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Author Topic: The price of HIV medication...  (Read 1026 times)

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Offline CanadianToAmerica

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The price of HIV medication...
« on: August 15, 2014, 03:16:27 PM »
After hearing about how the American system works (Insurance, Co-pays, Corporate Support Systems, Etc.) I thought I would ask "When does everyone think we will see cheap and or affordable HIV medication?"

I know members like Miss Philicia, Jeff G, Peter Staley, and others probably actually have evidence so I'd be interested to know.

In Canada medication is either completely covered or partially covered depending on the province.  I think Saskatchewan is the worst but I'm not totally sure.

Here is what I could find:

The wholesale price of Stribild in Canada is approximately $16,600 per person per year; this is considerably less than the wholesale price in the U.S., which is about $28,500 per person per year.

So what kind of changes have to take place and or time has to pass before say you could go to your local pharmacy and pick up a container of Stribild for 100 or 200 bucks. Meaning that is the cost all together.  No huge costs to assistance groups or the government.

Offline Since1993

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Re: The price of HIV medication...
« Reply #1 on: August 15, 2014, 03:30:11 PM »
Generic-equivilents allowed and produced.

Offline zach

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Re: The price of HIV medication...
« Reply #2 on: August 15, 2014, 04:01:58 PM »
change the laws on new patents for life saving drugs, to allow those generics to be produced and distributed sooner
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mecch

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Re: The price of HIV medication...
« Reply #3 on: August 15, 2014, 04:48:01 PM »
Canadian - you have to factor in US history and culture.
There is  significant block of legislators and voters who do not favour things like price controls on industry, which includes pharma and medicine.  Because "freedom" because "capitalism".
Obama could have gone after pharma and insurance, could have wrangled price limits or the ability to negotiate prices, in the meetings organising for ACA but it seems he had a balance and felt that was antithetical to the very important mission of getting SOMETHING in place.  Could have gone for single payer - seems that timing and politics was not right for that yet.
Obviously its not fair that the richest countries have been able to negotiate somewhat and the US cannot..  But many people like it that way.
The next step will be 8 more years of Democratic executive branch (US President) and hopefully a few years of a Dem congress - to continue a "progressive" agenda that favours the working stiffs of the USA, who have seen the safety net that was doing better in the 60's 70's 80's, whittled down from the 90s on. 
A part of american culture really does not see these issues for the sick and the poor who can't afford a decent life as a problem for the government to solve.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline eric48

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Re: The price of HIV medication...
« Reply #4 on: August 15, 2014, 04:53:40 PM »
Google for ´MSF untangling the web of antiviral prices ' document

You will find lots of answers to your questions in this authoritative document

Mobile.eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF)

Offline mecch

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Re: The price of HIV medication...
« Reply #5 on: August 15, 2014, 05:00:08 PM »
I don't think that the solution is generics and I don't think it is radical ideas such as zach's. I personally like those ideas but its not going to happen. 

There are laws to respect on intellectual property.

Realistically it would have been a huge step for the government to be free to negotiate prices on all pharma.

We do need the ingenuity of the US and Euro pharma companies to keep coming up with our drugs, and these companies are publicly held - like other corporations, in rich advanced open market economies.  Far as I know, India and Brazil aren't putting out miracle drugs that are going to solve the world's medical crises now and in the future.  The needed discoveries are coming out of pharma and the research institutes and research universities in the first world.

So maybe that price for the Stribild should be lower but maybe it can't be a 1000 a year.  But neither should it be 16K.... Or 28k!

The US needs a president, congress, and population that is OK with the idea that all citizens should have some comprehensive health care, that is affordable. 

Canadian - the us can't even get behind an affordable wage. 

The situation is not hopeless.  It is slow.  But ACA was a big step....

