By Bunmi Yekini
Gilead Sciences announced it will discontinue providing four HIV medications for free through its patient assistance program starting at the end of January. The change, which includes the widely used Truvada, has raised alarm among activists and healthcare providers, who fear it could limit access to essential treatments and hinder efforts to combat the HIV epidemic in the United States.
The company’s decision affects Truvada, Emtriva, Tybost, and Complera, now facing competition from lower-cost generics. The move comes as Gilead has opted to remove these medicines from its program due to low enrollment and the availability of cheaper alternatives. Community advocates argue the shift could significantly burden individuals and clinics that rely on these free medications.
Tim Horn, who oversees medication access at the National Alliance of State and Territorial AIDS Directors, expressed concern, stating, “The company has been a standard bearer, but now this change is adding unnecessary complications for individuals who can’t easily afford to pay even $20 or $30 a month for generics.”
Pharmaceutical companies often highlight their patient assistance programs as a way to ensure access to life-saving medications for low-income individuals. However, as Horn points out, many companies, such as AbbVie and ViiV Healthcare, continue to make older HIV drugs available through their assistance programs, even after their patents expire.
In Gilead’s case, the program had served as an important buffer against criticism over high drug prices and access limitations. Gilead, however, defended the decision, with a spokeswoman stating that the programs are regularly evaluated to ensure they meet patient needs and are available “particularly when there are no alternative sources for these medicines.”
The decision to stop providing Truvada for free has raised particular concern due to its use in the prevention of HIV, or PrEP. Although cheaper generics are available, the cost may still be out of reach for many, particularly for uninsured individuals. For example, in Colorado, over 500 people currently enrolled in a state program will now be expected to pay $360 annually for the generic version or as much as $22,000 for the brand-name drug.
Jeremiah Johnson, Executive Director of PrEP4All, emphasized the impact on uninsured individuals, stating, “For those of us advocating for a national PrEP program for un- and underinsured individuals, we see this as the most recent example of why manufacturer assistance programs are not a substitute for public health programs.”
The move also poses a challenge for healthcare providers, especially clinics that purchase Truvada under a federal discount program. They will now face higher costs, which could limit their ability to provide treatment, particularly for HIV prevention. Rob Renzi, head of Big Bend Cares in Tallahassee, Florida, noted, “Clinics that purchase Truvada to treat HIV under a federal drug discount program will no longer pay nothing for the pill. They will have to pay for the generic versions.”
The policy change has sparked concerns that it could make it more difficult for the U.S. to reach its goal of reducing HIV infections by 90% by 2030. Approximately 1.2 million people in the U.S. are currently living with HIV.
Patient advocates are also concerned about the lack of alternatives for certain groups, particularly those assigned female at birth, as Gilead’s newer HIV drug, Descovy, is not approved for use in individuals at risk of HIV through vaginal exposure. In response to advocacy efforts, Gilead has allowed individuals in this group to continue receiving Truvada through July, provided a letter of medical necessity is submitted. Tyler TerMeer, Executive Director of the San Francisco AIDS Foundation, said, “If there isn’t another oral PrEP option for those who are assigned female at birth by the time we get to next summer, then what?”
While Gilead has extended the deadline for some individuals, the broader issue remains, whether cost and access barriers will undermine efforts to combat the HIV epidemic in the U.S. As Horn explained, “In a moment where we’re so close to ending the epidemic, anyone who doesn’t have access, even if it’s a small number, these changes become a significant issue. We’re not talking about a few hundred people. We’re talking about tens of thousands who may lose access.”