Is a contraceptive that costs $4-6 per annum inexpensive enough?

                                               Comments due Nov. 23, 2014

Depo-Provera, an injectable contraceptive given once every three months, is
already a popular choice of women in developing countries, who value the
convenience and discretion of not having to take a daily birth control pill.
But the injections are out of reach for many more women because they
live in rural areas that are too far from a health clinic to make the
treatments practical.

Now, a major collaboration between Pfizer, the drug’s manufacturer,
and several global aid groups is aiming to change that by providing
financing to make a new version of the drug — redesigned with developing
countries in mind — available in 69 nations throughout Africa, Asia, Latin
America and Eastern Europe.

The new product, called the Sayana Press, is a single-use syringe
designed to be portable and easy to use.

Depo-Provera is typically injected into the muscle by health care
workers who must first draw the drug into a syringe from a glass vial. The
new product has been reformulated into a lower dose and uses an existing
device, called a Uniject system, that looks like a plastic bubble with a short
needle attached. It is injected under the skin by squeezing the bubble and
can be administered with minimal training.

“You can imagine somebody sticking this in their satchel and going into
a very remote area,” said Peter Stevenson, vice president for portfolio
management at Pfizer’s Global Established Pharmaceuticals.

The product is already being used in several African countries, but
Pfizer said it planned to expand distribution through a financial partnership
that would allow the product, which typically costs about $1.50 a dose, to be
sold to health care institutions in those countries for about $1.

Several groups, including the Bill and Melinda Gates Foundation and
the Children’s Investment Fund Foundation, as well as the United States
Agency for International Development, will help subsidize the cost and
assist in introducing it in countries around the globe.

Women will most likely receive the product free or at a reduced cost.
Chris Elias, president for global development at the Bill and Melinda
Gates Foundation, said the Sayana Press could be an important new choice
for the estimated 225 million women worldwide who would like access to
contraception but do not have it. “Family planning is an important priority
for us, and this is expanding the range of methods,” he said.

Pfizer declined to comment on the revenue it expected to generate from
sales of the Sayana Press, but John Young, president of Pfizer’s Global
Established Pharmaceuticals, said it was not seen as a major revenue driver
for the company. Depo-Provera sells to health institutions in those countries
for about 75 cents a dose.

Dr. Amitasrigowri S. Murthy, an assistant professor at NYU Langone
Medical Center in the department of obstetrics and gynecology, did not
work on the project but said the Sayana Press carried advantages because
injecting Depo-Provera into muscle requires the skills of a knowledgeable
health care worker. With the new product, “you press it and it injects it,” she
said. “It’s similar to insulin.”

Fiona Walugembe, who is overseeing the introduction of the Sayana
Press in Uganda through the global health group PATH, said women were
eager to hear about the new product. About a third of Ugandan women have
no access to family planning options, she said.

She said many women like Depo-Provera because they do not have to
tell their husbands that they are using a contraceptive.
Now, they will not have to make a long trip four times a year to receive
the injections.
“It is exciting,” she said. “It is really a big thing.”
NYT 11/14/2014)