{"id":380,"date":"2014-07-14T10:18:00","date_gmt":"2014-07-14T10:18:00","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/2014\/07\/kids-dont-read-this-one-updated.html"},"modified":"2014-07-14T10:18:00","modified_gmt":"2014-07-14T10:18:00","slug":"kids-dont-read-this-one-updated","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2014\/07\/kids-dont-read-this-one-updated.html","title":{"rendered":"Kids, don’t read this one (updated)"},"content":{"rendered":"\n<\/head>

(Originally posted July 11th, 2014)<\/p>\n

I popped over to The Atlantic just now to see what they had to offer and there it was: \u201cThe WHO Wants All Gay Men to Take HIV Prevention Medication<\/a>.\u201d <\/p>\n

This is insane.<\/p>\n

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. \u00a0I had read about this a while back but discarded it, but this makes the debate over contraception foolishness. \u00a0Do you know how much Truvada costs? <\/p>\n

$13,000 per year. \u00a0See this story<\/a> in the SF Gate for cost information.<\/p>\n

That\u2019s $13,000 a year per gay man in the world that the WHO thinks should be spent by \u2014 by who? \u00a0By governments, in most cases, presumably, and by private insurers in the U.S., for the benefit of gay men who won\u2019t use condoms.<\/p>\n

If you want to read something even more unsettling, try this article<\/a> (found via google) from Out.com, which makes it clear that the target are those gay men, apparently the majority, who don\u2019t use condoms, or don\u2019t use them consistently, and who openly say, \u201cI just don\u2019t like them and would rather take my chances with getting infected.\u201d<\/p>\n

UPDATE:<\/p>\n

According to this article from Healthline<\/a>, insurers are generally covering preventative Truvada. \u00a0 The rationale is that \u201cPrEP 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.\u201d \u00a0But 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.<\/p>\n

And here\u2019s Andrew Sullivan on the topic<\/a>, from April: \u00a0 insurers generally cover the pill, but on a non-formulary basis, so that the coinsurance is steep. \u00a0This article from Think Progress<\/a>\u00a0explains that, although prescription drugs are one part of the \u201cessential health benefits\u201d required by the ACA, insurers are allowed to develop formularies and make their own decisions on coinsurance.<\/p>\n

What I can\u2019t figure out is this: \u00a0the ACA requires prescription drug coverage \u2014 but clearly doesn\u2019t require that insurance cover every drug that\u2019s out there. \u00a0The eye drops that give you longer eyelashes, for instance, are prescription only, but presumably not covered as they\u2019re not medically necessary. \u00a0I\u2019m not finding anything online that tells me how the line is drawn for which drugs are \u201cmedically necessary\u201d and which ones aren\u2019t \u2014 and hence, what types of drugs are mandated by the ACA or not.<\/p>\n

Which leads up to this question:<\/p>\n

Is Hobby Lobby required by law to cover \u201cpreventative\u201d Truvada?<\/p>\n

Further update:<\/p>\n

One of the commenters on the Atlantic site linked to an article in the Chicago Tribune<\/a>, from 2012, which adds some startling new information: \u00a0the actual cost to manufacture this drug is a small fraction of its sticker price.<\/p>\n

WHO spokeswoman Sarah Russell said the agency could not recommend specific drugs for prevention, but added: \u201cIt needs to be a drug like Truvada that has been developed for prevention purposes.\u201d\u00a0<\/p><\/blockquote>\n

Russell said WHO expects Gilead to make Truvada available at a deeply discounted price for prevention programs in some poor and middle-income countries.<\/p><\/blockquote>\n

\u201cWe believe Gilead will bring the price down to about $100 per year per person\u201d in those countries, Russell said in an interview.<\/p><\/blockquote>\n

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.<\/p><\/blockquote>\n

The commenter further said the patent expires in 2021. <\/p>\n

Which means there are multiple issues: \u00a0what do you make of gay men asserting they have the \u201cright\u201d to have Society\/the government pay for their \u201cpreventive medication\u201d that enables them to have condomless sex, because using condoms is unacceptable to them, in the same way as women demand \u201cfree\u201d contraception? <\/p>\n

And where does it cross the line from \u201cyeah, I guess that\u2019s a reasonable measure\u201d to \u201cYou\u2019re insane if you think I\u2019m going to pay that much money for something that enables you to engage in risky behavior!\u201d?<\/p>\n

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\u2019t recall where I read this any longer), far exceed the cost in a place like India?<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

(Originally posted July 11th, 2014) I popped over to The Atlantic just now to see what they had to offer and there it was: \u201cThe WHO Wants All Gay Men to Take HIV Prevention Medication.\u201d This is insane. The medication in question is Truvada, a once-daily pill, initially used in HIV treatment and now proven […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-380","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nKids, don't read this one (updated)<\/title>\n<meta name=\"description\" content=\"(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\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2014\/07\/kids-dont-read-this-one-updated.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta 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