Generic Triko: A New Hope for Cystic Fibrosis Patients Beyond Borders

Josua Lottering, an 18-year-old with cystic fibrosis, arrived in Dhaka, Bangladesh, from South Africa, hoping to access a life-changing medication. His condition, marked by severe lung damage, made the journey emotionally and physically taxing. Yet, his relief was profound—he had secured a generic version of Trikafta, a drug that has revolutionized treatment in wealthier nations but remained unaffordable at home.

Cystic fibrosis, a genetic disorder, leaves patients like Josua struggling to breathe due to excess mucus production. Trikafta, developed by Vertex Pharmaceuticals, has transformed lives in North America and Europe, but its $346,000 annual cost in the U.S. made it inaccessible for many. Vertex, which holds a near-monopoly on such drugs, has not authorized its sale in lower-income countries, blocking generic production to maintain high pricing in affluent markets.

Beximco Pharmaceuticals, a Bangladesh-based company, circumvented this by reverse-engineering Trikafta through a legal loophole. Their generic, Triko, is priced at $6,350 annually for children and $12,700 for adults—still a burden for some, but a lifeline for others. This initiative leverages Bangladesh’s status as a least-developed country, exempting it from stringent WTO patent rules, allowing the production and export of generics.

Josua and his mother, who could not afford Trikafta in South Africa, purchased Triko in Dhaka. His first dose marked a turning point: his coughing subsided, and he regained his sense of taste and smell. Similar stories emerged from Slovakia, where a patient named Šimon Ševčík, unable to access Trikafta locally, traveled to Bangladesh to buy Triko. His goal now is to advocate for broader access in his home country or relocate closer to Bangladesh.

In South Africa, Vertex’s patent on Trikafta delayed access. While some patients now receive it through insurance or settlements, many lower-income families remain excluded. For Josua’s mother, Wilna, the cost of Trikafta—$150,000 annually—was financially devastating. She considered emigrating to secure coverage but found hope in Triko’s availability.

Beximco’s CEO, Rabbur Reza, emphasized the ethical imperative behind the initiative. “We are committed to bridging gaps in healthcare access,” he stated. While Vertex maintains that Trikafta’s safety and efficacy stem from extensive trials, generic producers rely on existing data, a standard practice in the industry.

The success of Triko highlights a growing trend: patients in low-income countries are finding innovative ways to access therapies that transform lives elsewhere. As demand rises, companies like Eudaico Health in India are stepping in, offering Triko for a 10% markup and handling import logistics. This model could reshape how life-saving medications are distributed globally, challenging traditional pharmaceutical monopolies.

Aadil Rahman, a 6-year-old from Dhaka, also benefited from Triko. His parents, who delayed diagnosis due to limited awareness, now hope to secure the medication long-term with family support. For them, Triko is not just a treatment—it’s a chance to give Aadil a normal life.

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