Kids, don’t read this one (updated)

(Originally posted July 11th, 2014)

I popped over to The Atlantic just now to see what they had to offer and there it was: “The WHO Wants All Gay Men to Take HIV Prevention Medication.”

This is insane.

The medication in question is Truvada, a once-daily pill, initially used in HIV treatment and now proven effective in preventing new infections among at-risk men.  I had read about this a while back but discarded it, but this makes the debate over contraception foolishness.  Do you know how much Truvada costs?

$13,000 per year.  See this story in the SF Gate for cost information.

That’s $13,000 a year per gay man in the world that the WHO thinks should be spent by — by who?  By governments, in most cases, presumably, and by private insurers in the U.S., for the benefit of gay men who won’t use condoms.

If you want to read something even more unsettling, try this article (found via google) from Out.com, which makes it clear that the target are those gay men, apparently the majority, who don’t use condoms, or don’t use them consistently, and who openly say, “I just don’t like them and would rather take my chances with getting infected.”

UPDATE:

According to this article from Healthline, insurers are generally covering preventative Truvada.   The rationale is that “PrEP is not intended to be taken forever, . . . and it is much cheaper than treating someone who ends up positive and will likely live a long life on costly antiretroviral medications.”  But according to the Atlantic and Out, it is intended to be, if not life-long, then a long-term treatment for the majority of gay men.

And here’s Andrew Sullivan on the topic, from April:   insurers generally cover the pill, but on a non-formulary basis, so that the coinsurance is steep.  This article from Think Progress explains that, although prescription drugs are one part of the “essential health benefits” required by the ACA, insurers are allowed to develop formularies and make their own decisions on coinsurance.

What I can’t figure out is this:  the ACA requires prescription drug coverage — but clearly doesn’t require that insurance cover every drug that’s out there.  The eye drops that give you longer eyelashes, for instance, are prescription only, but presumably not covered as they’re not medically necessary.  I’m not finding anything online that tells me how the line is drawn for which drugs are “medically necessary” and which ones aren’t — and hence, what types of drugs are mandated by the ACA or not.

Which leads up to this question:

Is Hobby Lobby required by law to cover “preventative” Truvada?

Further update:

One of the commenters on the Atlantic site linked to an article in the Chicago Tribune, from 2012, which adds some startling new information:  the actual cost to manufacture this drug is a small fraction of its sticker price.

WHO spokeswoman Sarah Russell said the agency could not recommend specific drugs for prevention, but added: “It needs to be a drug like Truvada that has been developed for prevention purposes.” 

Russell said WHO expects Gilead to make Truvada available at a deeply discounted price for prevention programs in some poor and middle-income countries.

“We believe Gilead will bring the price down to about $100 per year per person” in those countries, Russell said in an interview.

Gilead said generic versions of Truvada, costing as little as $8 a month, are already available in 112 countries, including countries hardest hit by the HIV/AIDS epidemic such as India, Thailand and South Africa, under special arrangements with 12 Indian generic partners.

The commenter further said the patent expires in 2021.

Which means there are multiple issues:  what do you make of gay men asserting they have the “right” to have Society/the government pay for their “preventive medication” that enables them to have condomless sex, because using condoms is unacceptable to them, in the same way as women demand “free” contraception?

And where does it cross the line from “yeah, I guess that’s a reasonable measure” to “You’re insane if you think I’m going to pay that much money for something that enables you to engage in risky behavior!”?

And will $8/month really come to pass in the U.S. after 2021, or will the cost of manufacturing even a generic medication in the U.S., with the tight safety regulations that are driving up even the cost of fairly ordinary vaccines (can’t recall where I read this any longer), far exceed the cost in a place like India?