" kunotungamirira aya mazano. Zvidzidzo zvakaratidza kwenguva refu kuti vanhu vane chirwere chepiritsi rimwe chete vanowanzoita kuti varambe vakagadzikana kana vachienzanisa nevaya vanotora mapiritsi akawanda. Izvi, zvakare, zvinoshandura muzinga rakakwirira rekuchengetedzwa kwehutachiona hwehutachiona, zvinoreva kuti hutachiona hahukwanisi kudzokorora uye iwe hausi kunyanya kuwedzera kushandiswa kwemishonga.
Zvakanaka kana kwete, mitemo iyi haigone kubatsira asi iyo inofarira asiri munhu anogadzirwa, zvichiita kuti zvive zvakaoma zvikuru kumakambani akazvimirira kukwikwidzana pane chero chinhu asi tangential level.
Kuti varambe vachidzivirira nzvimbo yavo yepamusika, vanenge vese vatengi vemazita vakagamuchira kupa rubatsiro rwemari kune avo vasingakwanisi kutenga mishonga yavo, kana nenzira yekubhadhara mari yekubhadhara kana kushandiswa kwevaya vasina kukodzera inshuwarisi. Izvo zvipo zvinogadzirwa zvinogadzirwa zvakamanikidzwa kufanana.
Asi, sechinhu chinokosha sezvo izvi zvinokurudzira, havachiri kutarisa mari inowanzokwirira yeHIV mishonga kana ichienzaniswa nemishonga imwe chete iripo kunze kweSouth
Kunze kwenyika Dambudziko reMari Dambudziko nekutsvakurudza nekukudziridza zvirevo
Iko huru ye pharma yekutengeserana ibhizimusi rese rinowedzera zvakanaka kupfuura mhiri kweUnited States. Haisi kungoisa tactikiti makambani aya mumoyo wemakambani ekubudirira apo zvirwere, sehutachiona hweHIV, zvakapararira, zvinovapa mukana wekuchengetedza humwe hutongi pamusoro pekodzero dzezvakanaka zvezvinhu zvavo.
Izvi zvinonyanya kuitika munyika dzakadai seIndia, mitemo yayo inobvumira kugadzirwa kwemishonga inokosha yeHIV pasinei nepamutemo. Somugumisiro, India ndiyo yanhasi ishandiswa huru yezvigadzirwa zvekare zvinopesana nemishonga kune dzimwe nyika dzichiri kusimukira, zvinodhaka izvo hazvisi zvemakemikari zvakafanana kune zvepakutanga asi zvakagamuchirwa zvakagamuchirwa neDFA.
Sezvo zvakadaro, munhu anogona kutenga shanduro yemutauro weAtripla kweanenge $ 50 pane imwe yezvokutengesa muSouth Africa, apo uri kutarisana nemutengo wakawanda wemadhora 2 500 kuWalgreens kana CVS yako.
Imwe mishonga yemishonga yakagara yakasimbisa kuti kupesana uku kuri mugumisiro wemari yakawandisa yekutsvakurudza nekusimudzira (R & D), iyo isingatori makore chete asi inosvika zvakanaka mumabhiriyoni emadhora. Pamusoro penzvimbo, iyo inofanirwa kubhadharwa yakapiwa yakawanda yekutanga R & D inowanikwa muU.S. ari pakati pebato re biopharma uye zvikoro zvekutsvakurudza.
Nezvirevo zvepamusoro pepa patent, ma pharmas anokakavadzana, nyika dzakadai seIndia dzinogona kuita nyore nyore purogiramu dzisina mari yakawanda sezvo dzisina kutakurwa neR & D investment. Mishonga yemishonga, nenzira yakasiyana, haina mararamiro akadaro, uye, nekutadza, kunyange nevatengi vavo.
Izvo zvinonzwisisika, ndeyekuti 80 muzana yezvigadzirwa mumishonga yeUnited States uye 40 muzana yemishonga yose yakapedza inobva kunyika dzakadai seIndia neChina, maererano neDFA. Uye, pasinei nezvirevo zvekuti India iri kuuraya nekuderedza zvibvumirano, kushandurwa kwegore negore kweIndia mishonga yemishonga inomiririra 2 muzana yehuwandu hwepasi rose inoshandiswa mari.
