MSF letter to Merck regarding the 200mg and 600mg formulations of efavirenz

I am writing on behalf of Doctors Without Borders/Médecins Sans Frontières (MSF) to demand immediate action on both the price of 200mg efavirenz (EFV) and the registration status of the 600mg formulation of EFV in developing countries.

In October 2002, Merck announced a price reduction for the 600mg formulation of EFV, bringing the price down to $346.75 per person per year ($0.95 per unit). The Merck communication at the time claimed that this price would be valid for low Human Development Index (HDI) countries plus medium HDI countries with adult HIV prevalence of 1% or greater. For medium HDI countries with adult HIV prevalence less than 1%, the price of the 600mg was announced as $767 per person per year ($2.10 per unit).

However, 16 months after the announcement, this offer has not materialized. By delaying registration of EFV 600mg and refusing to reduce the price of EFV 200mg, Merck has failed to make good on its promise. More importantly, Merck’s failure to deliver on this promise may have lead to needless suffering and perhaps death. In order to address the barriers to access to EFV in developing countries outlined below, MSF is demanding that Merck immediately:

1. Take all necessary steps to register the 600mg formulation of EFV in developing countries and publicly report on the status of registration on a monthly basis. 
    
2. Lower the price of the 200mg capsule of EFV to $0.32, so that the real price of the drug will be, as advertised, $0.95 per day ($346.75 per person per year).