1. Conceptual, historical, and normative framework of PDP
The first PDP projects were approved by the Ministry of Health of Brazil in 2009 for local production of drugs, vaccines, blood, and health products considered strategic for SUS. The basic model involved the participation of at least three partners. It should mandatorily comprise a public institution (receiver of the technology of the finished product, responsible for the presentation of the project to the Ministry of Health and the technology internalization in its industrial park); a private entity (a national or international holder of the technology to be transferred to the Brazilian public institution); and a public or private laboratory (producer of the active pharmaceutical ingredients − API, established in Brazil).
Following the regulation, public partners establish partnerships with private entities, holders of technology or knowledge, to develop strategic products for SUS. Public laboratories are responsible for the coordination of the partnership with their private partners. Purchases are carried out by the Ministry of Health during the technology transfer term, in a public commitment signed with the public laboratories. There is a guarantee of the public market during the knowledge transfer term, when there should occur the qualification of the public laboratory for the local production, with the follow-up and tutorial of the private partners.
Presently, there are 81 ongoing PDP involving technology transfer and national production of 75 drugs, vaccines, and blood products, and another six PDP of health products. Among the partnerships for drugs, vaccines, and blood products, eight are in Phase I (PDP project proposal), 43 in Phase II (PDP project), 24 in Phase III (PDP). Suspended partnerships represent 24% (18) of the partnerships, with 67% in Phase II and 33% in Phase III (Figure 1).
Figure 1. Ongoing and suspended PDP for drugs, vaccines, and blood products per PDP phase – 2019.
Among the partnerships for health products, one is in Phase I, six are in Phase II and three are in Phase III. Suspended PDPs represent 50% (Figure 2).
Figure 2. Ongoing and suspended PDPs for health products per PDP phase – 2019.
There are 11 PDP for drugs, vaccines, and blood products classified in Phase IV by the Ministry of Health; no PDP for health products has reached this phase yet. Phase IV is characterized as that in which the official public laboratories confirm the conclusion of the internalization of technology in their industrial parks for production technology and the finished drug or health product, as well as the APIs by the pharmaceutical or the biological producer.
2. Analysis of PDP objectives
PDP objectives were originated in 2009 and incorporated into the subsequent normative bearing the social and economic vision as needs foreseen by health policies and the Brazilian industrial development. The objectives are hereafter systematized into three main goals.
Broadening of access: the main PDP objective is to enlarge the population's access to public health strategic products by increasing the purchased volumes to attend pharmaceutical assistance programs, aiming, in the end, to treat more patients25.
Productive and technological development: to reduce the country’s productive, technological, and economic dependence to fulfill health needs in the short-, medium- and long-term, complying with the constitutional principles of universal and equitable access to actions and services of health. Also, to stimulate knowledge interchange for innovation to CEIS development; to promote the manufacturing of strategic products for SUS and contribute to commercial deficit reduction, and to stimulate the development of national producers network. In the end, it aims to reduce Brazilian historical dependence on finished products with a high aggregate value in a globalized economy, in which market oscillations, wars, pandemics, and environmental events can have damaging effects in a developing country.
The economy in public federal purchases: to rationalize the State’s purchasing power through a selective centralization of expenditure aiming at SUS sustainability and the increase of strategic products manufacturing in the country; to protect the society by seeking economics, considering the price, quality, technology, and social benefits.
3. Directives and requirements (criteria) for the establishment of PDP
PDP projects must observe criteria regarding participant subjects; object; intellectual property; executive project terms/schedule; registration and certification; productive integration degree; production process; sale price proposal and supply capacity estimation; currency balance; risk analysis; and necessary investments for the concretization of projects.
I - Participants: the presence of one or more public institutions responsible for technology absorption and product manufacturing and one or more private entities, holders, or developers of the product’s technology, responsible for technology transfer to a public institution. It is expected acceleration of nonexistent technology internalization process in the country, including product, process, and organizational innovations26.
Local synthetic or biological active pharmaceutical ingredients (APIs) producers, public or private entities, and also health product critical components producers must participate in the formation of a partnership.
In 2020, the PDP projects were distributed among 52 partners, of which 15 were public and 37 were private. Of the totality of private partners, 10 firms were of national origin and 14 firms were of multinational origin.
II - Objects: the products listed as strategic products for SUS are eligible for development, transfer, and absorption of technology16 as PDP. The List of Strategic Products of SUS should not be confounded with other lists developed to provide for several public policies, such as the National List of Essential Drugs (RENAME), which refers to the national list of essential drugs as required by the World Health Organization (WHO)26.
III – Intellectual property: research, development, and manufacturing of products to be purchased as PDP must comply with the legislation in force, i.e., will comply with the validity period of the patent granted by the National Institute of Industrial Property (INPI) in the national territory. Before each PDP approval, there is the verification of the number of patents granted or being processed for each molecule being analyzed.
