Insurers and Pharmas Must Help Fix HIV Drug Pricing System, Advocates Say

It used to be the drug companies that had the green light to do anything they wanted. Now, it's the insurance companies.

-- Lynda Dee

In an interview conducted at CROI 2018 by Fred Schaich, executive producer of the International Foundation for Alternative Research in AIDS (IFARA), Tim Horn, deputy executive director of HIV and hepatitis C programs for Treatment Action Group and co-chair of the Fair Pricing Coalition, noted that four new HIV medications and several generic versions of existing drugs are expected to come to market this year. As was seen with new hepatitis C drugs over the past several years, these new medications can be quite expensive, he said. The Fair Pricing Coalition is working with pharmaceutical companies to ensure fair prices for new drugs on par with those of older medications, he added.

Increasingly, insurance companies are determining the medications that are available to people living with HIV, said Lynda Dee, founder and president of AIDS Action Baltimore and Horn's counterpart as co-chair of the Fair Pricing Coalition. For example, if someone's insurance covers only the generic formulation of a drug, that person loses out on the co-pay assistance program offered by the manufacturer of the brand-name version, she explained. If co-pay assistance is used, it may no longer count towards that person's annual deductible, as it had in the past. Given some insurance plans' high deductibles, this may present a significant hardship. Similarly, insurers might cover only the individual components of a multi-drug pill rather than the combination drug. This can make adherence to a prescribed treatment very difficult for some people, Dee said.

However, focusing on insurance coverage could detract from the underlying problem, "which is the fact that the prices of these drugs are too high," Horn cautioned. The price increases are in part driven by the fact that company executives face legal consequences if they do not focus on increasing shareholder value, but they do not face similar problems if patients suffer adverse outcomes because they cannot afford necessary medications, Dee explained. Insurers and pharmaceuticals must come to the table to fix the current system for getting people living with HIV the antiretrovirals they need, the panelists concluded.

Watch the video on IFARA's "AccessHIV" YouTube channel to learn more.