« Last Edit: August 15, 2014, 05:02:37 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mitch777

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Re: The price of HIV medication...
« Reply #6 on: August 15, 2014, 05:03:51 PM »
Canadian - you have to factor in US history and culture.
There is  significant block of legislators and voters who do not favour things like price controls on industry, which includes pharma and medicine.  Because "freedom" because "capitalism".
Obama could have gone after pharma and insurance, could have wrangled price limits or the ability to negotiate prices, in the meetings organising for ACA but it seems he had a balance and felt that was antithetical to the very important mission of getting SOMETHING in place.  Could have gone for single payer - seems that timing and politics was not right for that yet.
Obviously its not fair that the richest countries have been able to negotiate somewhat and the US cannot..  But many people like it that way.
The next step will be 8 more years of Democratic executive branch (US President) and hopefully a few years of a Dem congress - to continue a "progressive" agenda that favours the working stiffs of the USA, who have seen the safety net that was doing better in the 60's 70's 80's, whittled down from the 90s on. 
A part of american culture really does not see these issues for the sick and the poor who can't afford a decent life as a problem for the government to solve.

That's it in a nutshell. I shiver to think what will happen should the politics not play out as you have described.
32 years hiv+ (oct. 2013) with a curtsy.

Offline eric48

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Re: The price of HIV medication...
« Reply #7 on: August 15, 2014, 06:09:48 PM »
Look for the complete edtion 2013

2014 publication is an incremental update

Mobile.eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF)

Offline leatherman

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Re: The price of HIV medication...
« Reply #8 on: August 15, 2014, 06:28:45 PM »
Google for ´MSF untangling the web of antiviral prices ' document

http://www.msfaccess.org/sites/default/files/AIDS_Report_UTW16_ENG_2013.pdf
100 pages stuffed with info. Thanks for the heads up on this doc, Erice ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline CanadianToAmerica

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Re: The price of HIV medication...
« Reply #9 on: August 15, 2014, 06:34:01 PM »
Awesome link eric48 - Obviously something I should take some time to review.

I couldn't agree more with the above posters as well, it would be a big step for your country to be able to negotiate medicine costs, etc. 

For those that say that generic versions are a great way to reduce the price:  Does anyone know at what point Stribild or even Atripla would be available to mass market by generic vendors?


Offline leatherman

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Re: The price of HIV medication...
« Reply #10 on: August 15, 2014, 06:58:59 PM »
a little dated but some interesting reads about HIV meds and patents

http://www.ft.com/cms/s/2/286774b4-81be-11e2-b050-00144feabdc0.html
"HIV drugs to be uniquely shielded from generic pricing pressure in public payer scheme"

"The generic generation"
http://www.aidsmap.com/The-generic-generation/page/2541038/

Quote
Gilead's combination HIV treatments, Atripla, Truvada, and Viread, comprised $1.84 billion of Gilead's $2.21 billion in net product sales in the first-quarter. Atripla and Truvada's patents don't expire in the U.S. until 2021, with Viread's patents expiring in 2017
http://www.fool.com/investing/general/2012/07/09/3-things-to-watch-with-gilead-sciences.aspx
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline eric48

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Re: The price of HIV medication...
« Reply #11 on: August 15, 2014, 07:06:57 PM »
I am now using more often generic nevirapine, in place of Viramune (tm)

I can't tell the difference: still UD , CD4>1000, etc.

Half the cost

Mobile.eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF)

Offline CanadianToAmerica

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Re: The price of HIV medication...
« Reply #12 on: August 15, 2014, 08:46:10 PM »
I am now using more often generic nevirapine, in place of Viramune (tm)

I can't tell the difference: still UD , CD4>1000, etc.

Half the cost

Mobile.eric

Eric you seem pretty knowledgeable about this stuff.  Do you know when the medication we enjoy today (Like Stribild or Atripla) will be open to generic manufacturing?

Offline eric48

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Re: The price of HIV medication...
« Reply #13 on: August 16, 2014, 07:24:31 AM »
The link I pointed to was posted in this very section by another poster (vertigo, if my memory is correct)

Reading this unvaluable, authoritative document was eye opening

Some posters, here, have or had a hard time accessing meds... Think of people living in Greece or Ukraine: so the problem is here and now

Your question is somewhat naive, though...

Generic Atripla ? why wait 15 y. for Generic Atripla ? Is a Generic Atripla the only alternative to Atripla ? What is Atripla made of ? (to start with...)

