The supply of critical medicines, including the three-in-one anti-Aids drug taken by most HIV patients, and morphine, is under threat after suppliers were placed in business rescue, raising questions about due diligence over the contracts and reliance on single providers, notes MedicalBrief.
Concerned MPs have resolved to ask Health Minister Aaron Motsoaledi to explain to Parliament how two companies that last year won a share of the lucrative contract to supply the three-in-one anti-Aids drug have entered business rescue, reports Business Day.
This comes as the country was faced with a shortage of critical morphine powder – the second in three years. A second Business Day report says the issue was resolved when Barrs Pharmaceuticals, the country’s sole importer of bulk morphine hydrochloride, which it repackages into smaller quantities, resumed supplies (see more details below).
And in Pietermaritzburg, patients are forced to turn to expensive medication from private outlets to treat the parasitic disease Bilharzia amid a national shortage of the standard treatment – supplied solely by Bayer – at public health facilities (see more details below).
On the multibillion-rand ARV contracts, however, Avacare Health subsidiaries Barrs and Innovata are not able to meet their obligations, Health Department spokesperson Foster Mohale confirmed.
Barrs and Innovata, which between them won roughly a quarter of the tender to supply the pills taken by most of South Africa’s HIV patients, failed to notify the Health Department that they went into business rescue just days after the tender period began on 1 December.
Now Parliament wants the Minister to explain how the situation arose and what it means for patients, said the Chair of Parliament’s Portfolio Committee on Health, Faith Muthambi.
“We need to get to the bottom of this … as a matter of urgency,” she said.
After a request from the DA’s Michele Clark, Muthambi said she would be writing to the Minister to ask him to appear before the committee as soon as possible.
Clark said she had questions about the due diligence conducted on the companies that had won the contracts, and why “very reputable” companies such as Cipla and Adcock Ingram had been left out.
The total Aids drug tender, which runs for three years, is worth an estimated R15.5bn. The core contracts to supply monthly and three-monthly packs of the three-in-one pills, which contain tenofovir, lamivudine and dolutegravir (TLD), are the biggest by volume and value, and are worth around R12.6bn.
When the tender award was announced in August 2025, several local pharmaceutical manufacturers that had previously supplied the state with TLD were excluded. They include Adcock Ingram, Cipla and Sun Pharmaceuticals (formerly Sisonke).
On Friday, the Health Department sought to reassure HIV patients that there was no imminent danger of medicine shortages, saying provincial Health Departments had sufficient stock to cover three months of demand and that the tender had deliberately split contracts between multiple suppliers to mitigate the risk of any of them being unable to fulfil their commitments.
Mohale said uninterrupted access to HIV treatment “remains a national priority and all measures are in place to ensure patients continue to receive their medicines without disruption”.
Aspen, Emcure, Innovata, Barrs, MacLeods, Viatris and Aurobindo all won a share of both the monthly and the three-monthly contracts, while Pharma Dynamics won a share of only the monthly pack contract. Barrs and Innovata won a combined 28.76% of the contract for three-monthly packs and 24.49% of the one for monthly packs.
Mohale said the department has agreed to Barrs’ request to supply an alternative product, while Innovata said its supplier has resumed production after the holiday shutdown but has yet to confirm when it would resume supply.
In the meantime, the department “has engaged with other awarded suppliers to increase their production to ensure continuous availability of these medicines while the two … address their supply constraints”.
Aspen Pharmacare’s head of strategic trade, Stavros Nicolaou, said the company was willing to step in. “We will work with the Health Department to try to solve whatever the volume gap is,” he said.
The Aids drug tender has been dogged by controversies, with a clamour of objections by pharmaceutical manufacturers in August when it was announced that several well-established local companies – including Adcock Ingram, Cipla and Sun Pharmaceuticals – had been excluded from the contracts to supply the TLD.
Very lucrative
The TLD contracts, worth R12.6bn, are the biggest in the R15.5bn tender, and any disruption to supplies puts patients at risk of developing resistance to the drugs.
Shortly after the award was announced, the South African subsidiary of Indian generic manufacturer Hetero Drugs launched legal action against the department, alleging it had been unlawfully excluded from the contracts for TLD because its prices had been lower than all but one of the successful bidders.
The Competition Commission opened an investigation into Hetero for alleged collusion, a move triggered by a referral from the Health department.
