An NGO leading the fight for drug price transparency has been forced into signing secrecy pacts with manufacturers, revealing the full might of Big Pharma in keeping its prices hidden.

Documents seen by POLITICO reveal that Doctors Without Borders, also known as MSF, signed a confidentiality clause with German pharma company Bayer in a contract to buy contraceptives for distribution in lower-income countries. The deal prevented MSF from disclosing the price it paid for the medicines. A Bayer spokesperson said the company would not comment on the content of agreements with third parties.

But it’s not a one-off: A top MSF official admitted the NGO had “reluctantly” signed NDAs with pharma companies on more than one occasion.

The news has shocked former staff at MSF who led the NGO’s world-renowned and successful campaign to expose Big Pharma’s drug prices.

Tido von Schoen-Angerer, a pediatrician who from 2006 to 2012 led the MSF Access Campaign, said he was “a bit speechless” that MSF would sign nondisclosure agreements (NDAs) because its approach in the past was to “never sign such agreements when it came to supply and cost.”

MSF has made transparency a key demand in its campaigning on access to medicines, often disclosing the price it pays for some drugs, including insulin pens, as well as the costs of its clinical trials.

But while MSF’s actions have drawn surprise, others can understand the pressure the NGO is under when negotiating prices with big players in the sector, arguing it’s a sign of the leverage pharma companies hold in such talks.

Ellen ‘t Hoen, another former head of the Access Campaign, argued the blame should be on the drug companies. “This is a symptom of the hostage-like situation single source suppliers — e.g. drug companies that hold patents and control the market — create with their pricing policies. It would be a difficult position to take for MSF to withhold medicines from the patients they care for. In other words, the resistance has its medical ethical limits.”

Drug companies often prefer to keep the price of medicines secret to prevent other countries from demanding the lowest available price. The European Federation of Pharmaceutical Industries and Associations has advocated for confidential tiered pricing that it says would ensure lower-income countries would pay less than higher income ones.

Transparency campaigners say NDAs allow pharma companies to inflate prices and assert extra conditions on buyers.

“MSF is firmly opposed to pricing secrecy, as we believe transparency is essential to improve access to affordable medicines,” Maria Guevara, international medical secretary at MSF International, told POLITICO. “However, sometimes companies force us into a position where we must sign NDAs or confidentiality clauses to be able to obtain critical medicines and tools to treat our patients.”

Guevara said that MSF “systematically resists” demands from suppliers, “though unfortunately we do not always win.”

“It is the option of last resort; we try our best efforts not to have to sign one,” Guevara added.

In 2023, the Access Campaign announced the NGO had refused to sign a contract to buy HIV medication from ViiV because of the pharma company’s “last-minute” demand for terms that are “not acceptable in MSF purchase agreements,” including an NDA.

“We refused to sign the [ViiV] agreement with these terms, as it would undermine drug pricing transparency, limit civil society activism for lower drug prices, and restrict supply to [low- and middle-income countries],” Guevara told POLITICO.

ViiV declined to comment on the story when contacted. The company has disclosed its non-profit price for the drug — currently £20.70 per vial excluding distribution costs — to buyers, but this price doesn’t apply to middle-income countries. MSF has called for ViiV to publish all of its prices and extend the access terms to all countries.

Access Campaign staff have urged MSF management to adopt a policy on NDAs. An email sent by members of the campaign to management last year noted MSF did “not currently have an agreed approach internally to guide the strategic decision making and practices concerning NDA.”

When asked what MSF’s current policy was, Guevara said: “We focus our resistance [to drug price secrecy clauses]on products where we know access is a major issue.”

This story has been updated with ViiV’s position.