Should You Get Your Hepatitis C Drugs From India?

Benefits and Risks of 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 we typically associate medical tourism with Americans traveling abroad, the United States is a major site of international medical tourism, including many high technology services.

There have been concerns 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.

Importing Hepatitis C Medications

Hepatitis C drugs are extremely costly in the United States, with one pill of Sovaldi (sofosbuvir) costing around $1,000. The same drugs can often be found in developing countries like India at a fraction of the price.

Manufacturers like Gilead Sciences have defended the practice, stating: "Gilead has agreements with 11 Indian companies to manufacture generic hepatitis C medicines for 101 developing countries. 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."

Though advocates agree that the reduced pricing increases access to life-saving medications in low- to middle-income countries, others argue that it is difficult to justify such vast differences in pricing. A 2017 study in the Journal of Clinical Experimental and Hepatology reported that a 12-week course of Sovaldi costing $42.017 in the United States can be purchased in India for around $110.

Among the international licensees of Gilead who manufacture hepatitis C drugs are Aurobindo Pharma, Biocon, Cadila Healthcare, Cipla, Hetero Labs, Laurus Labs, Mylan Laboratories, Natco Pharma, Ranbaxy Laboratories, Sequent Scientific, and Strides Arcolab. There are also in-country licensees in Egypt and Pakistan.

Pros and Cons of Drug Importation

For people who have been denied hepatitis C therapy in the United States, or for whom the out of pocket co-pay may reach into the thousands of dollars, the option to travel or receive medication at this price may be very attractive.

If you decide to buy your hepatitis drugs from India, most pharmacies will require a prescription for the drugs you need and some form of identity (such as a copy of your driver's license or passport).

An invoice will then be generated. Upon confirmation of the bank transfer, the drugs will usually be shipped by priority mail with a tracking number in two working days.

As easy as this may sound, there are risks. According to the U.S. Food and Drug Administration (FDA), there is an inherent danger when buying drugs of unknown origin or quality from an overseas pharmacy. Drug standards and regulations vary from country to country, and the FDA is responsible only for those marketed and sold inside the United States.

Obviously, this should not be considered unless all other options within the United States have been exhausted and your healthcare provider is supportive of your decision. The American Liver Foundation may offer additional guidance.

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Article Sources

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  1. Henry B. Drug pricing & challenges to hepatitis c treatment access. J Health Biomed Law. 2018;14:265-283.

  2. Gilead Sciences. Chronic Hepatitis C Treatment Expansion: Generic Manufacturing for Developing Countries. October 2015.

  3. Premkumar M, Grover GS, Dhiman RK. Chronic hepatitis c: do generics work as well as branded drugs?. J Clin Exp Hepatol. 2017;7(3):253-261. doi:10.1016/j.jceh.2017.08.003

  4. U.S. Food and Drug Administration. Imported Drugs Raise Safety Concerns. Updated March 1, 2018.