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Public health activists say the question goes beyond Glivec to whether drug companies should get special protection for minor tweaks to medicines that others could easily have uncovered.

“We’re looking to the Supreme Court to tell Novartis it won’t open the floodgates and allow abusive patenting practices,” said Eldred Tellis, of the Sankalp Rehabilitation Centre, a private group working with HIV patients.

The court’s decision is expected to be a landmark that will influence future drug accessibility and price across the developing world.

“We’re already paying very high prices for some of the new drugs that are patented in India,” said Petros Isaakidis, an epidemiologist with Doctors Without Borders. “If Novartis‘ wins, even older medicines could be subject to patenting again, and it will become much more difficult for us in future to provide medicines to our patients being treated for HIV, hepatitis and drug resistant TB.”