Accelareted Access To ARD's

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Accelareted Access To ARD's

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• Mostafa El Nakib
• N.A.P Manager Lebanon

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ARDS in Lebanon

• Establishment of guidelines for RX with
  eligibility criteria
• five ARD s selected to be purchased by the MOH
• provision of RX to AIDS patients for free
• other ARDs can be purchased according to a
  special request

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ARDS IN LEBANON

• 140 AIDS patients receiving Rx currently
• Its estimated to be 333 in 5 years
• MOH started provision of ARD s for free in 1998
• Private sector started HAART in 1997

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Status Summary

• The plan is still in progress
• It is expected to involve all the pharmaceuticals
  involved in ARD supply to Lebanon
• Our goal is to reach the maximum decrease in cost
  for ARDs
• We aim at classifying Lebanon in the rank of the
  African countries
• V.low GDP
• Increasing vulnerability to HIV/AIDS
• Enhancing patients access to treatment

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Pathway to negotiation

• Establishing the case
• forming a steering committee (National -WHO)
• studying the existing successful cases in the
  region
• preparing a National report

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The National Report

• Country Background Info
• Situation Analysis including national health
  policy status
• HIV/AIDS local situation
• current status of HIV/AIDS RX and cost
• Future projection of expected HIV/AIDS cases and
  cost of RX

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The National Report cont

• Mechanism of ARDs supply
• purpose of reduction in price of ARDs
• Goal price aimed at to be met
• Future regulatory process in case of success
  (payment, handling , disbursement)
• Guarantees to be provided to pharmaceuticals

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The Negotiation Process cont

• identification of key companies for negotiation
• sending the national report to HQs
• communicating with top officials at the targeted
  companies
• scheduling meetings and/or teleconferences with
  delegates
• setting terms, criteria and goals by all parties

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The Negotiation Process cont

• Conducting bilateral negotiation between
  Nationals and each targeted company
• Drafting a preliminary agreement contract and
  modify it in the negotiation process
• Assure the agreement on the final report by all
  parties
• Final endorsement by the authorities and then
  signature

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Lebanon Objectives

• Inforcing the availability,continuity and
  accessibility of treatment for all eligible
  patients
• Ensuring the presence of patent drugs in the
  market
• getting the lowest possible prices for patent
  drugs
• Facilitating and supporting the registry of new
  drugs
• minimizing and/or deleting additional costs

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Lebanon Options

• Buying drugs at the proposed rates
• Getting WHO recognized generics if 1st option
  fails
• Opening the market for competition between
  companies
• revisiting regularly the national guidelines for
  RX to match the type of drugs available and/or
  affordable

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The pharmaceutical companies objectives

• Ensure that their products are available,
  affordable and competitive
• promote wider access to Rx by ARDs
• Register new products
• Offer lower prices to MOH with the latest
  guarantee of protection against smuggling
• Bypass the product registered dealer

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Where we stand now?

• Negotiations started with the following
  companies
  - MSD, BMS, ROCHE, GLAXO,
  ABBOT,BOEHNINGER INGELHEAM
• MSD , final draft for agreement submitted to MOH
  and endorsed
• News conference to be scheduled early Marsh
• BMS and GLAXO advancing in the process

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What is needed now?

• More pressure on pharmaceuticals to encourage
  them decreasing their prices further
• WHO and UNAIDS assistance in negotiating with
  reluctant companies
• creation of a regional network of countries
  willing to embark in the process
• creation of a pressure group with enhanced
  capability to enforce demands

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Thank you Good luck