IV – Executive project terms/schedules: for execution, four phases are proposed: 1) elaboration, presentation, and analysis of the “PDP project proposal”; 2) implementation of the “PDP project” approved to grant the registration of the product, start the purchase by the Ministry of Health and carry out the technology transfer; 3) stage of “PDP” with technology transfer between public and private partners until the finalization of the technology transfer process, and 4) technology internalization in the country and knowledge portability by the public institution.
The maximum duration term should be proposed based on the complexity of the technology internalization and should not be longer than ten years. This complexity is based on productive processes difficulties faced by public or private institutions responsible for the national production of the active, biological, or synthetic pharmaceutical ingredient, or the critical technological component.
For example, processes that involve biological ingredients are more complex for national producers. This productive platform installation is under progress in the country yet and, for this reason, projects for biological products have been approved for over five years and less than ten years with effective purchases from the Ministry of Health.
The schedule presented should involve the prediction of budget and responsibilities; be compatible with the facilities and equipment specifications to the tech transfer. A special aspect is the adequacy of industrial installations to comply with sanitary regulations.
V – Registration and certification: public institution and private entity products sanitary registration, as well as its regulatory post-registration stages, should be prioritized in a PDP. Considering the complex steps to complete a tech transfer involving biological and pharmaceuticals ingredients the regulatory impact cannot be neglected. These steps include license renewals and Good Manufacturing Practices (GMP) Certifications.
VI – Productive integration degree: one of the main criteria for a new PDP approval is the promise to effectuate the tech transfer. It must be within the stipulated time and must complete the synthetic or biological API knowledge transfer for local production, as well as the critical technological components.
It is highly recommended access to public partners to the Drug Master File (DMF) for synthetics products and the Master Cell Bank (MCB) for biological/biosimilar products. In the case of health products, to the complete critical technological component for knowledge production.
VII – Production process: the production flow plan should be presented in detail, including the aspects of infrastructure adequations, with an indication of whether the production facilities of the partners involved will need new investment; the appropriate conditions to carry out the project, including procedures, and organizational resources.
When necessary, infrastructure adjustments should be specified by the public institution in the executive project, as well as data on needed resources, budgeted costs, and estimation of the conclusion of critical investments to make the PDP feasible for all partners. The necessary equipment for the production process and quality control should be described in the PDP executive project, informing the nominal capacity, whether the partners already have the needed equipment, or present an estimation of the purchase/spending with the respective specification of funding sources.
There should also be a specification of necessary human resources to carry out the management, development, and technological absorption process and quality assurance, with the indication of numbers, and necessary training and qualification.
VIII - Sale price proposal and supply capacity estimation: proposals should present sales nominal unit values and the annual supply capacity for the period of the tech transfer project. Proposed prices should be compatible with commercial practices and if necessary also with international market prices of countries considered by the Brazilian Drugs Market Regulation Chamber (CMED).
The sales prices should decrease every year during the effective tech transfer phase. The values presented must consider, on an actual basis, the variation of the National Consumer Price Index (IPCA) or the sector price index and the exchange rate variation, according to CMED regulation.
The construction of the sale price proposal and the supply capacity estimation should use the Ministry of Health’s average prices registered at official banks: Health Prices Bank (BPS) and the Integrated System of General Services Administration (SIASG). The sale price reference for the debutant PDP purchase should consider the Ministry of Health’s last sale price paid for the product, published in the federal official journal.
Other data sources should also be used: price registry minutes, SUS national health data, official average prices practiced in the national and international market databases, Drugs Market Follow-up System (SAMMED) of CMED, Revolving Fund of Pan-American Health Organization (PAHO), and Global Fund to Fight AIDS, Tuberculosis, and Malaria.
For innovative products, the final product price should consider the international average prices practiced in countries listed by CMED. For those products that the patent will expire during the phases of the tech transfer, a study should be presented containing an analysis in which the projections of price reduction are compatible with the changes in market levels.
IX – Foreign exchange balance: an evaluation should be made involving the finished product, APIs and, intermediary technological components to the foreign exchange balance. The methodology used for annual currency economy estimation during the tech transfer phases should also be declared.
X – PDP risk analysis: risks related to tech transfer processes must be enlightened by the public partner concerning production, regulatory, and management processes aspects, using some owned methodology.
XI - Investments: investments must be consistent with the capacity and financing sources. They should consider infrastructure adaptations, new equipment, staff recruitment, and training. Public partners should consider sales profit carried out with the Ministry of Health as a financing source during the tech transfer. Ministry of Health does not participate directly in this funding. Private partners must seek their funding as investments.
New PDP project proposals are analyzed according to the criteria presented above. It is also considered the accordance with SUS public policies implemented for health promotion, prevention, and care. Proposals are also analyzed concerning their importance for scientific, technological, and socioeconomic development. The absence or insufficiency of national production or shortage risk of the finished product, API, or critical technological component, contributes to the reasonable approval of a new PDP in the context of Brazilian CEIS.