U.S. Has Highest HIV Drug Costs, But Lower Rate of Viral Suppression: Study

A new study indicates that HIV drug costs in the United States are skyrocketing, as the country is falling behind other advanced nations in viral suppression, while paying far more.

Researchers with Massachusetts General Hospital report that the cost of HIV viral suppression drugs, such as Truvada, Stribild and Atripla, are increasing several times faster than inflation, without a corresponding benefit in overall national viral suppression rates. Their findings were published in a research letter earlier this month in JAMA Internal Medicine.

The letter notes that the U.S. has the highest antiretroviral treatment (ART) prices in the world, even though the rate of HIV viral suppression is only at 54%, which is below other nations such as Britain, Australia and Canada. Even the introduction of generic versions of the drugs has not brought the costs down or the rate of suppression up enough to compare to those nations.

Researchers looked at data on the average wholesale price (AWP) of HIV drugs and their use by people with HIV (PWH) from the U.S. Department of Health and Human Services’ Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents.

According to the findings, the annual average wholesale price of HIV drug treatments recommended for most infected patients ranged from $24,970 to $35,160 in 2012. That cost increased to $36,080 to $48,000 in 2018. This means the annual cost increased 34% during that time period, which was 3.5 times faster than the rate of inflation.

“Even with new generic options in 2018, initial regimens recommended for most PWH today are all priced at more than $36,000 per patient per year, with annual costs that increased 6% on average since 2012,” the researchers noted. “Increases in ART costs far outpaced the overall inflation rate.”

The researchers noted that the federal goal of ending the HIV epidemic requires a 90% decrease in new HIV infections by 2030. At the current pricing rate, that would require the U.S. to pay $35.6 billion in annual spending on HIV drugs in order to increase viral suppression by 33%.

Slowing the increasing prices of HIV drugs is “essential” to reaching that goal by expanding and sustaining access to effective care, they concluded.

HIV Drug Concerns

The study comes as Gilead, which has cornered the market on HIV viral suppression drugs, faces increasing scrutiny over how it has rolled out the drugs in recent years, and whether it held back safer alternatives to delay competition from generic alternatives, allowing the company to maintain high revenues from the critical treatments.

Gilead now faces a growing number of individual HIV drug lawsuits over bone and kidney problems linked to Truvada and other medications that contain tenofovir disoproxil fumarate (TDF). Those plaintiffs claim that Gilead knew about a safer alternative in 2004, known as tenofovir alafenamide (TAF), which is used in Descovy and other drugs introduced in recent years, yet held off on development of the newer drugs until Truvada and other TDF-based drugs started facing generic competition.

The company did not begin to sell TAF-designed drugs until 2015, plaintiffs point out, which extended Gileads essential monopoly on HIV treatments until 2032. TDF drug patents began expiring last year. While generic versions have been introduced, Gilead now markets TAF drugs as a safer and superior alternative, preserving the profits generated from the brand-name medications.