Medical Tourism: Should you get your hepatitis C medicine from India?

HCV and medical tourism

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Medical tourism refers to travel to another country for medical care. For decades, people have traveled to other countries to obtain either newer therapies that are unapproved in the United States or similar medications that are cheaper overseas. In addition, some travel elsewhere for surgical procedures when waiting times are considered too long in the United States, such as liver transplant. Finally, some desperate individuals travel to receive controversial and unapproved therapies. Although typically we associate medical tourism with Americans traveling abroad, the United States is a major site of international medical tourism, including many high technology services.

There has been concern that medications manufactured and sold elsewhere may not be of the same quality and manufacturing standards as those produced in the United States. Although some of these claims are apocryphal, many have been shown to be true. Information about manufacturing standards are typically difficult to obtain and confirm.

Some countries have promoted high-quality medical tourism as a destination event. There are risks, however. One may be exposed to infections endemic to that area. Quality standards may be subpar. Finally, there may be little legal or financial recourse for poor outcomes or negligence.

What About Hepatitis C Medications?

An article appeared in many Australian newspapers chronicling the events of an Australian patient with hepatitis C who traveled to India to receive new oral HCV therapy at a lower cost and was subsequently cured of his HCV. Gilead, who manufactures the hepatitis C therapies sofosbuvir and ledipasvir, has made these agents available to many lower GDP countries at a fraction of the cost in the United States. According to Gilead, “Gilead has agreements with 11 Indian companies to manufacture generic hepatitis C medicines for 101 developing countries”. In fact, these may be 1/100th the price in the United States. “Under the licensing agreements, Gilead’s Indian generic manufacturing partners have the right to develop and market generic versions of Gilead HCV medicines in certain developing countries. The generic drug companies may set their own prices and receive a complete technology transfer of the Gilead manufacturing process, enabling them to scale up production as quickly as possible.

Licensees also pay a royalty to Gilead that supports overall developing world product registration, medical education and training, safety monitoring and other business activities.”

Gilead International Licensees: Aurobindo Pharma Ltd., Biocon Limited, Cadila Healthcare Ltd., Cipla Ltd., Hetero Labs Ltd., Laurus Labs Pvt. Ltd, Mylan Laboratories Ltd., Natco Pharma Ltd., Ranbaxy Laboratories Ltd., Sequent Scientific Ltd., Strides Arcolab Ltd. (Gilead fact sheet). There are also in-country licensees in Egypt and Pakistan.

What Should Patients Do?

For patients with who have been denied hepatitis C therapy in the United States, or for whom the out of pocket co-pay may reach into thousands of dollars, the option to travel or receive medication at this price may be very attractive. A therapy that retails for $84,000 in the United States could be only $840 in India.

The Process

According to Dr. Amita Birla in India, they require a US prescription and payment mode by bank transfer against the invoice.

The following is the process according to Dr. Birla:

  1. “We need prescription copy and patient’s identity proof (driving license or passport copy etc)”
  2. “Once we receive these 2 documents we will send invoice for payment”
  3. “Once payment is confirmed, within 2 working days we ship the drug and share AWB” (shipment tracking).

Obviously, this should not be considered unless all other options within the United States have been exhausted and the patient’s health care provider is supportive. The American Liver Foundation (ALF) may offer additional guidance.

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