"The savings for U.S. payers will be so huge when these generic combination drugs are available in the U.S.," he said in an interview at the factory outside the Southern Indian city of Visakhapatnam. Payers will save "billions of dollars," he said.

The patent expiries are starting this month when Bristol-Myers Squibb Co.’s Sustiva loses protection. Gilead Sciences Inc.’s Viread follows next month. Both companies didn’t respond to requests for comment.

Big business

For generic manufacturers like Laurus, the U.S. market is alluring. With 1.1 million people infected with HIV in the U.S., and many of them living longer thanks to treatment, HIV drugs have become an $18.8 billion business for the pharmaceutical industry there, according to data provider IQVIA.

Part of that spending is due to the high cost of the medicines. For instance, a combination of Viread, Sustiva and a third drug sold in pill form under the brand name of Atripla has an average wholesale price of almost $37,000 per person annually, according to data from the U.S. Department of Health and Human Services.

The best way to fight HIV is with a combination of different drugs, and because Viread and Sustiva form key parts of some of the most effective combinations, the inclusion of generic versions of these chemicals could bring down the cost of the whole treatment. One analysis cited by the Department of Health found that replacing a three-medicine, branded combination with multiple pills, including a generic version of Sustiva, could save the U.S. $900 million its first year.

Different game

In the U.S., Laurus will be going up against much larger companies like Teva Pharmaceutical Industries Ltd. -- the world’s biggest generic drug company -- which will beat it to market on generic Viread and so be the first to slash prices and lock down customers. Other generic companies, both from India and elsewhere, many of whom are customers of Laurus, are expected to enter the market too.

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Cost savings that were an advantage in the developing world, may also prove less useful in a less price sensitive market like the U.S. Between government programs providing treatment for the uninsured, and drug company funded ones helping the insured with their co-pays, HIV patients in the U.S. are often sheltered from the full cost of their medicines.

So patients themselves may have little incentive to switch to cheaper alternatives, said Tim Horn, the New York-based deputy executive director of Treatment Action Group, an AIDS policy think tank. Newer drugs offer medical advantages to the ones going off patent, including fewer side effects, and the switch from one daily brand name pill to a mix of two or three may feel like a step back for many, he said.

Still, Horn says private and public insurers, who pay the greater part of the full sticker price and then spread those costs through the system in the form of higher premiums and health-care costs, are likely to push for generics.

New technology

For his part, Chava maintains he will eventually be able to undercut bigger rivals like Teva on price, and the magnitude of savings offered to insurers from generics will prove irresistible -- particularly as more components of the older combinations go off patent in the next three years.

"We believe we’ll be able to bring cost effective generic alternatives to the U.S. market," he said. "We have the scale."