Uyezve, vazhinji veAmerica mishonga yakanyatsopindira mumabhizinesi eIndia, kusanganisira Pennsylvania-based Mylan, iyo muna 2007 yakatenga huwandu hweMatrix Laboratories, mukuru wekuIndia anoshanda wemishonga inoshandiswa mishonga (API) inoshandiswa mumishonga inogadzirwa. Iko kutenga kwakabatsira Mylan kuva izvo nhasi nhamba yechina yakakura yekambani yezvinodhaka munyika.
Saizvozvowo, zvinodhaka zvinodhaka zvepasi rose GlaxoSmithKline (GSK) zvaive, kusvikira munguva ichangopfuura, gurukota rezvematongerwo enyika muAspen Pharmacare, reSouth Africa-based pharmaceutical iro rinoramba riri revatungamiri vemuAfrica vanotakura mishonga yeHIV yakawanda. Ukama, hwakagadzirwa muna 2009, hwakabvumira GSK kubvumidza hutachiona hweHIV huwandu kuApen, kusanganisira iyo iyo-simbahouse pamwe chete tablet, Combivir. Izvi zvakabvumira GSK kugovana muzvikwereti kubva kutengeswa kwemishonga yavo yakawanda yeHIV muAfrica apo ichichengetedza mutengo wakakwirira wezvikwereti, izvo zvisiri zvekare muSouth
Muna 2016, GSK yakatengesa chikamu che16 kubva muzana muAspen Pharmacare kuti iwane mari ye $ 1.9 mabhiriyoni. Izvi zvakabatana nekupera kweCombivir mugore iroro rimwe chete.
Icho chakanga chiri chisina kukanganiswa nevatsigiri, avo vaitaura kuti tsika dzakadaro dzinosarura. Kune rumwe rutivi, kambani yeAmerica yakadai seMylan inogona kubudisa zvidhura, zvinodhaka zveHIV zvinowanikwa munyika inosimudzira iyo yavasingakwanisi kutengesa muUnited States Kune imwewo, guru guru renyika dzakawanda se GSK rinogona "kuve nekake raro nekudya, zvakare" ne kudzivirira vatengi veAmerica kupinda kune izvo zviri chaizvo zvavo zveDaida-inogamuchirwa, mishonga inokonzerwa neHIV.
Chii Chandingaita Sevatengi?
Kuyerwa kwemuganhu wekutengesa kwemishonga yemishonga kubva kune dzimwe nyika kuenda kuUnited States kunoramba kuchikakavadzana, asi imwe inoshandiswa nevatengi veAmerica. Canada ndiyo muenzaniso mukuru, kugadzirisa kutsoropodza kubva kune avo vanoti ma pharmacy anozivikanwa munyika ino ari kubhadhara kubva kune zvisiri pamutemo zvinodhaka zvinodhaka kupinda muUnited States
Iko kutsoropodza hafu-kwakarurama uye hafu-kwete. Maererano nemari yemari, maInternet Canadian pharmacy anorondedzera kutengesa kwezvishoma kudarika $ 80 Mamiriyoni pagore, nhamba isingambofungidzi kuti inotyisa kana ichienzaniswa ne $ 425 mabhiriyoni mune zvekutengeswa yakashuma muAmerica muna 2015.
Parizvino, mutemo pamusoro pekudhakwa kwezvinodhaka zvemishonga ndeyeimwe nyaya uye imwe inogona kunge ichipesana.
Maererano nemitemo yeDDA, hazvisi pamutemo kuti vanhu vauye chero mishonga muU.S. kuti vashandise ivo pachavo kunze kwekunge vachitevera zvinotevera:
- Iyo mishonga ndeyekushandiswa kwehutano hwakakomba huri mushonga hauwanikwi muUnited States
- Izvo hazvina kumbobvira kushandiswa kwekutengeserana kwezvinodhaka kuvashandi ve US.
- Mushonga hauiti mungozi yehutano husinganzwisisiki kumunhu.
- Munhu anotumira mushonga wacho anonyora mukunyorera kuti ndeyemushandisi wake, uye anopa ruzivo rwekubatana kwekutsanangurira chiremba kana kuratidza kuti chigadzirwa chacho ndechekuenderera mberi kwehutano hwakatanga mune imwe nyika.