It has now emerged that Avacare and its South African subsidiaries – Barrs, Innovata and Supra Healthcare – are all in business rescue. Former Avacare CEO André Meyer, who resigned on 25 November, declined to comment.
Debt ‘north of R250m’
Business rescue consultant Karl Gribnitz said the companies had accumulated debt to their suppliers “north of R250m”, but they were all going concerns. Two groups of investors intended to recapitalise the companies once the business rescue process is complete, he said.
The business rescue plan for Innovata was approved by creditors earlier this week, sign-off was imminent for Barrs and Supra Healthcare, and all three companies were expected to be out of business rescue by the end of next week, he said.
Barrs and Innovata’s problems extend beyond HIV medicines, with Mohale saying there have been stock shortages of multiple items from both companies.
Barrs was unable to supply morphine powder from November 2025 to early January, said Independent Community Pharmacy Association CEO Jackie Maimin.
Morphine syrup, which is on the Health Department’s essential drug list, is the cornerstone of pain relief for cancer and palliative care patients as it is cheap, works quickly, and easy to administer to people who cannot swallow tablets, said Association of Palliative Care Practitioners of SA clinical lead Margie Venter.
Government patients were affected the most, because the state has no readily available alternative, she added: widespread stock-outs had caused unnecessary suffering, with many patients being left in uncontrolled pain.
Private sector patients had the option of costlier medicines like oxycodone or fentanyl, funded out of pocket or by their medical schemes.
Venter noted that although the resumption of the morphine supplies was welcome, it does not resolve the inherent risk of relying on a single supplier. She said this was not the first time Barrs has been unable to provide stock – there had been a nationwide shortage of morphine powder in 2022, as well.
Barrs pharmacist Wynand Erasmus said the company had run into difficulties sourcing morphine powder from overseas suppliers because global demand had risen due to ongoing wars.
However, other members of the African Palliative Care Association have not flagged morphine powder shortages, Venter said. Nor is morphine powder listed on the medicine shortage registries maintained by health authorities in the UK and Australia.
Erasmus said Barrs was aware of the impact of shortages, and has procured sufficient stock to cover demand for the next six months.
On the Bilharzia (schistosomiasis) medicine shortage, The Witness reports that the condition is usually treated using praziquantel, a drug listed by both the World Health Organisation (WHO) and the National Department of Health (NDoH) as an essential medicine that should be readily available at public facilities.
However, patients and pharmacists say the medication has been difficult to obtain for months, leaving many with no option but to turn to private pharmacies where alternative or compounded versions of the drug can cost R600 or more.
According to the National Institute for Communicable Diseases (NICD), the NDoH was informed by the sole supplier, Bayer, of the depletion of stock of praziquantel 600mg tablets for the public sector in October 2024.
While the department reportedly sourced stock of an alternative pack size by the end of April last year, patients continue to report shortages.
Pharmacists who spoke to The Witness confirmed that increasing numbers of patients are requesting compounded or specially prepared alternatives because praziquantel is unavailable. They said these are significantly more expensive and are mostly accessible only through private facilities.
“People are forced to take it because they need to treat the disease,” said one pharmacist.
But KwaZulu-Natal Health spokesperson Ntokozo Maphisa denied that there is a provincial shortage of the medication. “Currently there is sufficient praziquantel to treat bilharzia,” he said.
He said stock of praziquantel 600mg was available at the provincial pharmaceutical depot and that recent orders have either been allocated and collected by facilities or are in the process of being collected.
Maphisa acknowledged procurement challenges, noting that only one company globally manufactures the medication, making it difficult to source.
“Because of having only a sole supplier, no alternative medication is available,” he said, adding that shortages at clinics were often the result of stock expiring after remaining unused.
He said expiry issues are typically confined to one or two facilities and “do not mean that the entire province is out of stock”.
Patients were rarely turned away, he noted, and medication could usually be sourced from another facility. “If it is not available immediately, arrangements are made for patients to collect it later or to have it delivered by a community health worker.”
Business Day – Barrs Pharmaceuticals restores morphine powder supplies (Restricted access)
See more from MedicalBrief archives:
HIV drugs roll-out under threat in court tender row
SA companies lose out on ARV drugs tender
Government delays erode savings made on new HIV-drug tender
Government shuns local vaccine-maker and switches to imports