The Pharmabiz website carries an article titled "Most cancer patients in India denied free Glivec under Novartis' GIPAP", C H Unnikrishnan wrote "Although Swiss drug multinational, Novartis claims to offer free supplies of its highly expensive leukaemia drug, Glivec, to poor cancer patients worldwide under its Glivec International Patient Assistance Programme (GIPAP), a large number of patients in India are denied such a charity."

Glivec is a true breakthrough medicine that's part of a new class of anti-cancer drugs that attacks cancer cells through molecular targeting. It has revolutionized the treatment for chronic myeloid leukaemia (CML) and gastrointestinal stromal tumours (GIST) patients. Novartis recognized the dramatic effects that Glivec would provide CML and GIST patients once approved, so we made a commitment that no patient would be denied access to Glivec for financial reasons.

I was therefore rather distressed to read an article which has carried allegations without any basis. The headline is very damaging as it leads the reader to believe that cancer patients in general are denied free Glivec. Further, the article goes on to say, "But Dr Sapru emphasized that even though the company's figures on GIPAP enrolled patients are true, it is very small compared to the 25,000 CML patients and the 18,000 new CML patients per year in India. This only makes the drug out of reach for large majority of patients." According to estimates we have from oncologists, the incidence of CML in India is 15,000 cases, of which only 4,000 are diagnosed. Going by these estimates it is access to specialist healthcare facilities in our country which is more of an issue insofar as CML and its diagnosis is concerned.

Further, Mr Sapru is quoted as saying, "CPAA would like to cover all the patients in the country and our overall target is not just the 300 patients in Mumbai, but all patients with the minimum of about 200 patients all over the country by the end of 2005 and then increase it to at least 5000 by 2010". I am at a loss to understand why CPAA would like to cover only 200 patients by end of 2005 and at least 5000 patients by 2010, which is 5 years away, if as per his estimates there are 18,000 new CML patients per year in India. What happens to the balance? Novartis currently has more than 3,400 patients who receive Glivec totally free of charge under GIPAP which is more than CPAA's target for the year! Moreover, while we have no target for ourselves simply because diagnosis is the issue and so estimates can in reality be way off the mark, it is our endeavour to make sure that every single patient who is appropriate for therapy with Glivec and cannot afford the drug and is non-reimbursed and not insured receives Glivec totally free of charge.

The report goes on to say that "The CPAA sources informed that when the generic manufacturers were there in the market, the drug was available at one tenth of the price of Glivec, and even though the prices were high compared to the income of many of the patients, due to discounts the NGO could procure the drugs at Rs 4000 or less per year from them and provided to the patients free."

I am at a loss to understand why CPAA did not refer these patients to GIPAP where they could receive the drug totally free of charge. They have not responded to our repeated written requests to refer these "300 patients" to GIPAP I believe Mr Sapru and CPAA are doing a significant disservice to this patient community by persisting in making such irresponsible remarks.

--- Ranjit Shahani, vice chairman & managing director, Novartis India


Clarification from Pharmabiz desk:

Novartis' concerns about the report is understandable. However, the editorial desk wants to clarify the following.

While we regret for a typographical error in the report by mentioning the CPAA's projection of the patient adoption by the end of 2005 as 200 instead of 2000, the report had taken a balanced position on the issue by accommodating the views from Novartis India as well as CPAA. However, the Novartis letter has totally ignored their own views highlighted in the report.

Secondly, despite a written query from us, the company failed to give us a satisfactory reply explaining the modalities for registering patients to GIPAP. And the company's response was silent about many issues concerned with the implementation of the free drug supply programme through a third party and also about the practicality of the criteria adopted by Max Foundation for registering patients in the Indian context.