A New HIV Drug, And Things You Learn If You Google ‘How to Pay for HIV Drugs’
• The FDA has approved a third once-a-day HIV treatment drug, reports the NYT.
• Stribild will cost $28,500 per year.
• It joins Aptripla and Complera, which have been on the market since 2011 and 2006, respectively.
• All three drugs have been released by Gilead Sciences.
• “Stribild, which was previously known as the Quad, does not appear to represent a huge leap medically.” (NYT)
• “But Stribild could be important commercially for Gilead because the company owns all the ingredients. By contrast, Atripla contains a drug from Bristol-Myers Squibb and Complera contains a drug from Johnson & Johnson, so Gilead must split profits.” (NYT)
• HIV/AIDS treatment drugs can cost $15,000 to $40,000 a year, according to the National Association of People With AIDS (NAPWA).
• (This does not include doctors visits, tests, and other treatment.)
• “According to the Centers for Disease Control and Prevention, around half the people diagnosed with HIV in the U.S. don’t receive regular health care. Of those who do, 42 percent receive Medicaid and 24 percent are uninsured,” reports NPR
• So first choice: Commercial or individual insurance, if you have it. But even then, some of the drugs aren’t covered, and patients must either pay out of pocket or apply for prescription assistance through their state’s AIDS Drug Assistance Program (ADAP).
• Low-income people can apply for Medicaid, which has strict income rules that vary by state.
• Uninsured people who make too much to qualify for Medicaid can apply for their state’s Pre-Existing Condition Insurance Plan (PCIP).
• As a last resort, The Ryan White Care Act, enacted in 1990, provides funding for people who cannot receive coverage through personal insurance, Medicaid, or other means. It currently provides services to half a million Americans.
Also: 9 states (primarily southern states) don’t have enough money for their ADAP programs, so there are waiting lists. So if you are unlucky enough to be poor and uninsured and HIV-infected in, say, Georgia, you have to wait until someone receiving ADAP dies before you can get access to HIV medications. Even though we know that early and consistent access to HIV meds slows the progression to AIDS and significantly reduces the probability of transmission to others. It’s really a shame.
@Heckyes Yep.
Also, a lot of the waiting list qualifications have become more stringent in the last few years (basically the economy crash in 2008 gutted ADAP, and also drastically reduced the number of other grants for programs that help for people with HIV). It used to be pretty common that states would set the qualifying level of income at 300% of the poverty line, and now it’s been dropped to 150% or 100% in a bunch of states. And they’ve cut additional drugs and services to save money — dental care, mental health care, etc etc, plus drugs like OTC pain killers. (NASTAD does a regular ADAP watch for anyone who’s interested: http://www.nastad.org/)
ALSO also, the NIH just finished a pretty important study that shows early (and consistent) HIV treatment reduces transmission up to *96%* (at least among straight couples) — *and* it’s incredibly cost efficient to start treatment early, which keeps people healthier, than it is to wait and have to deal with additional medical costs down the line. (http://www.thebodypro.com/content/68552/landmark-hiv-treatment-as-prevention-study-demonst.html)
@allreb That study says that the couples also received free condoms and counseling, which might also have a big effect on the numbers? Condoms+lower risk sex (i.e. non-rough p-in-v sex) would drastically reduce transmission risk, would it not?
Also wonder why they mostly enrolled het couples.
@selenana Your first question: this was a two-armed study. Everyone in both arms got free condoms and counseling. One set of people also got HIV drugs early in disease progression (as soon as the study started) and the other set of people got drugs only when their disease reached a certain threshold (which was the recommendation for standard treatment at the time). But since everyone got condoms and counseling, the 96% reduction is a reduction in transmission beyond the effect of condoms.
Second question: the study was done in Africa and Thailand, where it is easier to study the effect of HIV medications because fewer HIV+ people are on HIV meds compared to, like, in the US. Homosexuality is generally stigmatized and/or criminalized in the African countries where the study was done, so fewer people are out as LGBT and they are harder to recruit.
Also also also a lot of these drug companies (including Gilead) have programs where you can get a voucher to pay less or nothing at all for your drugs if you are uninsured. It involves a lot of time on the phone and paperwork and stuff but it’s still worthwhile. A friend went through post-exposure prophylaxis treatment once while uninsured (scary process, btw) and managed to get her $1400 out-of-pocket cost down to something like $300 on a set of two antiretrovirals. She got her prescriptions filled through Walgreens and the pharmacist clued her into these programs after she had already filled them (you have to fill them ASAP after exposure, like, within 4 hours) but allowed her to come back and “exchange” the drugs for lower prices using the vouchers as long as she came back within 48 hours.
Another friend who is HIV-positive also gets his drugs for free through a state (EDIT: I may be wrong and it may be the Ryan White program, but it’s administered through the county health department) program specifically for uninsured HIV-positive folks. However, if he misses any appointments or anything, he’ll get dropped from the program forever, which is a little nervewracking.
Anyway I have been surrounded by people facing this problem for a while and solving it in ways not listed here and I felt I should share, as this could literally save someone’s life someday.
@ThatJenn Yeah, the relationship between HIV activists (and people living with HIV generally) and pharma companies is… really, really complicated. I have a lot of issues with pharmas, but they did take a *lot* of people into their voucher programs over the last few years, especially as people were getting booted from the ADAP programs that ran out of money.
@allreb I am sure it is really complicated. I don’t mean to make out the pharmaceutical companies as white knights here, but it’s important that people know the voucher programs exist, I think. It’s something I’d like to learn more about – why and how these programs came to be/are funded and what relationship they have to other ways people pay for medications.
@ThatJenn I definitely agree. I don’t have much in the way of background information (though I’d be willing to bet a lot of them initially were created at the urging of HIV activists), but I think not a lot of people know about them.
Here’s a roundup of programs for each drug, as of the spring, in case anyone needs to know what’s out there and how to get started. (Disclosure: it’s on the website I work for.) http://www.thebody.com/content/66047/hiv-co-pay-and-patient-assistance-programs.html