SA’s biggest private hospital groups have obtained supplies of Indian drug manufacturer Cipla’s cut-price generic version of the coronavirus drug remdesivir, which speeds up recovery in severely ill patients.
However, a question mark hangs over whether state patients will benefit as the company is yet to receive orders from provincial health departments.
Governments around the world have been scrambling to secure supplies of remdesivir despite its lukewarm reception from experts, as Gilead Sciences, which holds the patent on remdesivir, has earmarked almost all its stock for the US. Gilead has granted non-exclusive manufacturing licences to several generic pharmaceutical companies, including Cipla, which has a well established presence in SA.
Cipla SA CEO Paul Miller said on Monday that the company would sell remdesivir at the same price to state and private sector patients in SA, at $55 a shot, or $330 (R5,684) for a five-day course. This is markedly lower than the $520 per vial price tag set by Gilead for US patients with private insurance.
“Most private hospitals have placed orders, including Mediclinic, Life Healthcare and Netcare,” said Miller. But no provincial health departments have yet placed orders, he said.
Cipla has manufactured 54,000 vials of remdesivir for SA at its plant in Goa, India. The first shipment of 24,000 vials has arrived in SA and the remainder is expected to land within the next month, said Miller. Further stock will be brought in, subject to demand, he said.
Cipla’s remdesivir has yet to be registered with SA’s medicines regulator, the SA Health Products Regulatory Authority, but doctors may prescribe it in terms of section 21 of the Medicines and Related Substances Act. This section of the Act permits companies to import unregistered medicines that have been given the green light by other regulators, but requires detailed records to be kept for all patients.
An international panel of experts convened by the British Medical Journal and a rapid review commissioned by the national health department both concluded that remdesivir had the potential to speed up recovery in severely ill patients, but warned that the few studies done so far were small and had limitations.
The review conducted by the essential medicines committee recommended that remdesivir be used in a clinical trial setting so that more could be learnt about its effectiveness, said the health department’s deputy director-general for National Health Insurance, Anban Pillay. The committee’s recommendations are not binding, so provincial health departments have scope to order the drug if they wish to do so.
“It is not a life saver. The primary benefit is reducing the duration of illness, and the sooner you take it the better,” said Wits critical care professor Guy Richards, who has drafted a treatment protocol that would guide the use of remdesivir in Gauteng should the provincial health department decide to procure it. The protocol recommends remdesivir be restricted to patients who have been admitted to hospital.
All three JSE-listed hospital groups confirmed ordering Cipla’s remdesivir. Netcare’s group medical director, Anchen Laubscher, said Netcare did not recommend to doctors what treatments or drugs they should use, as they were independent practitioners who took sole responsibility for their clinical decisions.
However, it had encouraged doctors working in its hospitals to enrol patients in an observational study that it had designed for access to experimental treatments such as remdesivir.
Discovery Health Medical Scheme (DHMS), the biggest on the open market, said it would fund treatment with remdesivir for eligible patients. “DHMS will provide funding for remdesivir, working in close partnership with local clinicians, for a carefully selected cohort of patients, where the drug will provide maximum benefit in line with the clinical trial findings,” said Ryan Noach, CEO of Discovery Health, which administers DHMS.
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