AIDS prevention may be revolutionized if healthcare providers start to write more prescriptions for Truvada as a preventative measure for people at high risk for contracting HIV. As reported in the The New York Times, the U.S. Centers for Disease Control and Prevention is pushing for expanded use of Truvada as a prophylactic to prevent new HIV cases. To date, it has been primarily used to treat people who have already contracted HIV. If this recommendation is adopted, the number of prescriptions written for Truvada could increase from less than 10,000 per year to 500,000 per year, hopefully lowering the rate of new HIV infections, which has remained steady at 50,000 per year over the past decade.
But what if patients can’t access Truvada because of its cost? After all, a drug doesn’t work if a patient can’t afford to take it. The drug has a monthly cash price of about $1,500 at local U.S. pharmacies. Fortunately, Truvada is usually covered by insurance and Gilead offers an assistance program that covers the first $200 of a co-pay. They also have a program that covers the full cost of the drug for eligible uninsured or underinsured patients. Eligibility is not guaranteed to all!
Even if you’re insured and prescribed Truvada, the high cost might mean difficulties when it comes time to fill the prescription. Many pharmacy benefit formularies put the drug in tier 2 or 3, which means high co-pays. Other formularies place Truvada on a list of drugs that require pre-certification. In that case, the drug might not even be covered at all!
According to FiercePharma, dramatic increases in the number of prescriptions written for Truvada (and therefore requests for pharmacy benefit reimbursements) could increase co-pays and also curtail assistance programs. If that happens, patients may find themselves having to fork over a lot of cash for higher copays, deductibles or co-insurance. Some may very well end up stuck with a $1,500 per month bill.
For these patients, or anyone else who falls through the cracks, international online pharmacies may be an option. Truvada – the brand – is available for about $543.00 internationally; the generic – emtricitabine/tenofovir – not yet available in U.S. pharmacies, is $224.00. This could provide a lifeline for Americans who are prescribed Truvada in the coming years.
My insurance (medicare) covers with a $600 a month co-pay. So, I will not be able to get this medication. I understand that “money talks” and those with deep pockets receive.
So, I will continue my lifestyle, potentially infecting others. Oh well….guess that the “free enterprise system?”
Just know I have no guilt or responsibility in this matter. None!
I am open to any suggestions?
Hi James,
You can look on the internet for patient assistance programs. Often times these will help you get the medications very affordably. Check out the manufacturer’s page to see if they offer such a program.
Patient assistance programs are out of reach to Medicare recipients. Thanks to the Medicare revision act of the early 80’s.
As a healthcare provider, I am disturbed that our goverment has not made an effort to educate the mass public about options for HIV PREVENTION. I find it frustrating that our medical systom is a “wait and see, disease treatment” and not disease prevention and health promotion. I am only now learning about the option of this medication for my patients, and this study was done in 2010. How many new HIV infections that could have been prevented beginning in 2010. I will tell you, HIV prevention is not mainstream knowledge in primary care medicine and that is absolutly unacceptable. We spend millions of dollars to educate the public about “The back to sleep campaign” to prevent sudden infant death syndrome yet discover this tool to prevent HIV and do nothing. Shame on our government, and on our medical system that does not value education and prevention.
I have done research about acceptability of PrEP in my undergrad career. Out of curiosity, I asked my PCP about prescribing it and he said out of all the things he had time to worry about, HIV wasn’t among them. He said diabetes and obesity were much higher on his list and he was also bogged down by ridiculous things like gun control as dictated by the CDC. I was like oh… I thought it was a bit of a jaded response but maybe he had a point?? I think that truvada will be mostly accessible through HIV docs or community organizations. It’s unfortunate because I think PCPs should take on a bigger responsibility in terms of education and sexual health especially for populations at risk.
To James
Please check out the generic version of Truvada available in Canada at an out of pocket cost of 250-300 a month. Most health care providers would be more than willing to write a prescription that you could then send to a canadian pharmacy and obtain the generic form of the drug that is sold in other countries but not in the USA because of the greed of big Pharma in America. I personally, am outraged at our lack of empathy for fellow Americans. We are one of only two countries that allow direct perscription drug marketing to consumers. I am sick to death of watching t.v commercials for viagra, premarin cream, and warfarin’s rival that I cannot remember the name of because I find these commercials infuriating. Big Greedy America
This is an amazing topic, the truth is that the cost of these medications are so high that most people cannot afford them, there is some help available, but the level at which the government considers poverty is far too low, If you make more than $13.000 you don’t qualify for many of these help programs, that is crazy, when you look at the cost of food, lodging, living, you just exist, poverty should be anything below 29,000.00 this would take into account the inflation rate that the government denies exists. Some states are now changing the definition of where poverty exists, like Florida which now allows people who make up to 400 percent of the poverty level as eligible for help. This is a good thing, but other states like Alabama has decreased its eligibility from 300 percent to 250 percent, this will create more cases of HIV infection. As more patients drop off the ADAP program, there will be more resistance, more variations, more mutations, What is really horrifying is that the Governor of the State of Alabama has no clue what he is doing by cutting budgets that support HIV prevention and treatment programs. We are going backwards and one more thing, the true number of annual HIV infections is more like 59,000 and some vector models show as high as 78,000 Detection is difficult when some have one half of the immunity gene, were in a much deeper hole than anyone knows, but go ahead and send billions to Africa, while people in the US end up infected.
I called Gilead and they said for their income driven program you had to be below 59k for a one person household but completely uninsured.