Perspective from W. David Hardy, MD, AAHIVS
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Disclosures: The authors report no relevant financial disclosures.
September 08, 2020
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Truvada payments totaled more than $2B in 2018

Perspective from W. David Hardy, MD, AAHIVS
Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Third-party and out-of-pocket payments for a 30-day supply of Truvada for HIV pre-exposure prophylaxis added up to $2.08 billion in 2018, data show.

This may be an underestimation of national costs, researchers said, because previous findings indicate that more than 80% of individuals who have an indication for HIV pre-exposure prophylaxis (PrEP) did not have insurance coverage in 2018.

Average out-of-pocket payments for HIV PrEP: Left bar: 2014 = $54 Right bar: 2018 = $94
Reference: Furukawa NW, et al. Ann Intern Med. 2020;doi:doi:10.7326/M20-0786.

Nathan W. Furukawa, MD, MPH, a medical officer at the CDC, and colleagues conducted a review of outpatient retail prescriptions for a 30-day supply of Truvada (emtricitabine/tenofovir disoproxil fumarate; FTC/TDF) between 2014 and 2018. Their analysis showed the following:

  • Annual prescriptions of FTC/TDF increased from 73,739 to 1,100,684.
  • The average third-party payment increased from $1,350 to $1,638, a 5% compound annual growth rate.
  • The average out-of-pocket payment increased from $54 to $94, a 14.9% compound annual growth rate.
  • Those with commercial insurance had the highest out-of-pocket costs ($107), followed by Medicare recipients ($80) and those on Medicaid ($3).

President Donald J. Trump launched his “Ending the Epidemic” initiative in February 2019. Among other things, the plan is intended to leverage the Ryan White HIV/AIDS Program to increase viral suppression across the United States to 90% and end the epidemic by 2030.

In an editorial that ran alongside the study by Furukawa and colleagues, Kevin L. Ard, MD, MPH, and Rochelle P. Walensky, MD, MPH, of the infectious diseases department at Massachusetts General Hospital, wrote that “this public health effort must start by releasing the cost noose that is strangling its own success,” considering how effective PrEP is.

To help patients with the costs of PrEP, Gilead Sciences agreed in May 2019 to provide free FTC/TDF for a maximum of 200,000 individuals annually for up to 11 years or until its second-generation HIV preventive medication, Descovy (emtricitabine/tenofovir alafenamide; FTC/TAF), becomes available and FTC/TDF comes off patent.

The U.S. government has also sought to enforce its claim to the patent for HIV PrEP and sue Gilead to lower the price of the preventive treatment.

Furukawa and colleagues said that their findings “should promote action” to lower the cost of PrEP, remove prior authorization requirements and increase PrEP access.

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