Price Reductions in Drug-Resistant TB Treatments
4 June 2025
On April 16, 2025, the Stop TB Partnership’s Global Drug Facility (GDF) announced that the price of pretomanid, an antibiotic used in the WHO-recommended combination treatment regimen for drug-resistant tuberculosis, was reduced to US$169 per treatment regimen, a decrease of 25% from $224 in October, 2024. This reduction, combined with decreases in the price of other drug-resistant tuberculosis drugs—bedaquiline, linezolid, and moxifloxacin—in February, 2025, means the cost of the 6-month treatment course (known collectively as BPaLM) is now $310, a 47% reduction from $588 in December, 2022, when WHO first recommended this regimen.
The GDF, through which the BPaLM drugs are distributed, says these price reductions will save donors and national tuberculosis programmes approximately $37 million per year, roughly the equivalent of 120 000 BPaLM courses.
However, while experts welcomed the price reductions, some cautioned this might not automatically translate into a substantial improvement in global treatment of drug-resistant tuberculosis. Cuts to US foreign aid funding in early 2025 have had a devastating effect on global tuberculosis efforts, with national programmes in some countries substantially impacted, according to WHO.
Additionally, at the end of April, 2025, the Global Fund to Fight AIDS, Tuberculosis and Malaria contacted researchers about changes in investments, including potential pauses to some funding. “Given the current funding environment, I don’t think we can assume that the lower prices, though very welcome, will automatically mean more people getting diagnosed and treated. Programmes are being squeezed from every direction and are likely doing a lot of re-prioritisation”, Lindsay McKenna, TB Project Co-Director at activist organisation Treatment Action Group (New York City, NY, USA), told The Lancet Microbe.
However, others say that savings to countries’ tuberculosis budgets through lower drug prices will be especially helpful as major funding sources disappear. Stephen John, UN Consultant for national tuberculosis programmes in Nigeria (Yola, Nigeria) said: “In Nigeria, as soon as the US foreign aid cuts were announced, the government took measures to cover some of the subsequent funding gaps; so, other governments could do that too. And of course, the fall in prices of pretomanid and other BPaLM drugs will help in this situation because countries can buy more of them, and make savings which can be used in other areas of [tuberculosis] control”.
The Stop TB Partnership, which manages the GDF, is also enthusiastic about the falls in prices for BPaLM regimen drugs, describing them as vital at a time when “the future of tuberculosis funding hangs in the balance”. However, officials at the organisation warned savings from lower drug costs alone are unlikely to have a dramatic impact on global efforts to control drug-resistant tuberculosis, particularly with so many infections going undetected—it is estimated that 400 000 people globally develop drug-resistant tuberculosis every year, but less than half are diagnosed, treated, and reported.
Lucica Ditiu, Executive Director of the Stop TB Partnership (Geneva, Switzerland), told The Lancet Microbe: “There is only so much lower drug prices can do, they will produce savings, which could then be put back into tuberculosis programmes, but those savings will not be of the amounts needed to fill the gaps in other parts of the wider drug-resistant tuberculosis treatment cascade. People who are identified with drug-resistant tuberculosis generally get treatment, which is effective, but a lot of people are not being found. They need to be found, diagnosed, and kept on treatment, but the main problem is that many countries with high drug-resistant tuberculosis burdens lack the resources to ensure access to proper rapid molecular diagnoses for all people with tuberculosis”.
Meanwhile, TB Alliance, the non-profit organisation that developed pretomanid, is confident lower prices for its drug will help drive greater uptake of the BPaLM regimen, helping more people be treated globally for drug-resistant tuberculosis. Sandeep Juneja, Senior Vice President Market Access at TB Alliance (New York City, NY, USA) pointed out that as the price of pretomanid has decreased over the past 5 years, shipments of pretomanid have risen from less than 8000 doses sent to under 20 countries in 2020, to over 100 000 doses sent to 108 countries in 2024. Juneja said he expected to see pretomanid’s price reduce even further due to competition between manufacturers. TB Alliance has licensed production of the drug to five different manufacturers and the recent 25% decrease came after the third of those five, Lupin (Mumbai, India), started production. “Previous falls in the price of pretomanid have been due to an initial volume guarantee when WHO approved BPaLM, and large tender events. But this is the first time its price has fallen due to competition. I am optimistic it will fall even further in future as competition is maintained between manufacturers”, Juneja said.
By Ed Holt
Source: The Lancet Microbe
