Breaking News
October 24, 2018 - Loxo Oncology Announces Receipt of Breakthrough Therapy Designation from U.S. Food and Drug Administration for LOXO-292 for the Treatment of RET Fusion-Positive Thyroid Cancer
October 24, 2018 - Analysis of largest set of genomes from pregnant women reveals genetic links to disease, birth outcomes
October 24, 2018 - New vaccine strategy shows promise to protect chickens against serious respiratory disease
October 24, 2018 - First Asia Reference Center in Singapore
October 24, 2018 - New partnership aims to tackle cancer health disparities
October 24, 2018 - Two Roche Diagnostic tests identified as transformative
October 24, 2018 - Cocaine overdoses on the rise with fentanyl combo flooding the market
October 24, 2018 - Radiotherapy combined with androgen-deprivation therapy improves overall survival up to 10 years
October 24, 2018 - Spectrum Pharmaceuticals Receives FDA Approval of Khapzory (levoleucovorin) for Injection
October 24, 2018 - Researcher uses smartphone to detect breast cancer gene
October 24, 2018 - Advanced breast cancer patients can benefit from immunotherapy-chemotherapy combination
October 24, 2018 - Stress related to social stigma negatively impacts mental health of autistic people
October 24, 2018 - New 17-item questionnaire may help detect GI disorders in children with autism
October 24, 2018 - 12% of frequent marijuana smokers experience cannabis withdrawal syndrome
October 24, 2018 - Immune therapy may be potential treatment option for patients with hard-to-treat ankylosing spondylitis
October 24, 2018 - Poor Experience With PCP Linked to Hospitalization in CKD
October 23, 2018 - Dummies not to blame for common speech disorder in kids
October 23, 2018 - The future of ethics and biomedicine: An interview
October 23, 2018 - X4 Pharmaceuticals announces clinical data of X4P-001-IO and Opdivo in patients with clear cell renal cell carcinoma
October 23, 2018 - FDA targets 465 websites that sell potentially dangerous, unapproved drugs
October 23, 2018 - New approach may lead to better diagnostic techniques for autoimmune disorders
October 23, 2018 - Innovative computer software sheds new light on genetic processes underlying deadly diseases
October 23, 2018 - Juul Drawing Lots of Teen Followers on Twitter
October 23, 2018 - WHO says Zika risk low in Pacific ahead of Meghan visit
October 23, 2018 - A deeper look at ‘Reflecting Frankenstein’
October 23, 2018 - Breastfeeding can have protective affect against high blood pressure in women, confirms study
October 23, 2018 - Epigenetic modifications may contribute to Alzheimer’s Disease
October 23, 2018 - Volunteering for peer counseling programs benefits people with lupus
October 23, 2018 - Cancer treatment may undergo a paradigm shift to immunotherapy soon
October 23, 2018 - Study uncovers new mechanism of action in a first-line drug for diabetes
October 23, 2018 - New type of molecule shows early promise against treatment-resistant prostate cancer
October 23, 2018 - Lancet publishes pioneering study of Aimovig’s efficacy in episodic migraine patients
October 23, 2018 - Scientists grow functioning human neural networks in 3D from stem cells
October 23, 2018 - Using mushrooms as a prebiotic may help improve glucose regulation
October 23, 2018 - New ENT clinic treats children in Zimbabwe
October 23, 2018 - CUIMC Celebrates 2018-2019, Issue 2
October 23, 2018 - Immunotherapy is better than chemotherapy as first-line treatment for advanced head and neck cancer
October 23, 2018 - Intake of painkillers during pregnancy linked to early puberty in future offspring
October 23, 2018 - ConnectToBrain project seeks to improve techniques for brain stimulation in current clinical use
October 23, 2018 - Polyganics begins first-in-human clinical trial of LIQOSEAL for reducing CSF leakage
October 23, 2018 - Gut bacterial community of healthy adults recovers after short-term exposure to broad-spectrum antibiotics
October 23, 2018 - Lowering systolic blood pressure does not damage the kidneys, shows study
October 23, 2018 - Incyte Announces Positive Data from Phase 2b Trial of Ruxolitinib Cream in Patients with Atopic Dermatitis
October 23, 2018 - Cardiovascular admissions more common among most deprived
October 23, 2018 - Targeted drug and hormone therapy combination extends breast cancer survival
October 23, 2018 - Map of human liver cells reveals molecular make-up of individual cells
October 23, 2018 - Drugs approved for breast cancer treatment are effective and well tolerated in men
October 23, 2018 - EKF introduces new hand-held lactate analyzer for rapid sports performance monitoring
October 23, 2018 - Researchers identify common genetic connection in lung conditions
October 23, 2018 - Forbius initiates Phase 2a trial evaluating efficacy, safety of AVID100 in patients with squamous NSCLC
October 23, 2018 - Immunotherapy achieves major pathological response in early-stage mismatch repair deficient colon cancer
October 23, 2018 - New discovery may lead to better treatment options for pancreatic cancer patients
October 23, 2018 - FDA Approves Dupixent (dupilumab) for Moderate-to-Severe Asthma
October 23, 2018 - Researchers identify immune culprits linked to inflammation and bone loss in gum disease
October 23, 2018 - Despite lower risk factors, black men have higher rates of recidivism
October 23, 2018 - Study finds why pregnant women in mainland China, Hong Kong and Taiwan prefer cesarean delivery
October 23, 2018 - AbbVie’s U-ACHIEVE Phase 2b/3 dose-ranging study improves outcomes in patients with ulcerative colitis
October 23, 2018 - NCI grant awarded to Abramson Cancer Center to study CAR T cells In solid tumors
October 23, 2018 - Scientists use electron microscope to study chemical transformation in catalytic cross-coupling reaction
October 23, 2018 - Research offers new hope to men who received childhood cancer treatment
October 23, 2018 - New medical navigation system receives international innovation award
October 23, 2018 - Adverse Childhood Experiences Tied to Burnout in BSN Students
October 23, 2018 - High levels of oral disease among elite athletes affecting performance
October 23, 2018 - Study examines effect of immediate vs delayed pushing during labor on delivery outcomes
October 23, 2018 - LU-RRTC to spearhead capacity-building efforts for racial and ethnic populations
October 23, 2018 - Maintenance therapy with olaparib improves progression-free survival in advanced ovarian cancer patients
October 23, 2018 - Organic food may protect against cancers finds study
October 23, 2018 - Interweaving anxiety disorder associated with stuttering remains unrecognized
October 23, 2018 - Cannabis oil shown to significantly improve Crohn’s disease symptoms
October 23, 2018 - Knowledge of sex differences in lower urinary tract may help stimulate breakthroughs in diagnosis, management
October 23, 2018 - Common antibodies associated with myocardial infarction
October 23, 2018 - Study reveals new treatment option for women with advanced breast cancer resistant to hormone therapy
October 23, 2018 - Brain’s ‘Self-Control’ Center May Be Key to Weight-Loss Success
October 23, 2018 - Prosthetic valve mismatches common in transcatheter valve replacement, ups risk of death
October 23, 2018 - Can virtual reality help people become more compassionate?
October 23, 2018 - Screen time eclipsed outdoor time for most students, shows study
October 23, 2018 - SLU researcher seeks to find solutions for ‘chemo brain’ symptoms and side effects of opioids
October 23, 2018 - Plastics now commonly found in human stools
October 23, 2018 - Zoledronic acid increases disease-free survival in premenopausal women with HR+ early breast cancer
October 23, 2018 - Cancer survivors at risk for heart failure during, after pregnancy
Out-of-pocket costs put HIV prevention drug out of reach for many at risk

