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HIV Medical Providers Call for Fair Drug Pricing to Expand Access to Treatment

Practitioners from the American Academy of HIV Medicine (AAHIVM) and the HIV Medicine Association (HIVMA) delivered a joint statement to pharmaceutical company executives this week, asking the industry to reconsider its pricing for antiretroviral drugs so that more people in the U.S. and worldwide are able to access treatment.

The medical associations noted that despite advances in antiretroviral therapy (ART), new drugs have been priced out of reach of many people with HIV. Studies have shown that today in the U.S., only an estimated 28% of people with HIV know their status, have started treatment, stay on therapy, and maintain undetectable viral load.

"Unprecedented scientific achievements have produced effective HIV treatment and prevention tools that allow leaders worldwide to envision an AIDS-free generation 3 decades into the HIV pandemic," according to the statement. However, "[f]or too many HIV medical providers working on the frontlines of the HIV pandemic, the vision of a world without AIDS is tempered by the obstacles to accessing HIV care and treatment that remain today."

"HIV infection is largely a disease of vulnerable populations, especially the very poor, and HIV-infected individuals face many barriers in meeting complex and competing medical, social, and daily living needs," the statement continues. "Due to the socioeconomic distribution of the disease, drug accessibility based on price unduly affects individuals with HIV."

About 25% of HIV positive people in the U.S. are uninsured, many more rely on AIDS Drug Assistant Programs (ADAPs), and Medicaid is the largest source of payment for HIV medication; less than 15% have private insurance. At a time when healthcare funding is undergoing major change thanks to the Patient Protection and Affordable Care Act, lower HIV drug prices would take pressure off public programs.

The statement notes as examples the 400% price increase for Abbott's Norvir (ritonavir) several years ago when it began to be used as a low-dose booster for other protease inhibitors. Most recently, Gilead's 4-in-1 combination pill Stribild (elvitegravir/cobicistat/tenofovir/emtricitabine) was priced 33% higher than the company's earlier single-tablet regimen, Atripla (efavirenz/tenofovir/emtricitabine), which has similar efficacy.

The medical groups cautioned that as generic versions of older antiretroviral drugs become available, "newer, more effective, and better-tolerated antiretrovirals are at risk of not being covered, or of being priced out of reach of HIV-infected patients."

"HIV care providers across the country can prescribe the therapies available to treat patients to properly manage their disease, [h]owever, if patients are unable to afford to fill the prescription, the treatment link is broken," said HIVMA Board of Directors chair Michael Horberg, MD. "Reliable access to HIV medications is imperative for viral suppression and effective management of HIV infection, not only to improve the patient’s health but also to help prevent the spread of the disease."

AAHIVM and HIVMA proposed a set of recommendations to improve access to effective HIV treatment domestically and worldwide, while supporting research to develop new and better therapies:

• Pharmaceutical companies should set prices for antiretrovirals at levels that support access for the populations most in need.           
• Companies and U.S. policymakers should work with insurers and government payers to ensure that drug formularies include all antiretrovirals, and that they are not subject to burdensome cost-sharing, prior authorization, or other restrictions.
• Companies should sustain and expand co-pay assistance programs to cover all antiretroviral drugs, and set income eligibility limits at a level that includes individuals who cannot access drugs due to cost-sharing requirements.
• Companies should participate in the HarborPath program, which streamlines antiretroviral access for people without insurance or with inadequate drug coverage.
• Companies and policymakers should promote access to antiretrovirals in "under-resourced" countries by allowing manufacture of generic drugs outside the U.S. and offering deep discounts on branded antiretrovirals. They should also refrain from blocking efforts of developing countries to produce generic antiretrovirals to meet the needs of their own citizens and people in other resource-poor settings.
• Companies should continue to develop pediatric formulations of antiretroviral drugs to reduce the gap in availability, approval, and access to ART for children and adolescents with HIV.
• Philanthropists, industry, federal and state government, medical providers, and other stakeholders should work together to explore all options for lowering the costs of ART and to identify solutions to ensure access to HIV treatment for everyone who needs it.

The full joint statement is available online on the HIVMA (www.hivma.org) and AAHIVM (www.aahivm.org) websites.

12/11/12

Sources

American Academy of HIV Medicine and HIV Medicine Association. HIV Providers Call for Increased Access to Lifesaving Drug Therapy. Press release. December 10, 2012.

American Academy of HIV Medicine and HIV Medicine Association. Fair Antiretroviral Drug Pricing and Robust Coverage for Antiretrovirals: Critical Factors in Ending the HIV Pandemic. Joint statement. December 10, 2012.