“About how much is your family income?”
“12,000 rupees ($180) per month”
“…and let’s see the antiretroviral medication is 2000 rupees ($30) a month”
This was an example of several conversations heard between physician and HIV patient while rounding at the Nizam Institute of Medical Science.
While incredible for several reasons that I’m only beginning to explore on my fourth day here, India has been touted by organizations like Médecins Sans Frontières (MSF) and for their incredible production of generic drugs thus earning it the moniker “pharmacy to the developing world.”
These drugs have become the predominant supply for low income countries and this has certainly been a strong disrupter of the marketplace as noted below and in past MSF reports:
The production of medications in India has become so prolific that it has mirrored the western pharmaceutical industry in ways not limited to the quality of drugs. While working in other low resource settings I’ve observed frequent visits from India pharma reps offering data, samples, and assorted appreciation freebies. One might expect with such robust local production and international distribution that patients in India would have little difficulty affording essential medicines.
Understanding this discordance requires the assessment of income verse drug pricing. Many who have traveled to low income countries may have noted that their dollar goes much further. In this case it might be assumed that while Indian patients make less money their income will go much further. One method termed the purchasing power parity tries to level this discrepancy to truly compare incomes. Per the world bank India’s PPP in 2015 was $6,020 compared to $56,430 in the USA. This means that even after correcting for a cheaper cost of living Indian income is over $50,000 less per year. Further, this represents the median income or 50th percentile and does not represent the poorest of the population who certainly account for a disproportionate amount of the HIV disease burden. Regardless to be on par with the HIV regimen of their American counterparts an Indian patient’s treatment regimen would have to be over 9 times less costly. This very simplified calculation does not include other out of pocket expenses including doctor visits, hospital admissions, and missed opportunities to earn money. So while the global health community may rightfully celebrate victories in drug prices, these changes must be drastic to really become affordable. We’re learning that some government programs are trying to pick up the slack and our patient above was ultimately referred to an antiretroviral distribution center for cost free medication. Expansion of such programs and easier access to services associated to these lifesaving drug regimens would seem imperative to curbing the incredible burden disease.
Stay tuned for more posts on what makes India Incredible and our journey to explore it. You can follow me on twitter @eddiebriercheck or search #BMCglobalhealth to learn how the rest of our team is doing. And please tweet us your thoughts, questions and culinary suggestions.
Eddie Briercheck is a PGY-2 at Boston Medical Center and a member of the Global Health Pathway.
GNI per capita, PPP (current international $) http://data.worldbank.org/indicator/NY.GNP.PCAP.PP.CD
MSF: The impact of patents on access to medicines