Once you have answered this question, by yourself, then you  have the answer to your question at hand (a quite important question, BTW, since Atripla is the most prescribed in the US)

If you are willing to explore this, then, please, start by listing the 3 molecules

Then, I can guide you through the tangled web, if you wish
« Last Edit: August 16, 2014, 07:35:46 AM by eric48 »
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF)

Offline mecch

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Re: The price of HIV medication...
« Reply #14 on: August 16, 2014, 09:01:30 AM »
I believe india already manufactures a generic like atripla.  But only allowed to sell it in certain countries..

The components of atripla are available as generics. Again, only legal in certain countries.

intellectual copyright protects these molecules for a good amt of years and yet a number of years ago the pharma were shamed, pushed, seduced, persuaded, bullied, and blackmailed, to allow developing world to knock off certain molecules - before patents expire in 1st world - because in the grand scheme of things it was the only moral and human thing to do as the need was so great.  I don't know the particulars however. 
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Miss Philicia

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Re: The price of HIV medication...
« Reply #15 on: August 16, 2014, 09:56:32 AM »
After hearing about how the American system works (Insurance, Co-pays, Corporate Support Systems, Etc.) I thought I would ask "When does everyone think we will see cheap and or affordable HIV medication?"

I know members like Miss Philicia, Jeff G, Peter Staley, and others probably actually have evidence so I'd be interested to know.

1) P. Staley no longer participates here in any regular sense

2) Evidence of what? When HIV meds will be affordable as generic medications?

3) "When does everyone think we will see cheap and or affordable HIV medication?" -- possibly never. Why? Because there are always a reasonable amount of newer HIV medications being approved with lower side effects profiles, and as long as that occurs doctors and patients will demand those medications at least in resource rich countries.

For example with Atripla, it's well known that it causes more side effects than as a % of patients than the other NIH guideline recommended first line regimens (20% switch). Suicidal ideation is twice thatfound in other regimens. I suspect the day soon approaches when Atripla is removed from the NIH list -- IMO it should be already.

Then look at Truvada, the NRTI-class "cornerstone" of most current NIH first line recommended regimens (~50% of patients use this medication). Also well known that Gilead has been sitting for years on a formulation that is vastly superior in having less side effects (Tenofovir alafenamide fumarate/GS-7340) and yet it's still not FDA approved. It only recently went into Phase 3 trials.

As of last year the intention by Gilead was to only develop this medication in "stand alone" formulations with other drugs and not make it available for combinations containing non-Gilead medication, rendering it useless for a patient such as myself who must take a standard 3-drug HAART regimen plus one extra HIV medication due to my resistance profile. Meaning I would be forced to stay on Truvada for years, possibly, even though a superior medication would be FDA approved.

Note: viread's patents begin expiring in 2018; Gilead has been sitting on GS-7340 for at least a decade.
« Last Edit: August 16, 2014, 09:59:02 AM by Miss Philicia »
"I’ve slept with enough men to know that I’m not gay"

Offline leatherman

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Re: The price of HIV medication...
« Reply #16 on: August 16, 2014, 10:05:08 AM »
The link I pointed to was posted in this very section by another poster (vertigo, if my memory is correct)
you're obviously have some of that HIV dementia. LOL

Do you know when the medication we enjoy today (Like Stribild or Atripla) will be open to generic manufacturing?
thanks to google, here are some patent expiration dates:
Quote
the Atripla including Sustiva (efavirenz) and Reyataz (atazanavir) - both produced by Bristol-Myers Squibb - in 2014 and 2017 respectively,

Quote
Sustiva is part of the three-drug STR regimen known as Atripla, approved in July 2006. It is coupled with Gilead Sciences’ (NASDAQ:GILD) Truvada (emtricitabine/tenofovir). Gilead and Teva Pharmaceuticals (NYSE:TEVA) recently settled a patent dispute over Viread - generic tenofovir on 15 December 2017. Patent expiry for both Emtriva (emtricitabine) and Truvada are not until 2021.
http://www.ft.com/intl/cms/s/2/286774b4-81be-11e2-b050-00144feabdc0.html

Stribild just came to the market in 2012 so don't expect it, or any of the other drugs released in the last 5 yrs, as a generic for another 15-20 yrs probably.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline eric48

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Re: The price of HIV medication...
« Reply #17 on: August 16, 2014, 01:15:54 PM »
I agree with Miss P. : there will always be a demand, in the US, for the newest stuff and new stuff won't come with a low price tag.

