Provider Groups Demand Fair Antiretroviral Pricing and Coverage


2 major HIV provider groups recently sent pharmaceutical companies and manufacturers a statement urging them to make their antiretrovirals more accessible to patients.

2 major HIV provider groups recently sent pharmaceutical companies and manufacturers a statement urging them to make their antiretrovirals more accessible to patients.

Two prominent HIV provider groups, the HIV Medicine Association (HIVMA) and the American Academy of HIV Medicine (AAHIVM), recently called on drug manufacturers to lower the prices of antiretroviral therapies.

One of the major obstacles affecting drug accessibility, the group noted, is the socioeconomic distribution of the disease. Nearly 25% of people with HIV are uninsured, with fewer than 15% having commercial insurance coverage. Nearly half of these patients rely on Medicaid for their prescriptions. In fact, HIV was among the top 3 conditions causing the largest specialty spend under the pharmacy benefit in Medicare in 2012, according to Express Scripts’ Vice President of Research & Analytics Sharon Frazee.

Cost control strategies like clinical pathways will restrict coverage to only the lowest cost options within each class, the groups pointed out. This may keep patients from using newer, more effective, more tolerable medications as they come onto the market. “For a subset of patients with HIV infection who develop antiretroviral drug resistance, access to newer drugs and formulations will continue to be the only effective treatment option.”

Michael Horberg, MD, chair of the HIVMA, pointed out that most diseases now can be treated with generics, but this is not the case with HIV. “That may be changing as more effective medications lose their patents and become generics, but for now, it is really a disease of name brand,” Dr. Horberg noted. He told Specialty Pharmacy Times that many of the inexpensive nucleosides are fraught with adverse effects, and this can add to the total cost of care.

Although Dr. Horberg would not speculate about which HIV drugs in the pipeline will be most promising, he stated, “The standing principles of fewer pills, greater potency, and fewer side effects will always hold in medicine. The medications that come along that meet those criteria will be the most promising.”

HIVMA and AAHIVM are working to gain access to medications for people impacted with HIV, and have released a list of 6 pricing and access suggestions to pharma companies and manufacturers, recommending:

  • Pharmaceutical companies set prices for antiretrovirals at levels that support access for the populations most in need.
  • Pharmaceutical companies and US policymakers work with insurers and government payers to ensure that drug formularies include all antiretrovirals, and that antiretrovirals are not subject to burdensome cost-sharing, prior authorization, and other restrictions that limit timely patient access or provider prescription.
  • Pharmaceutical companies sustain and expand their copay assistance programs so such programs are available for all antiretroviral agents and income eligibility levels set to address the needs of individuals who are not able to access medications due to extraordinary cost-sharing requirements.
  • Pharmaceutical companies participate in the HarborPath program that streamlines access to antiretrovirals for people with HIV infection without insurance or with poor drug coverage. Participation by all companies is urgently needed to realize the potential of this important program.
  • Pharmaceutical companies and US policymakers continue to support agreements that promote access to antiretrovirals in under-resourced countries by allowing for the manufacturing of generic antiretrovirals outside of the United States and offering deep discounts on branded HIV antiretrovirals. Industry and US policymakers should also refrain from blocking the efforts of developing countries to produce generic antiretrovirals to meet the needs of their own citizens, as well as those of HIV-infected individuals in other resource-poor settings.
  • Pharmaceutical companies continue to develop pediatric antiretroviral formulations in order to decrease the gap in availability, approval, and access to antiretroviral therapy in pediatric and adolescent populations.
  • Philanthropists, industry, federal and state government entities, medical providers, and other stakeholders work together to explore all options for lowering the costs of antiretroviral therapies and to identify solutions to ensure access to HIV treatment for everyone who needs it.

The price of specialty pharmaceuticals has come under recent scrutiny in other treatment areas as well. In response to a letter from oncologists about the sometimes prohibitive cost of Zaltrap (ziv-aflibercept), Sanofi lowered the price of the drug, which is indicated for patients with metastatic colorectal cancer.

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