Out-of-pocket costs put HIV prevention drug out of reach for many at risk

image_pdfDownload PDFimage_print
Credit: CC0 Public Domain

Public health officials are expanding efforts to get the HIV prevention pill into the hands of those at risk, in a nationwide effort to curb infections. But the officials are hitting roadblocks—the drug’s price tag, which has surged in recent years, and changes in insurance coverage that put a heftier financial burden on patients.

Since brand-name Truvada was approved for HIV prevention six years ago, its average wholesale price has increased by about 45 percent. Now, the drug—which rakes in billions of dollars in annual global revenue for its manufacturer, Gilead Sciences—carries a list price of close to $2,000 for a 30-day supply.

Most insurers cover the pill, also known as pre-exposure prophylaxis, or PrEP. It has been shown to be more than 90 percent effective in HIV prevention when taken daily.

But patients can get stuck with out-of-pocket costs that make it unaffordable.

“If there is any example of the dysfunction in the American pharmaceutical system, it is this case,” said James Krellenstein, a member of the AIDS advocacy group ACT UP New York. “We have the most effective tool for ending the HIV epidemic, and one reason we’re unable to scale up is because it costs so (much) unnecessarily.”

As policymakers and the health system debate how to control ever-climbing drug prices, experts say this case underscores how patients are left holding the bag.

Private health plans are making patients responsible for a larger share of drug costs. And more are restricting use of the “copay coupons” pharmaceutical companies have used to shield patients from out-of-pocket expenses. Insurers say the drug companies use coupons to steer consumers toward pricier meds. One way health plans are limiting their use is by no longer allowing them to count toward patients’ deductibles.

“This is one more thing that is going to push people off their medications,” said Jim Pickett, a senior director at the AIDS Foundation of Chicago.

Jared Wile, who lives in Chicago, started taking PrEP about three years ago, when he was dating someone with HIV. Wile, who has a $2,750 deductible, used a coupon to obtain the drug. He never paid anything out-of-pocket, he said.

