Should Generic DAAs Be More Widely Imported?

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Even in high-income countries, patients can have problems getting the new but expensive direct acting antivirals that are so effective in treating hepatitis C.

A recent article (free but you must register) written by Narcyz Ghinea, BSc, of the Center for Values, Ethics, and the Law in Medicine at the University of Sydney in Australia, and several colleagues, and published in The Lancet, suggests that importing generics could be the answer.

In Australia patients can “import up to 12 weeks of unlicensed medicines at their own risk,” say the authors. In fact, before the funding in Australia was increased to meet the need for more HCV treatments, “an estimated 1400 Australia patients received treatment with the assistance of FixHepC, a web-based platform for the importation of HCV therapies,” say the authors.

The success of such importation schemes raises the question of why more don’t exist. Regulations, limitations on what physicians can prescribe, and other policies — many related to safety — are all cited as reasons. Additionally, the authors say there are “unresolved legal, political, and operational complexities when it comes to large-scale importation.” They specifically discuss Australia, but the same is true in other high-income countries.

One argument against importation schemes as those discussed the authors say is “that patients in high-income countries should not have access to cheaper medicines available in low-income countries because price discrepancies are legitimate responses to the ability of different markets to pay for medicines.” However, the authors go on to point out that “the fact that medicines can be sold at massive discounts in many parts of the world (and presumably not at a loss) calls into question the legitimacy of prices charged in many high-income countries.”