PrEP Is About to Get More Expensive Again

Many people know Truvada as the sky blue, 500mg tablet that people take daily to prevent HIV. But it's something else all together: a cash cow for Gilead, the drug company that distributes the pill.

According to a new report in the Washington Post, Gilead Sciences earned $3 billion in sales from Truvada in 2018.

That's an awful lot of profit, but here's the catch: Gilead didn't actually put up the money to prove Truvada could prevent HIV infection. You did. The research that went into making the drug, the Post reports, was done by Thomas Folks at a federally-funded U.S. Centers for Disease Control and Prevention lab. Using $50 million in federal grants, Folks proved that Truvada could prevent HIV infection in people who were exposed to HIV.

The U.S. government owns the patent for Truvada as pre-exposure prophylaxis. The patent was filed in 2007 and approved in 2015. Truvada itself has been used as a drug to fight HIV since 2004 and was approved by the Food and Drug Administration as PrEP in 2012. Despite owning the patent, the U.S. government gets no share of the profits, which it could use to find ways to get PrEP to the people who paid for its development.

"With the amount of effort and time and taxpayer money that went into it, for CDC and Gilead not to come to an agreement, so the taxpayer could get some of that money, is really unconscionable,'' Folks, who is retired, told the Post.

Meanwhile, Gilead stands to make even more money from the drug with an announced price increase of 4.9 percent. Truvada, taken daily, costs anywhere from $1,600-$2,000 a month.

The price increase is actually lower than it has been in years past. According to BioPharmaDive, in previous years, the company increased the price of its preventative drug by 6.9% in 2017 and 2018. The percentage is also smaller than the industry-wide price increase average, which is about 6%, down from 8% in 2018 and 12% in 2014.

Despite -- or because of -- the looming end of the patent in 2021, you can expect Gilead to try to wring any value it can out of the drug, according to Tim Horn, director of medication access and pricing at NASTAD, a leading public health organization focused on HIV and hepatitis.

"You'd better believe that Gilead will take price increases while it still has the monopoly," Horn tells Out in an email interview. "Once generics become available - and assuming Gilead actually decides to keep Truvada on the market - it may continue to take price annual price increases on the product; it certainly won't drop the price to compete with generic competitors."

Further complicating the problem is the Trump administration's announced Ending the Epidemic plan, of which PrEP is apparently a cornerstone. If Gilead makes a product essential to the government's plan to end the HIV/AIDS epidemic, but continues to up the price on it, is it participating in the effort?

"I think the announcement of a federal plan to end the HIV epidemic in the United States begs the question of the role the pharmaceutical industry should play in supporting this effort," Kenyon Farrow, senior editor at HIV/AIDS news website TheBody.com, tells Out.

The high price of the drug is particularly troublesome for state Medicaid programs, who are paying sticker price for the drug and often have little left over to do education or awareness programs about the drug to help get those who need it, especially people in the U.S. South, where HIV infection rates are highest in the country.

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