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December 29, 2015 at 07:18 AM
(Bloomberg) — Outsiders don’t want their daughters to marry any local boys, according to the village elders swapping stories in a tailor’s shop behind the Sikh temple, because most residents are infected with black jaundice.
That’s what they call hepatitis C, which is so common in parts of India’s Punjab state that the tailor-shop gossips might not be off base in their estimate. But prevalence could be something of an advantage these days. Drugmakers have made the village of Lande Rode one of the theaters in a battle to grab market share for sofosbuvir, a miracle cure that Gilead Sciences Inc. (Nasdaq:GILD) sells in the U.S. as Sovaldi at a retail price of $1,000 a pill. Gilead licensed 11 Indian companies to make generic versions, and they sealed marketing deals with others. Competition has been so fierce it’s driven down the cost and spurred thousands to be tested.
See also: Gilead’s India patent snag may spur more low-cost Sovaldi copies
Manufacturers “want more and more patients” and are willing to wheel and deal on price, said Nirmaljeet Malhi, a gastroenterologist at Apollo Hospitals in Ludhiana, about 200 kilometers (124 miles) from Lande Rode. “If one agrees to it, the others will also have to. It’s a race where one cannot say no — because then they’re going to lose the business.”
The companies sponsor screening drives, hand out free test kits to hospitals and offer bulk discounts to entire villages. Sofosbuvir was cheap by most any standard when it hit the market in Punjab at $10 in March. Then the cost kept dropping, to as low as $4.29, and doctors predict it will continue to fall.
Game changer
That’s in contrast to the situation in the United States, where Gilead set off a firestorm in December 2013 by listing Sovaldi at $84,000 for a 12-week course regimen. It’s a game-changing drug, often wiping out an infection in three months, and without the debilitating side effects of earlier treatments that took longer. Still, the cost started the latest backlash over high medicine prices. Dozens of state Medicaid plans limited access to the drug, and a U.S. Senate report chastised the company. Gilead, which has said it priced Sovaldi responsibly and thoughtfully, is giving insurers and bulk purchasers discounts.
Like others in the industry, the company arranges to make life-saving cures available in some parts of the world for far less; laws and pressure introduced so-called tiered pricing after expensive anti-HIV treatments became available in the ’90s and reduced deaths in rich countries and not poor ones. In exchange for a 7 percent cut of sales, Gilead gave companies including Mylan NV, Cipla Ltd. and Natco Pharma Ltd. rights to make generics for distribution in 101 developing nations where hepatitis C is often untreated and $1,000 is more than people might earn in a year. The company wants to “foster competition in the marketplace” in low-income areas, according to spokesman Nathan Kaiser.
Now there are more than a dozen sofosbuvir versions for sale in India. “The market has become highly competitive in the last six months with close to 20 companies launching their own,” said M.V. Ramana, executive vice president and head of branded markets at Dr. Reddy’s Laboratories Ltd.
Competition benefits
The sofosbuvir rivals are aggressive about expanding the customer base by making the pills affordable and diagnosis easier. Dr. Reddy’s, for example, set up a venture with lender Arogya Finance to offer no-interest loans for patients, and Abbott Laboratories worked with French medical equipment company Echosens SAS to supply Indian hospitals with 13 ultrasound machines that determine the level of fibrosis, or hardening, without a liver biopsy.
A main benefit of the competition, according to doctors, is that so many are being tested for hepatitis C, which can lead to cirrhosis and liver cancer. As many as 150 million people have the disease, according to the World Health Organization, including at least 12 million in India. Common modes of transmission are tainted medical equipment and reuse of syringes.
Liver scans
