Public health officials are stepping up their efforts to put the HIV prevention pill in the hands of at-risk individuals to tackle infection nationwide. But the officials hit roadblocks – the price of the drug, which has risen sharply in recent years, and changes in insurance coverage that place greater financial burdens on patients.
Since the brand name Truvada was approved for HIV prevention six years ago, the average wholesale price has risen by about 45 percent. Well, the drug – which saves Billions of dollars in annual global sales for its maker, Gilead Sciences – carries a list price of just under $ 2,000 for a 30-day supply.
Most insurers cover the pill, also known as pre, from exposure prophylaxis, or PrEP. According to the Centers for Disease Control and Prevention, it has been shown to be more than 90 percent effective in daily HIV prevention.
But patients can get stuck with expenses that make medicine unaffordable. 1
How politicians and the health care system discuss how to always climb According to the experts, this case highlights that patients need to keep the bag
Private health plans make patients responsible for a larger share of drug costs. And more restrict the use of "copay coupons" that pharmaceutical companies have used to protect patients from disbursements. Insurers say pharmaceutical companies are using coupons to drive consumers towards more expensive medicines. One way to limit health plans is to stop counting on patients' deductibles.
"This is another thing that will put people off their medication," says Jim Pickett, senior director of Chicago's AIDS foundation
Jared Wile, who lives in Chicago, started working with the company about three years ago Taking PrEP when he was with someone who was HIV-infected. Wile, who has a deductible of $ 2,750, used a coupon to get the drug. He says he never paid anything out of pocket.
Gilead waives up to $ 4,800 for commercially insured patients.
That changed for Wile last May, when he counted the coupon no longer on his deductible and that he would have to pay the full cost of the recipe – $ 1,600 a month – until he met his deductible. Wile says he feels "blind" and stops taking the medication.
Gilead spokesman Ryan McKeel says the company has made additional efforts to help patients overcome financial barriers. He mentions support programs for uninsured and underinsured people.
"We designed our utilities so that people can benefit from their full value and we can not control the policies or decisions of health insurers," McKeel said via email.
According to estimates from the Federal Center for Disease Control and Prevention, more than 1 million people are at high risk of contracting HIV, but according to Gilead, only about 167,000 people currently live on PrEP.
Beyond Financial Crisis
The prize is one of the many hurdles – in addition to the lack of patient awareness and the hesitant prescribing of physicians – that address the already stark differences in PrEP usage and the HIV infection rate could worsen.
A significant discrepancy exists in geographical lines. The South, for example, accounts for more than half of new HIV diagnoses, but only about 30 percent of new PrEP users, according to AIDSVu data, mapped HIV and PrEP use. HIV rates and PrEP use also vary by race and ethnicity.
"We do not necessarily see that the most vulnerable are those who start PrEP," says Kristin Keglovitz Baker, chief operating officer of Howard Brown Health, a health center in Chicago.
Gilead has been widely publicizing lately to reach endangered people, including print campaigns and TV commercials that are going to blow up this summer. Since 2012, it has spent $ 28 million to fund US organizations that want to raise awareness of HIV, says McKeel, the company's spokesman.
"We recognize that many people at high HIV risk still have difficulty accessing Truvada for PrEP, and we are in regular dialogue with public health officials, lawyers and physicians to better understand these challenges and, where possible, to help. "
But the price is also an obstacle to publicly funded programs, which have limited budgets and are now pouring out more money for prevention work.
"If only it were pennies … we'd throw it around," says Joey Mattingly, assistant professor at the University of Maryland's School of Pharmacy. "Because of how expensive it is, we have to control it."
Some states, including California and Florida, have established PrEP programs that can help patients cover the cost of the drug. Visits
Apart from these government programs, some health departments and HIV organizations provide PrEP navigators to help patients cross the maze of deductibles and deductibles and improve the recruitment and retention of new PrEP users.
Washington "The Health Department of DC has doubled prevention, and Truvada is the key," says Michael Kharfen, deputy director of the Department of HIV / AIDS, Hepatitis, STD and TB.
The insurance usually covers PrEP Patient care programs should fill all the financial gaps, he says. But if that's not possible, the department intervenes and distributes free Truvada starter packs to vulnerable patients.
According to Kharfen, over the past three years, the city has spent nearly one million dollars on Truvada pills alone, which it buys at a discounted rate through the federal 340B program, which benefits certain health care providers who treat low-income people. And because of the new publicity, he expects the department to buy and distribute more pills – a mystery.
Treating more people is net positive, he says. But "how do we support that?"
Medicaid programs generally cover PrEP, so they face a similar situation. Public relations leads to more beneficiaries taking the drug, but that, in turn, could expose the states' Medicaid budgets to financial difficulties.
States spend millions of dollars on the drug. The California Medicaid program, for example, spent about $ 50 million in 2017 and expects costs to continue to rise. But the officials said the cost will be offset by long-term savings in the prevention of new HIV cases.
The Massachusetts Medicaid program spent about $ 22 million on Truvada in the same year – about $ 18,000 per beneficiary, according to a spokeswoman for the Executive Agency of the Health and Social Services Agency. These figures do not take into account the discounts that the state of Gilead receives, which remain secret and are considered protected information.
A Complex Solution and No Competition
PrEP is only one part of HIV prevention Help in paying the pill is only part of the puzzle.
Patients also need regular HIV testing and medical care, which contributes to the costs borne by both the patient and the healthcare system. Some experts warn that the high price of Truvada could financially undermine such comprehensive prevention efforts.
Competition could help.
A generic version of the drug, manufactured by Teva Pharmaceuticals, is available overseas and was approved last year by the Food and Drug Administration. If it becomes available in the United States, it could lower prices, though it is unclear when that will happen. Gilead's own forecasts reflect these expectations and show a decline in Truvada's future revenues.
"When generic drugs get lost, brands lose market share," says David Howard, health economist and professor at Emory University, who has previously worked in the pharmaceutical industry.
For the moment, Truvada is the only available PrEP option in the US, he says. "From a business perspective, their best strategy is to make as much money as possible."
Kaiser Health News a non-profit news service on health issues, is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. KHN's coverage of the development of prescription drugs, costs and prices is partially supported by the Laura and John Arnold Foundation .
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