We have identified a small number of companies that are manufacturing generic versions of cystic fibrosis drugs including Gador and Tuteur in Argentina. However,  Bangladeshi pharmaceutical company Beximco has now also entered the market.  Beximco has provided us with current prices for their generic version of triple combination therapy CFTR modulators. It will be available for purchase and shipping from Spring 2026.

Beximco have priced their ETI product at $6375 per year for children and $12750 per year for adults

Although currency fluctuations have led to significant changes in the Gador prices, it is approximately $60,000 per patient per year.

Vertex’s list price in the US for Trikafta is $370,000 per patient per year.

There are a number of mechanisms by which the safety and efficacy of generic medicines is ensured:

1. Ensuring the ingredients in the medicine are comparable to the originator product. This can be demonstrated through in-vitro dissolution testing. Beximco have conducted these tests and the results show close alignment to Vertex’s reference product. These results have been included in the annex at the end of this document.

2. Demonstrating comparable bio-equivalence of the generic and originator medicine in the body: Bio-equivalence testing of this nature is generally required to secure regulatory approval of a medicine in western health systems, particularly for drugs with the solubility profile of ETI. These tests are expensive and time consuming, but we are working with globally respected experts to design and implement bio-equivalence studies as soon as possible.

3. Ensuring good manufacturing practice (GMP) at the factory production site: Beximco’s state of the art manufacturing facilities have been awarded certificates of GMP from stringent regulatory authorities around the world, and produce and supply medicines for multiple markets including the US and western Europe.

4. Post-marketing studies and real world use: After a drug is being used within a clinical context doctors can monitor the impact on their patients. We hope that CF clinicians will be able to measure and share sweat-chloride, lung function, and other markers of CF patient health once they are using the generic product.

Trikafta / Kaftrio (Vertex, US)

• Triko (Beximco, Bangladesh)

• Trixacar (Gador, Argentina)

• Trilexa (Tuteur, Argentina)

Kalydeco (Vertex, US)

• Bexdeco (Beximco, Bangladesh)

• Ivacar (Gador, Argentina)

• Ivadeco (Tuteur, Argentina)

Orkambi (Vertex, US)

• Lucaftor (Gador, Argentina)

• Lumiva (Tuteur, Argentina)

Symdeko / Symkevi (Vertex, US)

• Tezacar (Gador, Argentina)

Patents are granted at a national level. As a least developed country, Bangladesh is not obligated to fully implement WTO rules on patents, and so there is no  intellectual property barrier to them producing the medicines. Beximco has secured regulatory approval for export of their product from Bangladesh from the antional regulatory authority.

What follows is not legal advice. You may however find it useful in making an assessment about the legality of importing CF medications into your country.

Domestic law in many countries around the world include a personal use exemption allowing patients to bring medicines into the country for personal use. In the UK this is understood as up to a three month supply and can be either brought in on your person when you are travelling into the country, or it can be bought from an overseas supplier and delivered to a patient or their family member in the mail.

This may not be the same in all countries and it is the responsibility of each buyer to understand and adhere to the rules around personal importation and taxation in the country where they live.

An adult patient - or a child aged 6-12 years and over 30kg in weight - will need two pots of Triko (60 tablets in total) and one pot of Bexdeco (30 tablets) every month. Families could also discuss if children in this category could start on a lower dose to check for side-effects and to lower the cost of the treatment, but you would need to discuss this with your CF doctor. 

For a child aged 6-12 years and under 30kg in weight, they will need to take half of the adult dose - therefore, two pots of Triko (60 tablets) and one pot of Bexdeco (30 tablets) will last for two months instead of one month.

For an adult patient - or a child aged 6-12 years and over 30kg in weight, who is also taking a strong CYP3A inhibitor - two Triko tablets are taken on days one and four every week, therefore four Triko tablets are needed per week. 

At this dosage, one pot of Triko (30 tablets) will last for 7.5 weeks. Bexdeco is not needed. 

Clarithromycin is a strong Cytochrome P450 3A (CYP3A) inhibitor that delays liver metabolism of elexacaftor, tezacaftor and ivacaftor (ETI) when administered alongside ETI. The recommended dose adjustment is to reduce ETI to twice weekly when coadministered with a strong CYP3A inhibitor. Left with little choice to save costs, some patients in South Africa opted to exploit this drug interaction on a long-term basis under the supervision of their medical practitioner. You can read the study here. 

The study concluded that there was no clinically significant difference in outcomes between the modulator-sparing and standard dosing approaches. The authors of the study propose that modulator-sparing strategies with a strong CYP3A inhibitor may be an acceptable, effective, and cost-saving interim measure to increase access to lifesaving CF modulators in low and middle income countries.