As two long-time advocates for LGBTQ+ health, we’re here with a surprising public service announcement: You can afford Truvada for PrEP – the groundbreaking pill that can prevent HIV transmission.
You read that correctly.
Lowering the price of drugs is an easy rallying cry, and HIV activists are using this political momentum to call for government intervention to lower the price of Truvada for PrEP -– as the key to ending the HIV epidemic. It’s hard to talk about healthcare and the cost of prescription drugs without wading into politics and rhetoric. But in order to make real progress in improving our nation’s public policy, we need to bring a dose of truth to the conversation.
And the truth is that those calling for price cuts in PrEP are actually making it harder for those who need PrEP most to access it.
There’s no question that Gilead Sciences, the maker of Truvada for PrEP, profits from the market of PrEP, and it’s fair for the public to question whether drug companies across the board are charging too much for medications. However, we can say without reservation as service providers and educators that no one – literally not one patient — pays the listed price for PrEP.
In fact, a U.S. Centers for Disease Control and Prevention (CDC) study states that cost is a barrier to less than 1 percentof people who are indicated for PrEP. For anyone who may be impacted by cost there are financial assistance programs that help provide PrEP for free – or close to it.
We work with people every day who either don’t know PrEP is a preventative option or don’t know how to access it. We help them navigate the system and fill out the paperwork. Time and again, we also help them navigate the cost. At Open Arms Healthcare Center in Mississippi, for example, more than 400 patients have filled PrEP prescriptions. The actual cost for prescriptions disbursed to those patients is millions of dollars. But the total patient expense, to date, is $0.00.
It’s not the cost of PrEp that keeps more patients from accessing it; it’s the lack of awareness and the daunting nature of our complicated healthcare system. The reality of HIV education, prevention, and care has created a divide between the “haves” and “have nots.” Of course, income and ability to afford and access quality treatment is a key part of this divide. But we find that lack of access to information is just as big of a problem.
Though new HIV infections overall are on the decline, we’re still a long way from ending the epidemic, in part because healthcare access for those with health insurance and a supportive community versus those isolated, stigmatized and likely without proper healthcare are vastly different. For those in the latter category, society and accompanying economic norms are stacked against them. There are significant structural barriers, like racism, homophobia, and transphobia, that either prevent people from accessing the healthcare system or prevent them from receiving the care they need from their health providers.
We sympathize with those who are calling for the government to break the PrEP patent in order to bring down prices. They share our goal of ensuring that everyone in America is able to obtain the care they need at a price they can afford. Yet their argument that people can’t afford PrEP isn’t grounded in facts. The sad truth is that their efforts can scare the individuals and communities most at risk of acquiring HIV into assuming the medicine they need is beyond their means
Those calling for government intervention hope that ending the patent would bring less expensive generics into the market. Even if that did occur, these generic drug companies don’t offer the support programs that a major pharmaceutical company like Gilead can offer. Many patients would find themselves forced onto products that, while listed at slightly lower wholesale prices, would actually cost more out-of-pocket because the subsidies that a company like Gilead can offer would cease to exist.
This would be the very definition of a Pyrrhic victory.
The HIV activist community has a lot of reasons to be proud. We’ve made extraordinary progress in recent years, both medically and culturally. Much of that progress has been built on the partnership of community leaders and medical companies, united in their belief that we really could conquer a disease that once seemed insurmountable. This progress has been incredible, but the fight’s not won. The worst mistake we could make today is to turn our backs on what has taken us this far. PrEP has been nothing short of a miracle for many, and we need to focus on the steps that may not grab headlines, but will help ensure that more in our community can access the medicine and care they need.
June Gipson, Ph.D. is the President/CEO of My Brother’s Keeper, Inc. of Mississippi and Open Arms Healthcare Center – Mississippi’s first LGBTI primary healthcare clinic and the first clinical safe space established in the Southeast.
Damon L. Jacobs is a Licensed Marriage and Family Therapist and PrEP Educator. He has been helping individuals around the world access PrEP through the “PrEP Facts” group on Facebook since July, 2013.