Background Brazil became the first developing country to ensure free and common usage of HIV/AIDS treatment with antiretroviral medicines (ARVs) being sent to almost 190 0 individuals. In-difference estimation offered in-depth info on ARV marketplace features which BMS 433796 impact prices significantly. Although general ARV prices adhere to a declining craze changing features in the generic segment help explain recent increase in generic ARV prices. Our results show that generic suppliers are more likely to respond to factors influencing demand size and market competition while originator suppliers tend to set prices strategically to offset compulsory licensing threats and generic competition. Significance In order to guarantee the long term sustainability of access to antiretroviral treatment our findings highlight the BMS 433796 importance of preserving and stimulating generic market dynamics to sustain developing countries’ bargaining BMS 433796 power in price negotiations undertaken with originator companies. Introduction Brazil became the first developing country to guarantee free and universal access to Highly Active Antiretroviral Therapy (HAART). Access to HIV/AIDS treatment was established as a legal right in 1996 but public delivery of antiretroviral drugs (ARVs) started as early as 1991. In 2009 2009 HAART was delivered to nearly 190 0 people living with HIV and AIDS (PLWHA) covering more than 90% of estimated need according to previous 2006 World Health Organization (WHO) guidelines . Access to HIV/AIDS treatment in Brazil has been sustained through a set of strategies mixing local universal creation of off-patent ARVs centralized procurement as well as the risk of issuing compulsory licenses on patent-protected medications . Historically Brazil’s defiance to originator business monopolies created positive spillovers to antiretroviral treatment (Artwork) scaling-up applications in various other developing countries. Brazilian imports of energetic pharmaceutical substances (APIs) from countries such as for example India and China facilitated the creation of a global market for universal ARVs . From 1998 to 2004 there is a 2.5-fold upsurge in the amount of treated individuals while mean annual ARV spending per affected person in Brazil including all affected person groups (prophylactic pediatric and mature) and regimens reduced a lot more than 73%. This craze however continues to be interrupted since 2005 because of both incorporation of brand-new ARVs to deal with healing toxicity and medication resistance and the necessity of an increasing number of sufferers to move onto more costly second and third-line regimens. In ’09 2009 regarding to information supplied by the Brazilian Ministry of Wellness total ARV spending contacted $316 million with nearly 72.5% of this budget spent on drugs delivered exclusively by originator patent-holding companies. The Brazilian experience in ART provision and its drawbacks can help anticipate many of the issues soon to afflict other developing countries as the 2010 revision of the WHO guidelines shifts demand towards more expensive therapies  ; at the same time current evolution of international legislation and trade agreements on intellectual property rights (IPRs) may reduce availability of generic drugs for HIV care Rabbit polyclonal to LCA5. -. As Table 1 shows the Brazilian Health System provides the decentralized delivery of 20 ARVs and one fixed dose combination (FDC) totaling 33 child and adult formulations. Pharmaceutical patent protection has been enforced in the country since May 1997. Considering the latest available information on patent approvals and pending patent applications in Brazil from the Brazilian Institute of Intellectual Property patent database nine of the ARV drugs included in Table 1 are under IPR protection. The patent on Abacavir expired in June 2008. That same 12 months the patent on Tenofovir was denied. Regarding the use of compulsory licenses although several threats to grant them were made in the past notably involving drugs such as Nelfinavir Efavirenz and Lopinavir boosted by Ritonavir only one compulsory license was actually declared on Efavirenz in May 2007 . Table 1 ARV Drugs Delivered in Brazil. ARV procurement in Brazil is usually BMS 433796 centralized by the Ministry of Health which is also in charge.