Benjamin Ryan
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Blog

Facts We Learned at the House Hearing On PrEP

5/20/2019

26 Comments

 
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By Benjamin Ryan

On May 16, the House Committee on Oversight and Reform held a three-and-a-half hour hearing about the pricing of Truvada as pre-exposure prophylaxis (PrEP). You can watch the whole video here. The following facts about PrEP were established at the hearing:

  • The current list price for a month of Truvada is $1,780.
  • Medicaid as well as clinics that care for underserved populations and thus have access to 340B pricing receive about a 75 percent discount off of Truvada’s list price. 
  • Gilead’s donation to the Centers for Disease Control and Prevention (CDC) of enough Truvada to cover 200,000 uninsured people for 10 years will be in addition to the drug Gilead already provides to uninsured people through the company’s existing payment assistance program.
    • The CDC estimates that of the 1.1 million people in the United States who are at risk of HIV and therefore good PrEP candidates, 200,000 are uninsured. So the donation would provide Truvada to all of this group should these individuals seek PrEP.
    • The precise details of the donation to CDC are currently being worked out.
    • Gilead will not count the list price of Truvada as a charitable tax deduction for this donation, but will count the manufacturing price. Gilead says that the claim that the manufacturing cost is only $5 per month is inaccurate, and that the true cost is higher.
  • If Descovy is approved as PrEP, as it probably will be by the end of the year, the donation to the CDC will be of free Descovy rather than Truvada.
    • Descovy is associated with improved biomarkers of kidney and bone health compared with Truvada when these drugs are used as PrEP. (Note that it may remain unknown whether Descovy actually provides a clinically significant benefit over Truvada by actually preventing the rare outcomes of bone fractures and kidney disease.) 
  • PrEP is covered by insurance, including private insurers and Medicaid.
  • Ninety-eight percent of PrEP users who use the Gilead copay card—which covers out of pocket costs associated with Truvada up to $7,200 annually with no monthly limit—pay zero dollars for the drug each month.
  • The first generic version of Truvada, manufactured by Teva Pharmaceuticals, will hit the market on September 30, 2020.
    • This is expected to lower the cost of the drug by about 10 percent to 15 percent. 
  • Six months later, on March 30, 2021, multiple generic versions of Truvada will enter the market, which should reduce the cost of the drug dramatically. (Tim Horn of NASTAD, who testified at the hearing, recently estimated to me that the new cost at that point, which is 22 months from now, would be about $30 per month.)
  • PrEP is predominantly used by white men who have sex with men (MSM), despite the fact that the rate of new HIV infections is much higher among black MSM in particular.
  • There was a disagreement at the hearing over how many people are currently taking PrEP. Gilead estimates that just over 200,000, people are currently on Truvada for prevention. (The company has always insisted that the PrEP-use estimates it releases each quarter represent current users.) However, Rochelle Walensky, MD, MPH, from Harvard insisted that this figure represented people who have ever taken PrEP. 
    • It is, in my opinion, very difficult to determine who is correct in this dispute, since Gilead does not release the data behind its estimates. Also, when academics estimate PrEP use figures, their own estimates come out on a considerable delay. So they do not provide an estimate of current users, but of those using PrEP a year or more previously. 
    • Note that there is no specific prescribing code that differentiates Truvada’s use as PrEP from its use as treatment, which is why figuring out how many people are on the drug for prevention is so difficult and requires a certain amount estimating. Once multiple generics enter the market, such estimates will likely become even harder to conduct.
  • The major global PrEP trials that proved its efficacy were largely funded by the National Institutes of Health, the Bill & Melinda Gates Foundation and the CDC. 
  • Gilead scientists were essentially uninvolved in the iPrEx study that was published in 2010 and which first proved PrEP’s efficacy among MSM.
    • The New England Journal of Medicine paper, in fact, says the following: “Gilead Sciences donated both [Truvada] and placebo tablets and provided travel-related support for meetings conducted by non-Gilead investigators. The role of Gilead Sciences in the development of the protocol was limited to sections regarding the handling of the study drugs. Neither Gilead Sciences nor any of its employees had a role in the accrual or analysis of the data or in the preparation of the manuscript. [The National Institute of Health's Division of Acquired Immunodeficiency Syndrome (DAIDS)] agreed to give Gilead 30 days to comment on the manuscript, but there was no agreement to accept suggestions.” 
  • A Yale Law School study, admitted into the record, found that the CDC holds the patents to Truvada's use as PrEP. Gilead claims those patents are invalid.
  • And finally, a personal observation: It's amazing that we've come so far in the United States that Congress can hold a three-and-a-half hour hearing that is largely about preventing the spread of HIV through condomless anal sex between men, and not one person says anything even the slightest bit homophobic or sex negative. Instead, while many people in the room disagreed with one another over matters of policy and capitalism, all clearly agreed that promoting the use of Truvada as prevention is a worthy goal. 
  • To quote Tim Horn: "We're all in this together."
 



