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 of such a charity.

The Mumbai based Cancer Patients Aid Association has alleged that the GIPAP instituted by Novartis does not actually work in India. As the company keeps the patient- registering criteria and other procedures absolutely non- transparent, majority of the patients referred to the programme were not given the free treatment with no substantial reason, the NGO alleged.

The CPAA sources said that about 300 chronic myeloid leukaemia (CML) patients under its care in Mumbai alone denied registration to GIPAP when they were referred to the Programme after Indian generic manufacturers forced to withdraw their low cost drugs from the market with the grant of EMR to Novartis last year.

As Glivec costs around Rs 1,20,000 for an year's treatment as against less than Rs 10,000 per year for Indian generic versions, most patients in the country are now either struggling to buy this expensive drug or are slowly dieing without the treatment, the Association informed. "While refusing admission to GIPAP, these patients, mostly very low income labourers, were given the explanation that they are under ESI coverage," the Association points out.

"If ESI coverage, which provides the general hospitalisation expenses with a cap of very low amount, can be considered as a factor to deny GIPAP to these dyeing patients. Is it not hypocrisy of the company?" asks the Association.

Besides, since the Programme is being administered by a little known agency called Max Foundation, Novartis stays away from the direct allegations against refusal of deserving cases, the CPAA alleged. "This is a calculated strategy by the multinational company to use GIPAP as a Trogen Horse to weaken the possible challenges to its market exclusivity in India," they added.

Nevertheless, the company has so far not responded to our queries regarding the modalities it has adopted to accept patients for GIPAP. "It adds to our doubt that the company has no commitment to the poor patients as it claims through this Programme," says Y K Sapru, Founder Chairman, Cancer Patients Aid Association.

However, Ranjit Shahani, vice chairman and managing director, Novartis, said that the allegation made by Cancer Patients Aid Association (CPAA) is absolutely false and totally baseless. In fact, we have repeatedly asked CPAA in writing to "immediately refer patients to The Max Foundation" the administering body for the GIPAP, which incidentally they consistently refused to do.

"While appreciating the work done by various NGOs in the field of cancer care, including CPAA, it must be stated that it is only a practicing oncologist/haematologist who is qualified to recommend therapy with Glivec. Oncologists/haematologists are aware of GIPAP and are recommending patients to the program on a regular basis," he added.

According to Novartis, it currently has more than 3400 patients from all over the country on GIPAP, who receive the drug completely free of charge while only around 45 patients pay for the product. The company added that on an average around 30 new patients are enrolled into the Programme every week.

But, Dr Sapru emphasized that even though the company's figures on GIPAP enrolled patients are true, it is very small compared to the 25000 CML patients and the 18000 new CML patients per year in India. This only makes the drug out of reach for large majority of patients. "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,"Sapru added.

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 of charge or at highly discounted prices.

The Association argued that considering these very facts the government decision to allow monopoly to a multinational company, which sells the product at a quite an unaffordable price can never be imagined and the government should immediately intervene in this classic case to make this most essential drug affordable to needy.