Background: Brazil has a public and universal health care system (SUS), that offers free of charge ARV medicines for all those in need. Since 1996 when Brazil changed its law and complied with TRIPS requirements the universal access policy sustainability is under threat. ABIA/GTPI is civil society organization working to reduce the impact of monopolies in public health. Issued in 2007, the compulsory license (CL) for the antiretroviral (ARV), efavirenz is a landmark for the pro-access to medicines policies. However, from 2008 the Partnerships for Product Development (PDP), a policy based on voluntary licenses, technology transfer and prices set in contracts dominated this field in Brazil. A PDP between BristolMyersSquibb (BMS) and Fiocruz to produce atazanavir was signed in 2011. After analyzing the contract''s prices and timelines, we compared the two approaches in order to determine which one was the most effective from an access to medicines and guaranteeing the sustainability point of view.
Methods: ABIA/GTPI selected four categories to conduct the comparison: (a) savings to the public health system; (b) percentage of price reduction; (c) months to produce the ARV locally; and (d) royalties to the patent holder. The data used is from published works, public databases and BMS-Fiocruz contract.
Results: The efavirenz CL generated savings of US$ 104 million (2007 to 2011). The atazanavir voluntary license generated US$ 17 million. In relation to percentage of price reduction, efavirenz CL reduced the price paid by SUS in 58%, the reduction in the atazanavir case was 6%. Efavirenz was produced locally in 21 months. The national version of atazanavir was only available 26 months after the contract signature. Regarding royalties, Brazil paid to Merck in the efavirenz CL 1,5%, whereas the royalty paid by Brazil to BMS is set in contract in 4,5%.
Conclusions: The study showed that in the four parameters selected - savings, price reduction, months to produce locally and royalties paid -, the CL was more effective than the PDP. It is possible to say, therefore, that the efavirenz compulsory license was most effective in guaranteeing the sustainability of the access to medicines'' policies in Brazil.

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