26 Comments
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5/17/2021 06:38:18 am

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4/17/2023 03:43:49 pm

Finally there is a cure for herpes1&2 and Dr Osato herbal medicine is the cure for herpes1&2. I saw a post in a health forum from miss cherlyn solie on how she was cured from herpes with the use of Dr Osato herbs and she also wrote Dr Osato cure all kind of diseases/virus including Herpes, HIV, ALS, HPV, HSV1&2, MND, Epilepsy, Leukemia, Asthma, Cancer, Diabetes. At first i doubted if it was real but decided to give it a try because i was desperate to get cured from herpes and i contacted this herbal Doctor on email which she provided on the comment and explain my problem to him and he told me that he is going to prepare a herbal medicine for me which he did and he sent it to me through UPS service, when i receive this herbal medicine, he gave me instructions on how to use it, after taken the medicine as instructed, i went for a check up and the result was Negative, i went to two other clinic to retested and the result was still Negative and all the symptoms of herpes where gone from my body and my doctor confirm with me that am completely free from herpes , I am now free from Herpes. You can contact Dr Osato on his email: OSATOHERBALCURE@GMAIL.COM or WhatsApp him on +2347051705853. All thanks to Dr Osato for what he has just done for me and I will continue to share this great testimony on every platform so we can join hands to eradicate these diseases and viruses out of this world. DR Osato website is https://osatoherbalcure.wordpress.com

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4/25/2023 11:21:55 pm



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I'm truly grateful for their service and work ethics.

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Nobert
5/28/2023 10:10:29 pm

The greatest Joy in my life today is that i have been cured of Herpes by a Doctor called Dr. Ishiaku, I was infected with HERPES Disease in 2019, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution,so that my body can be okay. Until one faithful day as I was browsing the internet I saw a testimony on how Dr. Ishiaku has helped people in curing Herpes and other diseases, quickly copied his WhatsApp number so I contacted him for a solution for my Herpes disease, So Dr. Ishiaku told me that he was going to prepare his herbal medicine for my health which he sent to me, luckily after 2week my Herpes was cured. Dr Ishiaku is well recognized as one of the best herbalist doctors in Africa, you don't have to be sad anymore or cry anymore on this disease when the cure is available. The medicine has NO SIDE EFFECT,there's no special diet when taking the medicine. He also cures  ALS, HIV AIDS,  HPV, DIABETES and lots more.
For enquiries:
WhatsApp: +2348180828544  or visit his website: www.ishiakuherbalcure.wordpress.com

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ANDERSON link
5/30/2023 08:35:41 am


JAMES GONNA, a hardworking entrepreneur, found himself entangled in a devastating online investment scam. He had invested $100,000 in what seemed like a promising venture, only to discover that it was a fraudulent scheme. Feeling helpless and desperate, he turned to MR WILLIAMS Recovery Team [William-Mercado@cyber-wizard.com] for assistance.
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Maccagnan Cosetta
5/31/2023 04:34:55 pm



I was having Herpes Simplex Virus then i came across a review of people saying that they got treated from Herpes Simplex Virus by Dr Abiodun, So i gave a try by contacting him through his email and explain my problem to him. He send natural medicine herbs to me and told me all the things I need to do and also gave me instructions to take the medicine, which I followed properly. Before I knew what is happening after two weeks the HERPES SIMPLEX VIRUS that was in my body got vanished . so if you are also heart broken by any deadly diseases like HERPES HIV, shingles,low sperm count. this great man is extremely the best in which I have seen if you also need a help, Tel/Whats-App: Dr Abiodun on +23498114880069 working 24 hrs world wide Email:drotaborabiodun@gmail.com

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Thomas Riley
5/31/2023 10:27:21 pm

I’m recommending Dr Akhigbe to everyone who have herpes simplex virus to get the cure from him. I was diagnosed with genital herpes in 2018 and I have been searching and asking questions to see if I could get something to cure the disease because I did not believe what the doctors say that no cure is found yet. I came across a comment and the person testified how she was cured from herpes and hpv after using Dr Akhigbe herbal medicine. I quickly contact Dr Akhigbe and explain my problem to him and he prepare the herbs and send it to me through UPS and gave me instructions on how to use it and tell me to go for checkup after usage which i did after two weeks of taken the herbal medicine and my result was NEGATIVE. I waited another month and retested the result was still NEGATIVE and my doctor told me that I am completely free from herpes. Am so happy and grateful to Dr Akhigbe for what he has done for me and I will continue to share this for people out there to know that there is a cure for herpes. You can contact Dr Akhigbe on email and WhatsApp to get the cure from him. Email:  Drakhigbeherbalhome5@gmail.com or WhatsApp +2349021374574    .      

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