PrEP Use Increasing, But Too Low Due to Extreme Cost

The United States' health care system remains one of the most inefficient of any developed nation and medications that cost little in Europe and Canada are exorbitantly expensive and out of financial reach of many.  A prime example is so-called PrEP which prevents HIV/AIDS infections.  At a cost of $2,000 -$3,000 per month, even good insurance coverage leaves one with thousands of dollars in out of pocket costs. A generic version sells for $200.00 a year and, as this blog has noted before, the actual production costs is about 6 cents per pill.  Making matters even more outrageous, government programs and charities funded the development research, not Gilead which markets the drug making obscene profits.   As long as insurance companies and pharmaceutical company greed control America's health care, quality health care remain out of the reach of millions. Meanwhile, the rest of us pay the price through astronomical hospital and drug costs.  A piece at NBC News looks at the under usage of PrEP.  Here are excerpts:

Thirty-five percent of gay and bisexual men at high risk of HIV infection were using PrEP, or pre-exposure prophylaxis, the daily pill that prevents HIV infection, in 2017, according to data released Thursday by the Centers for Disease Control and Prevention. In 2014, just 6 percent of these men used PrEP.

However, despite the nearly 500 percent jump in PrEP use among men who have sex with men, the CDC notes “PrEP use remains too low, especially among gay and bisexual men of color.”

The study was presented Thursday in Seattle at the 2019 Conference on Retroviruses and Opportunistic Infections, a major annual HIV/AIDS conference, and was based on more than 8,000 interviews in 20 American cities.

More than 40 percent of white gay and bisexual men at high risk of HIV used PrEP in 2017, while only 30 percent of their Latino counterparts and 26 percent of their African-American counterparts did so. The updated data highlights the fact that minorities access PrEP at lower rates than whites, despite being at higher risk of HIV infection.

The data also found high awareness of PrEP, which is also known by its brand name, Truvada, among all gay and bi men: Eighty-six percent of African-Americans know about it, as do 87 percent of Latinos and 95 percent of whites.

“The study’s findings suggest that efforts to increase PrEP awareness and use among populations at risk is working, but it remains underutilized,” according to a press memo distributed by the CDC.

Many people struggle to access PrEP because of its high cost — a roughly $2,000 per month list price — and complex insurance procedures.

“Of the estimated one million Americans at substantial risk for HIV and who could benefit from PrEP, fewer than 10 percent are actually using this medication,” the CDC noted, referring to low uptake overall among heterosexual and injection-drug-using populations that are also at high risk of HIV infection.

The CDC said it is funding government and private health organizations’ efforts to spread awareness of PrEP, and “developing new ways to connect gay and bisexual men of color and transgender people to PrEP."

Break Gilead's strangle hold on PrEP and allow generic forms and I suspect you would see usage surge.  But that would mean members of Congress would have to vote against their financial overlords. 

Pharmaceutical Company Greed Impedes Fight Against HIV

The Center for Disease Control and Prevention describes PrEP as follows:

Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.

When used consistently, PrEP has a very high success rate of preventing HIV infection. So why aren't many more Americans on PrEP if it works so well.  The answer is simple: the cost. In the USA, the cost can be over $20,000.00 per year. In other parts of the world, the cost is $100.00 per year.  Why do Americans pay 200 times what those in other countries?  Simply put, because American's utterly screwed up health care system allows it. Typically, pharmaceutical companies justify shockingly high costs by citing the cost of developing new drugs.  That argument does not work with PeEP because the federal government and charities funded the development costs. So again, why the exorbitantly high cost?  I offer a few other possible factors: (i) the current Trump/Pence regime caters to allowing large corporations to act as the robber barons of old, and (ii) gays and increasingly blacks, including black women, are disliked by the Trump/Pence regime and its extremist supporters.  As reported by the New York Daily News, in New York State, some are beginning to demand that federal government use its existing authority to make PeEP available to the masses, not just the rich.  Here are article highlights:

As the number of people in New York City living with HIV or AIDS continues to rise, local advocates are calling for the federal government to take steps to make the life-saving prevention drug PrEP more affordable.

City Council Speaker Corey Johnson joined other politicians and activists at the city’s AIDS Memorial on Monday to demand that the National Institute of Health “break the patent” on the drug, which dramatically reduces the spread of the HIV virus.

“It’s life or death for people who do not get access to this live-saving medication that they need,” said Johnson, who is HIV-positive. “Other countries pay $100 year for PrEP. Americans end up paying more than $20,000 a year for the same medication.”
 