Gilead waives up to $4,800 in out-of-pocket expenses for commercially insured patients.

That changed for Wile this past May, when Wile learned the coupon no longer counted toward his deductible and that he would have to pay the full cost of the prescription – $1,600 per month—until he hit his deductible. Wile said he felt “blindsided” and stopped taking the medication.

Gilead spokesman Ryan McKeel said the company has made extra efforts to help patients overcome financial barriers. He cited assistance programs for uninsured and underinsured people.

“We have designed our assistance programs with the intent that people can benefit from their full value, and we cannot control the actions or decisions of health insurers,” McKeel said in an emailed statement.

The federal Centers for Disease Control and Prevention estimates that more than 1 million people are at high risk of contracting HIV, but Gilead says only about 167,000 people currently take PrEP.

Price is one of many barriers—alongside patients’ lack of awareness and doctors’ hesitation to prescribe—that threaten to exacerbate the already stark disparities in PrEP use and HIV infection rates.

One major disparity is along geographic lines. The South, for example, accounts for over half of new HIV diagnoses but only about 30 percent of new PrEP users, according to data from AIDSVu, which maps HIV disease and PrEP use. HIV rates and PrEP use also vary by race and ethnicity.

“We are not necessarily seeing that those most at risk are the ones starting PrEP,” said Kristin Keglovitz Baker, chief operating officer of Howard Brown Health, a Chicago health center.

Gilead has recently gone all-in with advertising to reach people at risk, including print campaigns and TV ads that will air through the summer. Since 2012, it has spent $28 million to fund U.S. organizations that seek to raise awareness of HIV, McKeel, the company spokesman, said.

“We recognize that many people who are at high risk for HIV infection still face challenges in accessing Truvada for PrEP, and we are in regular dialogue with public health officials, advocates and physicians to better understand and, where possible, help to address these challenges,” he added.

But price is also an impediment for publicly funded programs, which have limited budgets and are now shelling out more cash for the prevention effort.

“If it was only pennies … we would be throwing it around,” said Joey Mattingly, an assistant professor at the University of Maryland School of Pharmacy. “Because of how costly it is, we have to control it.”

Some states—California and Florida among them—have launched PrEP assistance programs that can help patients cover the cost of the medication, along with required lab work and medical visits.

Beyond these state-based programs, some public health departments and HIV service organizations are hiring PrEP navigators to help patients navigate the maze of copays and deductibles, and to improve recruitment and retention of new PrEP users.

Washington, D.C.’s health department has doubled down on prevention, and Truvada is key in that effort, said Michael Kharfen, the department’s senior deputy director for HIV/AIDS, Hepatitis, STD and TB Administration.

Insurance usually covers PrEP, and patient assistance programs should fill any financial gaps, he said. But when that isn’t feasible, the department steps in, distributing free Truvada starter packs to at-risk patients.

Kharfen said the city has in the past three years spent almost a million dollars just on Truvada pills, which it purchases at a discounted rate through the federal 340B program, which benefits certain health care providers that treat low-income people. And because of new publicity efforts, he expects the department will need to buy and distribute more pills—posing a conundrum.

Treating more people is net positive, he said. But “how do we sustain this?”

Medicaid programs generally cover PrEP, so they confront a similar situation. Outreach efforts lead to more beneficiaries who take the drug, but that, in turn, could subject the states’ Medicaid budgets to financial hardship.

States are spending millions of dollars on the drug. California’s Medicaid program, for example, spent about $50 million in 2017 and expects the costs to continue climbing. But officials said the expense is offset by long-term savings in preventing new HIV cases.

Massachusetts’ Medicaid program spent about $22 million on Truvada that same year—about $18,000 per beneficiary, according to a spokeswoman for the agency’s Executive Office of Health and Human Services. Those figures don’t account for rebates the state receives from Gilead, which are undisclosed and considered proprietary information.

PrEP is only one part of HIV prevention, so help paying for the pill is only one piece of the puzzle.

Patients also need regular HIV testing and medical care, which add to the cost borne both by patients and the health system. Some experts warn that Truvada’s high price point could financially undermine such broad prevention efforts.

Competition could help.

A generic version of the drug, manufactured by Teva Pharmaceuticals, is available abroad and gained approval for use last year from the federal Food and Drug Administration. When it becomes available in the United States, it could bring down prices, though it’s unclear when that will happen. Gilead’s own forecasts reflect that expectation, showing declines in future revenue from Truvada.

“When generics enter, brands lose market share,” said David Howard, a health economist and professor at Emory University, who previously worked in the pharmaceutical industry.

For now, though, Truvada is the only PrEP option available in the U.S., he said. “From a company standpoint … their best strategy is to make as much money as they can.”


Explore further:
New simulation tool predicts how well HIV-prophylaxis will work

Tagged with:

About author

Related Articles