The price of pretomanid, a critical medicine used to treat drug-resistant tuberculosis (DR-TB), has dropped by 25% to $169 per treatment course, marking a significant advancement in the global fight against TB. This price reduction makes the treatment available for less than $1 per day, a key affordability benchmark identified by TB advocacy groups.
The price cut follows the entry of Mumbai-based pharmaceutical company Lupin into the market as the third manufacturer licensed by the non-profit TB Alliance to produce the drug. When pretomanid was initially approved in 2019, it cost $364 per treatment course, before dropping to $224 in October 2024.
"We work to ensure our products are both affordable and sustainable by licensing only to high-quality manufacturers. When these companies compete, it drives prices down without compromising quality," explained Dr. Mel Spigelman, President and CEO of the TB Alliance.
Impact on Treatment Access and Affordability
The price reduction represents a crucial milestone for TB treatment across Africa and other high-burden regions. According to The Stop TB Partnership, which manages the Global Drug Facility (GDF) procurement platform, the new pricing will save an estimated $37 million annually, potentially enabling treatment for an additional 120,000 people with DR-TB.
Together with recent price reductions for other components, the cost of a full BPaL/M treatment course has dropped to $310—less than $2 per day and a 47% reduction from its December 2022 price. The BPaL/M regimen combines bedaquiline (B), pretomanid (Pa), and linezolid (L), with or without moxifloxacin (M), and can be completed in just six months.
"For years, advocates from the TB community have called for TB treatments that are not just effective, but also affordable for every person who needs them," said Olya Klymenko, Development Director of TBPeopleUkraine. "The full BPaL/M regimen now costing less than $2 per day is deeply meaningful. There really is no reason for governments and health systems around the world to not provide these treatments to every person who can benefit from them."
Multi-Manufacturer Strategy Driving Affordability
TB Alliance's innovative access model involves partnering with multiple quality-assured manufacturers to ensure rapid, sustainable, and affordable access across high-TB burden countries. This strategy has enabled healthy competition while maintaining strict quality standards.
"This progress demonstrates how thoughtful collaboration and planning can translate into real-world impact," said Dr. Spigelman. "By enabling multiple high-quality producers to supply this medicine, we're fostering a healthy and sustainable market to deliver on our mandate that the life-saving medicines we develop will be adopted, available, and affordable to all those in need."
Ramesh Swaminathan, Global CFO, Executive Director, and Head of API Plus SBU at Lupin, emphasized the company's commitment: "Lupin is proud to collaborate with TB Alliance and the Global Drug Facility to make pretomanid, an essential medicine in the fight against multidrug-resistant TB, more accessible and affordable for TB patients across the globe."
Rapid Global Uptake
In 2024 alone, approximately 110,000 courses of pretomanid were ordered worldwide—enough to treat more than 60% of the global market for DR-TB treatment. This represents one of the fastest scale-ups for a new TB medicine in modern times.
The BPaL/M regimen, recommended by the World Health Organization to treat most forms of DR-TB, offers a significant improvement over previous treatment options. Before its introduction, less than two-thirds of drug-resistant TB patients were successfully treated, with existing regimens requiring patients to take more than 20 pills per day for 9-20 months.
Supporting Implementation
To help countries implement the BPaL/M regimen more efficiently, TB Alliance has been supporting peer-to-peer initiatives like Peer Link, first launched in the Philippines. "Countries can now learn directly from others' experiences, cutting down the time it takes to introduce new treatments," Dr. Spigelman explained.
Beyond pricing strategies, TB Alliance continues to develop and execute innovative market access initiatives like LIFT-TB, SLASH-TB, and the PeerLINC Knowledge Hub to accelerate global uptake, procurement, and implementation of shortened DR-TB treatments.
"We're doing everything we can to make sure the best tools against TB reach the people who need them, without delay," added Dr. Spigelman.
With additional planned future tenders, TB Alliance expects further price reductions for pretomanid, continuing its mission to ensure that new innovations in TB treatment reach all who need them as rapidly as possible.
