PrEP: An Expensive End to HIV


PrEP is sold under the brandname Truvada.

By LUKE OSBORN, Sports & Health Editor

One of the most political, virulent and tragic diseases is now easily preventable with the assistance of a small blue pill. PrEP, or pre-exposure prophylaxis, can reduce the risk of HIV infection by more than 90 percent when taken consistently. This drug is so effective that it is listed on the World Health Organization’s List of Essential Medicines. PrEP is the combination of two anti-HIV drugs called emtricitabine and tenofovir disoproxil fumarate. These drugs inhibit the pathway through which HIV infects and multiplies within white blood cells. In essence, if your body ever comes in contact with HIV while you’re on PrEP, these medicines would make it very difficult for HIV to survive.

In the United States, the pharmaceutical company Gilead Sciences owns the patent for PrEP and sells the drug under the brand name Truvada. This drug is not over the counter, so individuals who are at risk for HIV must obtain a prescription from a doctor.

It’s important to remember that PrEP is an HIV prevention drug, so only HIV-negative individuals should obtain PrEP. Therefore, PrEP is most useful for individuals who are at high risk of becoming infected with HIV. According to the Truvada website, individuals who have been diagnosed with a sexually transmitted infection (STI), have ever had unprotected sex or have a partner with a positive or unknown HIV status should highly consider using PrEP. Altogether, a drug like PrEP can end the spread of HIV and remove the epidemic status of HIV infections.

What makes PrEP so unique and effective is its minimal side effects. Most people taking PrEP even report having no side effects at all. There are some listed, however, including nausea, upset stomach, fatigue and headaches that tend to go away after the first month of taking the drug. Extremely rare side effects include kidney, liver and bone problems. Nevertheless, PrEP is a seemingly safe drug that can prevent HIV, a feat in medicine capable of saving millions of lives.

Individuals taking PrEP must do so every day in order to reduce their risk to the greatest extent; the clinical studies of PrEP demonstrate that the drug loses its effectiveness when taken sporadically. Moreover, individuals taking PrEP must get tested for HIV every three months because PrEP is only effective as a preventative drug; PrEP alone cannot treat a full-blown HIV infection.

Most importantly, individuals who take PrEP should not stop having protected sex. PrEP is very effective at preventing HIV transmission, but it is not 100 percent effective. Adding extra protection, like using a condom, during sex can significantly help individuals reduce their risk of getting HIV. Also, PrEP does not prevent infection from other STIs like gonorrhea, chlamydia and syphilis. Again, condoms are the best sources of defense against these STIs.

Though PrEP is a highly impactful drug, the monthly price of PrEP is a deterrent for some, especially for underinsured individuals. In the U.S., the sticker price of a one-month supply of PrEP can be as much as $1,600. Most private insurers cover PrEP, and New York State Medicaid covers PrEP prescription costs, medical appointments and lab tests. New York State also has a PrEP Assistance Program that serves uninsured and underinsured HIV-negative residents.

There are also medication patient assistance programs that help cover the costs of PrEP. Gilead Sciences offers a service which supplies individuals with a co-pay coupon card that reduces prescription fees. By the same token, Patient Access Network Foundation (PANF) aims to provide access to critical medicines to individuals who cannot cover the costs themselves. One service the PANF offers is a $7,500 grant that goes toward co-pays for prescription medicines.

There are financial assistance options that can help underinsured individuals obtain PrEP, but the pricing of the drug will not change drastically until the expiration of Gilead’s patents. The patent on tenofovir disoproxil fumarate expired in July 2017, but the patent on the second component of PrEP will not expire until 2021. Generic PrEP will most likely not come to market until that expiration date. Though PrEP’s characteristics warrant its status as a “wonder drug,” there is still work to be done on reducing the price in order to increase affordability.