Several pharmaceutical companies have withdrawn price reductions in the case of anti-retro viral (ARV) drugs in middle-income countries like India, Indonesia, Thailand, Vietnam, Ukraine, Colombia and Brazil, according to price report by Medecins Sans Frontieres (MSF, or Doctors Without Borders).

“While there is continued progress to reduce prices for the poorest countries, a significant number of people with HIV/AIDS live in countries that are now excluded from price reductions,” said Nathan Ford, medical director of MSF’s Campaign for Access to Affordable Medicines, in a release.

The report Untangling the Web of ARV Price Reductions – which analyses the prices of 23 antiretrovirals with information provided by 19 manufacturers – also shows continued trends of price reductions for drugs not blocked by patents.

“Tibotec/Johnson & Johnson exclude all countries classified as ‘middle-income’ from their price reductions; Abbott excludes low-income and lower middle-income countries from discounts for one of its drugs; and ViiV (Pfizer GlaxoSmithKline) no longer offers reduced prices to middle-income countries, even when programmes are fully funded by the Global Fund to fight AIDS, TB and Malaria or the US-government’s PEPFAR programme,’’ the release said.

In a reversal, Merck has now announced that it will no longer issue price discounts for 49 middle-income countries for its new drug raltegravir. This move leaves out countries with large numbers of people living with HIV/AIDS, such as India, Indonesia, Thailand, Viet Nam, Ukraine, Colombia and Brazil. Today, Brazil is paying $5,870 per patient per year (ppy) for just this one HIV drug; in least-developed countries, Merck charges $ 675 ppy for the drug, which is already four times the price of the recommended triple first-line combination (TDF/3TC/EFV), the report said.

“This development comes on the heels of a number of developing countries being excluded from last week’s agreement between drug company Gilead and the new Medicines Patent Pool, which aims to increase access to affordable ARVs by negotiating licensing that can be used by generic manufacturers,” the MSF release said.

“Drug company discount programmes have proven not to be a long-term solution,” said Janice Lee, HIV/AIDS pharmacist at MSF’s Campaign for Access to Essential Medicines. “When patents get in the way and drug companies refuse to cut prices, governments are going to have to start overriding patents so that they can afford to keep their HIV-positive people alive.”