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Wednesday 12 February 2020
Human immunodeficiency virus (HIV) is the virus that, when left untreated, causes acquired immunodeficiency syndrome (AIDS), an incurable and potentially fatal condition.
HIV and AIDS began to spread rapidly in the U.S. during the 1980s. By 1987, the first drug for HIV treatment became available. In the following years and decades, many other medications for the virus emerged, and countless people have been able to avoid contracting AIDS as a result.
For U.S. residents with HIV, though, those medications are inordinately expensive. Why do Americans have to pay so much for the drugs they need to treat their HIV, and how can those costs be mitigated?
Ahead, we'll explore these questions.
Azidothymidine (AZT) is an antiretroviral medication that was released in 1987 as the first medication designed to treat HIV and prevent AIDS. In 1997, a treatment called highly active antiretroviral therapy (HAART) resulted in a 47 percent decline in death rates.
Today, a wide variety of FDA-approved HIV medications exist; the U.S. Department of Health and Human Services (HHS) lists almost 50 FDA-approved HIV drugs. These drugs can be broken up into several classes.
For instance, there are nucleoside reverse transcriptase inhibitors (NRTIs) such as:
● Ziagen (abacavir)
● Epivir (lamivudine)
● Viread (tenofovir disoproxil fumarate)
● Retrovir (zidovudine, formerly azidothymidine [AZT])
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as:
● Sustiva (efavirenz)
● Viramune (nevirapine)
Protease inhibitors (PIs) such as:
● Reyataz (atazanavir)
● Prezista (darunavir)
● Lexiva (fosamprenavir)
● Norvir (ritonavir)
● Invirase (saquinavir mesylate)
Integrase inhibitors (INIs) such as:
● Isentress (raltegravir)
And a large selection of combination medications such as:
● Epzicom (abacavir/lamivudine)
● Trizivir (abacavir/lamivudine/zidovudine)
● Atripla (efavirenz/emtricitabine/tenofovir)
● Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir)
● Stribild (elvitegravir/cobicistat/emtricitabine/tenofovir)
● Truvada (emtricitabine/tenofovir)
● Combivir (lamivudine/zidovudine)
● Kaletra (lopinavir/ritonavir)
Despite the broad variety of HIV drugs on the market, though, patients still face exorbitant treatment costs.
According to the HHS, the undiscounted lifetime medical costs for a patient who gets HIV at the age of 35 was $597,300 ($326,500 discounted) in 2012.
Since then, the cost has risen even more. As research from GoodRx revealed, the cost of HIV drugs rose both steadily and significantly between 2014 and 2019.
Worse still, U.S. residents pay much more for HIV drugs as do residents in other countries for the exact same medication.
For example, one HIV drug containing dolutegravir (DTG) costs about $75 per year in African countries like Kenya and South Africa. In the U.S., the same drug cost almost $40,000 per year as of 2018.
As with many of the highest-priced drugs, one major reason for HIV medications' sky-high prices is a lack of generic alternatives. As of 2019, only six generic HIV drugs have been approved by the FDA.
Many of those generic drugs are now considered to be alternative treatments, since newer and more effective medications continue to be released under exclusive patents.
Perhaps the biggest factor behind HIV drugs' high U.S. prices, though, is a lack of regulation.
While countries like Canada have a central regulatory body that negotiates with drug manufacturers to set fair prices, the U.S. has no such system and manufacturers are thus free to raise prices as much as they wish.
This problem gained global infamy in 2015 when the price of Daraprim (pyrimethamine), a medication that prevents pneumonia in patients with HIV/AIDS, was raised from $13.50 per pill to $750 per pill overnight.
That increase in price came despite the fact that Daraprim has been available since 1953 and was not reformulated.
Despite widespread outrage over Daraprim's price hike, its cost has still not been lowered, and a generic version is still not available at the time of writing.
This case perfectly illustrates the state of drug prices in the United States. With neither generic alternatives nor any form of federal drug price regulation, Americans are subject to drug manufacturers' pricing decisions, whether justified or not.
If you or someone you love is one of the many HIV patients who's struggling to pay for the medications needed, there are seven measures you can take to reduce the cost of your HIV drugs:
1. Look for HIV-specific discount programs. Some organizations offer prescription assistance programs specifically for people with HIV. For example, the Ryan White HIV/AIDS Program provides financial treatment assistance for low-income people with HIV who are under- or uninsured.
2. Research your State Pharmaceutical Assistance Program (SPAP) eligibility. Some states offer SPAPs, state-funded programs that offer prescription assistance to qualifying residents. Click here to find out if your state has an SPAP.
3. Utilize any existing insurance benefits. If you already have a health insurance plan, whether it's from your employer, a family member, a private insurance company or the U.S. government's Health Insurance Marketplace, it's time to review your plan's benefits. You'll be able to identify "preferred pharmacies" at which you can enjoy lower copays, or learn about any tiered copayment options.
4. Take advantage of manufacturer coupons. Drug manufacturers' themselves often offer discounts and assistance programs to patients. For instance, Gilead, the manufacturer of Truvada, offers a coupon card for qualifying patients.
5. Look into Medicare prescription programs. Take a look at the Medicare website to learn how you can get prescription drug coverage. If you're enrolled in Medicare and have an annual income of less than $18,735 (or $25,365 for a married couple), you may also be eligible for the Extra Help program.
6. Use veteran discounts. If you're a veteran of the U.S. military, then you're likely eligible for government-sponsored assistance that can help you cover the cost of your HIV drugs. In fact, the U.S. Department of Veteran Affairs (VA) is the largest provider of HIV care in the U.S., and treated more than 27,000 people in 2015 alone. Click here to learn about prescription assistance from the VA.
7. Ask about generic alternatives. As mentioned earlier, there are very few generic versions of HIV drugs. However, some do exist, so it's worth asking your doctor if you can switch from a brand-name version. After all, generic drugs cost about 85 percent less than their brand-name versions.
Another way you can lower your HIV drug costs is by purchasing your prescriptions from online pharmacies that import drugs from countries like Canada.
If you choose to purchase your medications from an online pharmacy, just be sure to do your due diligence and find one that's trustworthy. Only purchase HIV drugs from online pharmacies and pharmacy referral services that:
● Require a valid prescription.
● Don't allow the purchase of more than a three-month supply of any medication.
● Don't sell any controlled substances or narcotics.
● Only sell medications from licensed pharmacies and approved suppliers.
With the right online pharmacy or pharmacy referral service, you can purchase the same drugs that you would in the U.S. at drastically lower prices.
For instance, brand-name Atripla pills (30 count) from My Drug Center cost $1,575, or $52.50 per pill. By comparison, brand-name Atripla pills (30 count) from a U.S. pharmacy cost up to $3,269, or $108.97 per pill.
Unfortunately, there's no getting around the fact that HIV drug prices are often unreasonably high.
By following smart strategies, however, you can significantly cut down on your HIV drug costs, whether you buy your medications from a reputable online pharmacy referral service like My Drug Center or get prescription assistance from other sources.
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