Cost of initial HIV regimens on the rise
Initial regimens of antiretroviral therapy for most people living with HIV cost up to $48,000 per year, and prices have risen by an average of 6% each year since 2012, according to research published in JAMA Internal Medicine.
“The big problem is that this expense trickles back to the patient — either in copays, formulary restrictions or lack of drug access entirely,” Rochelle P. Walensky, MD, MPH, a professor of medicine at Harvard Medical School, told Healio Primary Care. “There is a clear association between drug affordability and adherence in many diseases, not just HIV.”
She explained that although public insurance and the Ryan White HIV/AIDS Program help defray the costs of antiretroviral therapy (ART), patients in states that do not have Medicaid expansion or drug assistance programs have limited options for financial support.
Walensky and colleagues evaluated the costs of initial ART regimens from 2012 to 2018 in the United States. They used data on the average wholesale price of ART published in the HHS’s annual update of the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents.
Researchers calculated the annual cost per person for each available ART regimen during the study period, including those recommended for patients with comorbidities.
They found that the annual wholesale prices of initial ART regimens varied between $24,970 to $35,160 in 2012 and rose to a range of $36,080 to $48,000 in 2018.
Between 2012 and 2018, researchers found that the average annual cost of ART recommended for most people with HIV increased by 34% — approximately 3.5 times faster than the rate of inflation.
Walensky and colleagues found that although the mean annual cost of initial ART regimens recommended in certain clinical situations from 2012 to 2018 was lower than the mean annual cost of ART regimens recommended for most people HIV, it increased by 53% during the study period — 5.6 times faster than the rate of inflation.
The cost of initial ART regimens for most people living with HIV increased 2.8 to 6.7 times faster than inflation during the period in which the drugs were recommended, and after no longer being recommended for most patients or being limited to certain clinical situations, the average wholesale costs increased 4 to 5.7 times faster than the rate of inflation.
A major goal of a federal initiative to end the HIV epidemic by 2030 is a 90% decrease in HIV infections in the U.S. To meet that objective, the country needs to increase the rate of viral suppression by 33% and requires an estimated $35.6 billion in spending annually on ART alone.
Walensky told Healio Primary Care that half of the "geographic focus" counties — those identified with high numbers of new HIV diagnoses that will receive additional support as part of the federal plan — did not implement Medicaid expansion, and the drug costs in those areas creates “a substantial barrier to achieving this national public health goal.”
“We published this piece so that physicians — who are notoriously blind to costs in their prescribing patterns — could become increasingly aware of this issue,” Walensky said. “If physicians work to prescribe more generics, thereby driving more competition to decrease drug costs, I believe that will move branded prices down. Currently, because everyone is using branded options, there is no incentive for the [pharmaceutical] companies to charge anything less than top dollar.” – by Erin Michael
HIV.gov. What is ‘Ending the HIV Epidemic: A Plan for America’?. https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Accessed on Feb. 4, 2020.
Disclosures: Walensky reports grants from the National Institutes of Health and Massachusetts General Hospital during the conduct of the study and serving as a member of the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Please see study for all other authors’ relevant financial disclosures.