Preço como um desafio à sustentabilidade da política de acesso universal a antirretrovirais no SUS: o caso dolutegravir

The price of antiretrovirals (ARVs) continues to be a challenge to guarantee universal, comprehensive, and equitable pharmaceutical services. This article aimed to analyze the acquisition of the most widely used ARV in Brazil, comparing national and international prices. Our study conducted a documentary analysis of the history of the national procurement of dolutegravir (DTG) from 2017 to 2023. The price comparison was based on reports from the Clinton Health Access Initiative (CHAI), considering exchange rate and inflation variations. In 2022, generic versions from Farmanguinhos and Lafepe were distributed, but a patent barrier restricted the procurement from Lafepe. A major difference was found between national and international prices, even with the entry of generics into the Brazilian market; in 2023, the price of international generics was almost 12 times lower than that of the national procurement. The DTG case highlights the importance of monitoring prices, patent barriers, and local production, and of becoming familiar with the structure of production costs in order to negotiate fair prices and ensure the sustainability of the national pharmaceutical assistance policy.