New Price Cuts for DR-TB Treatment Could Help Expand Access – But Policy and Programmes Must Catch Up

In a significant move for global TB control, the Stop TB Partnership’s Global Drug Facility (GDF) has announced dramatic reduction in the price of pretomanid by 25%, bringing it down to $169 per treatment course. Combined with earlier price reductions for bedaquiline, linezolid, and moxifloxacin, this brings the total cost of the 6-month BPaLM regimen to just $310—a 47% drop from its $588 price tag in December 2022.

According to the Stop TB Partnership, the reduced price of the BPaLM regimen could yield up to $37 million in annual savings for donors and national TB programs—enough to cover the cost of 120,000 treatment courses. With just  5,646 of the 132,000 people estimated to have been eligible for the BPaLM regimen accessing the treatment last year, this is a game-changing shift in affordability.

“We want everyone to be aware of this price of $310 per 6-month BPaLM – we know that there are countries that pay much more for these treatment regimens,” said Dr Lucica Ditiu, Executive Director of the Stop TB Partnership.

The WHO Global TB Report 2024 paints a mixed picture. While more countries are adopting shorter, all-oral regimens, treatment coverage for MDR/RR-TB remains alarmingly low:

In 2023, an estimated 400,000 people developed MDR/RR-TB, yet only 175,923 were enrolled on treatment—representing just 44% coverage. Treatment outcomes, while improving, still fall short, with a global success rate of 68% for patients who began treatment in 2021. With such a large treatment gap and persistent outcome challenges, new, shorter, and more effective regimens like BPaLM are urgently needed to shift the trajectory.

The Promise of BPaLM

It offers a shorter, six-month, all-oral course that is less toxic and easier to complete than traditional regimens. First recommended in 2022, the BPaLM regimen is one of three shorter regimens now recommended by WHO which are not only highly effective but also safer and more tolerable. These regimens significantly reduce treatment time and improve patient outcomes, reinforcing BPaLM’s role as a patient-centred and health system-efficient option. As more countries update their national policies to align with these WHO recommendations, BPaLM offers a clear path to better outcomes, stronger adherence, and greater equity in TB care.

However, despite WHO's endorsement of BPaLM in late 2022, its adoption remains uneven. While 58 countries had approved or implemented BPaLM/BPaL regimens by the end of 2023, actual uptake remains limited. Just 5,646 people globally were reported to have started treatment with BPaLM or BPaL last year—a fraction of those eligible. Policy inertia, budget limitations, supply barriers, and slow implementation have all contributed to this lag, undermining efforts to scale a proven solution.

Why Demand Matters

The recent price drop changes the equation. With pretomanid now more affordable and the full regimen costing nearly half of what it did two years ago, national TB programmes have a unique opportunity to scale up access while reducing long-term treatment costs. Widespread procurement and use of BPaLM can also boost market stability and encourage greater manufacturer confidence, ultimately driving further savings through increased demand.

The Time for Policy Change Is Now

This is a critical moment to align affordability with political action. BPaLM offers a way forward for countries to close the treatment gap—if countries act quickly. National TB programmes must integrate the regimen into their guidelines and procurement pipelines without delay, either procuring through GDF or using the new price to set a reference when procuring independently. Donors and implementers must also step up to support training, logistics, and delivery systems that enable effective rollout.

The tools are available. The price is right. What’s needed now is policy urgency and political will to ensure that everyone who needs BPaLM can access it. If countries act swiftly, this price reduction could be remembered not just as a fiscal win—but as the moment MDR-TB treatment for all became within reach.