Advocates say a major barrier between patients and PrEP is the cost of the drug, which is patented by Gilead Sciences and was approved for use by the FDA in 2012.

“Gilead Sciences charged over $2,000 a month for a drug that costs them less than $6 a month to make, and whose research was funded entirely by the fed govt and other charities,” Christian Urrutia, co-founder of the PrEP4All Collaboration, said on Monday.

Because the U.S. government funded the research for PrEP, federal law allows the NIH to exercise “march-in” rights to break its patent and allow other manufacturers to produce it at generic costs.

The legal maneuver dates back to 1980 and the passage of the Bayh-Dole Act, which requires patent holders of federally-backed drugs to allow third party companies to produce the drug when requested by the government.

The advocates are calling on the feds to make such a request for PrEP.  If the price of the drug plummets for New Yorkers, advocates believe the rate of new HIV infections would follow.

American Pharmaceutical Company Keeps HIV Risk High

One of the reasons for America's sky high health care costs is the daily gauging of consumers by large pharmaceutical companies.  Americans pay in some cases, thousands of times more for crucial drugs that cost a relative pittance in other countries.  A prime example is Truvada, the brand name for a type of HIV pre-exposure prophylaxis, or PrEP, which is up to 99 percent effective at preventing HIV infection.  The cost in America?  Thanks to the monopoly of Gilead Sciences, over $20,000 per year, far outside the reach of even many affluent individuals even with insurance (assuming carriers do not deny coverage).  The cost elsewhere?  In other countries, a one-month supply of generic Truvada costs less than $6.00. If widely administered, PrEP could largely eliminate HIV/AIDS in America.  But just like the opioid manufacturers behind the crisis in many parts of America, money is Gilead Science's god.  Human lives mean little.  A piece in the New York Times looks at this shocking example of corporate greed.  Here are excerpts:

On July 3, 1981, this newspaper wrote about a “rare cancer” killing gay men in New York and California. . . . Today, after 37 years, we finally have a proven pathway to ending the AIDS epidemic in this country.

The only catch? Poor policy and pharmaceutical price-gouging have blocked the way, making critical drugs a luxury rather than an imperative.

The solution comes in a pill: Taken daily, Truvada, the brand name for a type of pre-exposure prophylaxis, or PrEP, is up to 99 percent effective at preventing H.I.V. infection; it also lowers the amount of H.I.V. circulating in infected patients' blood streams. Used as directed, it’s one of the most effective methods of preventing a viral infection ever discovered, as good as the polio vaccine, the miracle of modern medicine. When you combine that protection with the discovery that people with H.I.V. cannot transmit the virus to others once Truvada has suppressed it to undetectable levels, we could be on the verge of a swift end to the epidemic.

Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be. Gilead Sciences, the company that makes Truvada, maintains a monopoly on the drug domestically. In other countries, a one-month supply of generic Truvada costs less than $6, but Gilead charges Americans, on average, more than $1,600, a markup from the generic of 25,000 percent. Infuriatingly, American taxpayers and private charities — not Gilead — paid for almost all of the clinical research used to develop Truvada as PrEP. Yet the price stays out of reach for millions, and will for at least several more years.

The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men . . .

The ability of PrEP to greatly reduce new H.I.V. infections is no longer in question. In New South Wales, Australia, a program providing free access to PrEP led to a drop in H.I.V. diagnoses in the most vulnerable communities by a third in just six months, one of the fastest declines recorded since the global AIDS crisis began.

So how can we import such progress into the United States? Faced with more than half a decade of inaction by the federal government, activists have developed their own national strategy to begin the end of the H.I.V. epidemic. At the International AIDS Conference later this month, our organization, the PrEP4All Collaboration, will release its plan for a national PrEP program to ensure all Americans who need PrEP can get it.

A critical component of this plan is insisting that federal agencies use their statutory authority to break Gilead’s undeserved monopoly. With low-price, generic Truvada, the cost to cover every American who needs PrEP — including both drug costs and clinical care — would be less than a tenth the amount that the federal government already spends on H.I.V. care. The billions saved could pay for vital services to ensure those who need PrEP the most can get it and those living with H.I.V. can keep the virus suppressed. If the patent on Truvada remains, the plan will cost over $20 billion. Science has delivered answers, but Gilead’s greed and the government’s inaction are keeping it from those who need it most. There’s a pill that stops H.I.V. We can make it possible for everyone who needs that pill to get it.

Gilead's greed is replicated across the medical spectrum and is a prime reason why Americans pay far, far more for healthcare than in any other nation in the world.  We need a single payer system with government negotiation of drug prices.