Will India Get Impacted By US Buying ‘All’ of Remdesivir Supply?

Indian pharma companies Cipla Ltd and Hetero Labs have received approvals to sell generic versions of remdesivir.

While multiple trials on the drug are still underway, the evidence so far has been divided on the drug’s efficacy for COVID-19.

(Photo Courtesy: iStock)

When reports of the United States securing almost all of the world’s stock of remdesivir – an investigational antiviral drug for COVID-19 – emerged, concerns over the availability of the medicine for moderate cases (on oxygen support) gripped the rest of the world.

Remdesivir, the only drug that has an emergency use authorisation from the Food and Drug Administration (FDA) for COVID-19, is patented by the US pharma giant Gilead Sciences. The company had first developed it to work against Ebola (where it failed), but remdesivir has now resurfaced as a potential medicine for COVID-19 treatment – even though trials are still ongoing.

The Department of Health and Human Services announced on 29 June that it had bought 100% of Giliead’s projected production for July and 90% of its production for August and September, reported CNN. In a press release, the HCC secretary Alax Azar said, “President Trump has struck an amazing deal to ensure Americans have access to the first authorised therapeutic for COVID-19.”

Owing to the patent, such a development could be worrying for high-income countries, including many European nations and China, Japan and Brazil, among others. But what does it mean for India?

Generic Drug Makers of Remdesivir in Developing Countries

In May, Gilead Sciences signed non-exclusive voluntary licensing agreements with six Indian pharmaceutical companies to boost the supply of remdesivir.

Gilead has also signed agreements with generic pharmaceutical manufacturers based in Egypt and Pakistan. In all, this will allow the following companies to manufacture remdesivir for distribution in 127 countries – Cipla Ltd; Dr Reddy's Laboratories Ltd; Eva Pharma; Ferozsons Laboratories; Hetero Labs Ltd; Jubilant Lifesciences; Mylan; Syngene, a Biocon company; and Zydus Cadila Healthcare Ltd.

In a statement, Gilead said, “The countries consist of nearly all low-income and lower-middle income countries, as well as several upper-middle and high-income countries that face significant obstacles to healthcare access. The regulatory approval status of remdesivir varies by country, and the distribution of remdesivir within each country listed below is subject to local laws and regulations.”

A list of these countries can be found here.

Notably, Bangladesh’s Beximco Pharmaceuticals Ltd became the world’s first company to start selling the generic version of the drug in May, even without such a licensing agreement with Gilead. This was made possible under the World Trade Organisation’s provisions granting least developed countries a waiver from seeking licenses.

Who Can Make the Drug in India?

Drugs Controller General of India approved remdesivir for restricted emergency use for the treatment of suspected or laboratory-confirmed COVID-19 cases in adults and children hospitalised with severe symptoms.

Drug makers Cipla Limited and Hetero Healthcare Limited, on Sunday, 21 June, announced the launch of their generic versions of remdesivir – named Cipremi and Covifor respectively – after they received the approval to manufacture and market the drug from the DCGI.

According to an Economic Times report, Hetero said it has so far supplied 20,000 doses of the drug, of which half went to Tamil Nadu which had made advance purchases, 7,000 went to private hospitals, and the rest to other state-run hospitals in the country.

A press release by the company from 24 June reads, “Following the approval of ‘COVIFOR’, the generic of Remdesivir by DCGI, Hetero Healthcare Limited, a group company of Hetero is set to deliver the first set of 20,000 vials in two equal lots of 10,000 each, one of which will be immediately supplied to Hyderabad, Delhi, Gujarat, Tamil Nadu, Mumbai and other parts of Maharashtra; while the other lot will be supplied to Kolkata, Indore, Bhopal, Lucknow, Patna, Bhubaneshwar, Ranchi, Vijayawada, Cochin, Trivandrum and Goa within a week’s time, in order to meet the emergency requirements.”

Cipla, on the other hand, is expected to start its supply of Cipremi on 9 July, the ET report states, even though the company is yet to respond with confirmed dates. Five more companies are expected to launch their versions of Remdesivir in India in the next few months.

What Is Remdesivir Priced At?

Gilead announced in a letter that it had decided to set a price of $390 per vial for governments of developed countries. A typical five-day treatment course would include six vials, which would equate to $2,340 per patient. The price for a US patient (those on private insurance or the government Medicare and Medicaid programs) will be $520 per vial, amounting to a total of $3,120 for a five-day treatment, CNN reported.

In India, Hetero has priced Covifor at Rs 5,400 per vial. It needs to be administered intravenously in a hospital, critical care setting, under the supervision of a registered medical practitioner.

Cipla will reportedly be pricing Cipremi below Rs 5,000 per vial.

Therefore, the typical five-day treatment involving the use of six vile could cost above Rs 30,000 using either of the generic drugs.

Bangladesh’s Beximo is also charging private clinics about 6,000 taka (Rs 5,291) per vial but providing it free of cost to state-run hospitals treating COVID-19 patients, Rabbur Reza, chief operating officer at the company, said in an interview, reported The Print.

Can I Get it For Myself?

No, the medicine cannot be used by an individual for self-medication. PTI reported that “the injectable drug can be sold by retail on the prescription of specialists for use in hospital or institutional setup only”.

“The drug is given in the form of an injection and that is why it has to be administered under the supervision of a doctor in a hospital setting,” the news agency quoted a source as saying.

The ‘written informed consent’ of each patient would have to be taken.

(This story was first published on FIT. You can read the original article here.)