- Munhu wacho haatore zvinopfuura mwedzi mitatu inopa.
Izvi zvinonyanya kushamwaridzana nemumwe kunze kwevakangobva kusvika kune vakabva kune dzimwe nyika kana avo vane chirwere chakakomba, chisingaregi kutumira mishonga.
Iyo conundrum, yezvokwadi, ndeyokuti mitemo yaive yakavakirwa mukufungidzira kuti FDA, mumashoko avo pachavo, "haigoni kuvimbisa kuchengetedza nekubudirira kwemishonga iyo isina kubvumirwa." Kutaura kwekuti huwandu hwemishonga inokonzerwa neHIV inoshandiswa munyika dzichiri kusimukira inopupurirwa neDAA haina kukanganisa sangano kana vemuAmerica kuti vashandure mitemo yezvino.
Izvi zvinoreva here kuti vatengi vane HIV mukati meUnited States vane imwe nzvimbo inoshandiswa pakunyorera ma antiretroviral mishonga kubva kune dzimwe nyika? Zvichida kwete, zvichipiwa kuti kune nzira dzakawanda dzekuvandudza kukwanisa kweavo vane chirwere ichi, kusanganisira mapurogiramu emubatsiro (cops) uye mapurogiramu anobatsira varwere (PAPs) inobhadharwa nevatengesi veHIV.
Uye icho, zvichida, ndicho chinonyanya kukura kwevose. Kunyange kana vanhu vachikwanisa kuwana rusununguko kumadhura-madhura madhiragi kuburikidza neCAPs uye PAPs, iyo mishonga inogadzirisa kubatsirwa zvikuru.
Maererano neasina purogiramu AIDS Healthcare Foundation (AHF), mapurogiramu aya akareruka haagoni kunyatsoonekwa sekuti rudo rwakapiwa kuti vashandi vanogona kuda kubhadhara mutero wekodzero yekodzero yekugadzirwa kwezvinodhaka apo vachichengetedza mitengo yakakwirira kuti ibudirire zvose zviripo ADAP mari. Sezvo zvakadaro, maCAP uye mapepa haabatsiri chete kumakambani ezvinodhaka asi kuderera mari yakawanda.
Izvi zvinogona kuchinja sezvo mamwe madhiragi anosvika pakurongedza zuva ravo rekushandiswa kwechirongwa, achiita kuti vakawanda vabatane mune zvekushandisa zvinodhaka. Kusvikira panguva iyo, vashandi vakawanda vekuAmerica vachazofanira kuvimba nemapoka ezvino anotsigira-ADAPs, CAPS, PAPs, inshuwarisi-kuderedza mutoro mukuru wezvinodhaka zvinodhaka zveHIV.
> Sources:
> Business Wire. "Mushandiro Mwoyo Murefu Scam - AIDS Mishonga Dhizinesi 'Charity' Zvirongwa Zvinokundikana Varwere, Asi Vanopa Mamiriyoni Emitero Anoputsa Indasitiri, inoti AHF." Yakabudiswa paIndaneti musi waAugust 2, 2011.
> Farnham, P .; Gopalappa, C .; Rudzikinuro, S .; et al. "Kuvandudzwa kweHupenyu Time Costs Care and Quality-of-Life Inofungidzira vanhu vane HIV vane utachiona muUnited States: Mazuva Ekupedzisira Kufananidzirwa Kwepakutanga uye Kupinda Mukutarisirwa." Zvinyorwa zveAkawana Immune Defence Syndromes. Gumiguru 2013: 64: 183-189.
> London Stock Exchange. "GlaxoSmithKline inopedza kutengesa kwemaAspen asara." London, England; magwaro ekuronga 1740L; Gunyana 29, 2016.
> National Institutes of Health (NIH). "Mazano ekushandisa kweAntiretroviral Agents muHIV-1-Vakabatwa Vakuru uye Vana Vachiri Kuyaruka - Appendikisi B: Zvinodhaka Mishonga Tables (Mwedzi Unoverengeka Wakawanda Wakawanda weAnterretroviral Drugs)." Rockville, Maryland; April 2016.
> US Food and Drug Administration (FDA). "Yakagamuchirwa maitiro anonzi antiretroviral zvinoshandiswa mukurapwa kweHIV." Silver Spring, Maryland; February 4, 2014.