I should be about right when I visualize about 50 % of current users, in the US, are on Atripla (give or take). Same in 'intermediate' countries

So revisiting the cost of Atripla is of importance: cost can be significantly reduced and it is all legal

The whole new thing was anticipated here:
http://tinyurl.com/HPC-SAX

http://blogs.poz.com/tim/archives/2013/05/preparing_for_generi.html

and has just happenned here: 600 mg Efavirenz generic by Mylan got approved last month, here, so for the US and similar, it is just a matter of months; it may already be available

I have approximated monthly cost for the ease of understanding
Atripla : 1000

Atripla is Efavirenz (Sustiva (tm)) + Truvada (tm) (TDF+FTC)

So let's break and reconstruct

To reconstruct you may want to use
www.tinyurl.com/HPC-PS

The case are detachable, so you can reassemble about anything into one case. It is really easy to use, rugged and cheap
Truvada (tm): 650
Generic Efavirenz: 150
1 case, 2 pills: 800

So... coming to a Pharmacy near you, all ledgit, this is 20 % savings

modified to add:
see EMA EPAR here (updated last week...)
http://tinyurl.com/lrjh589
« Last Edit: August 16, 2014, 01:28:40 PM by eric48 »
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF)

Offline BKKKevin

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Re: The price of HIV medication...
« Reply #18 on: August 16, 2014, 11:52:33 PM »
My partner and I live in northern Thailand... He uses a generic version of Atripla called Teevir which sells here for 1,068 baht for 30 tablets... That converts to about $30us... I take a generic two pill version of Complera (one pill not available here yet)... Cost for 30 tablets about $40us

Offline joemutt

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Re: The price of HIV medication...
« Reply #19 on: August 17, 2014, 12:07:06 AM »
Same here, northern thai, generic viramune and truvada 40 usd, cd4 >1100.

Offline mecch

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Re: The price of HIV medication...
« Reply #20 on: August 17, 2014, 05:02:48 AM »
My partner and I live in northern Thailand... He uses a generic version of Atripla called Teevir which sells here for 1,068 baht for 30 tablets... That converts to about $30us... I take a generic two pill version of Complera (one pill not available here yet)... Cost for 30 tablets about $40us

There it is in  nutshell, eric, I don't know what you are blabbing on about and those linked articles are alarming, not consoling....   Small savings for rich countries while the price remains xxx times more than the budget price in special class countries.  Also potentially less effective dosing methods. Also -- older molecules that don't suit many HIV+ people.  Who really wants some of those molecules - blurk!
And I do believe in the USA one could easily face a sort of 2-tier system with poor citizens being offered crappier regimes...
Outrageous remarks this week even in rich Switzerland that maybe not all HEP C patents "deserve" (in a nutshell translation) the expensive new cure - for example drug users.... Didn't dare say bum-fuckers... But you know they are next of the undeserving list.... Even a suggestion to let the public vote... Because otherwise if everyone infected gets it, the population's health premiums increase an unsubstantiated "20%".

Like the guy in NY said about the rent being too damned high.....
« Last Edit: August 17, 2014, 05:06:04 AM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline eric48

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Re: The price of HIV medication...
« Reply #21 on: August 17, 2014, 05:18:45 AM »
Hello to my S.E. Asia readers & Thanks for sharing ...

Generics have solved there a problem we can solve here and now.

Efavirenz would not be bettered even by Dolutegravir (Tivicay(tm)), if the CNS issues were solved
How do you solve EFV CNS AND cost, here and now ?
1- once UD, switch to NVP (cheap and leaves no place untreated) and be pill buddy to Joemutt
OR
2- once UD, switch to RPV (Rilpivirine, the 3 rd in Complera (tm) and be pill buddy to BKKKevin
OR
3- Learn from ENCORE1 (and thanks again Bill Gates!) and reduce 600 mg (!) to 400 mg

read here : 2% adverse effects vs 6%
http://www.ncbi.nlm.nih.gov/pubmed/?term=encore1

Found in 2009... :
http://tinyurl.com/kmnx5me

Even Swizerland's famed Pr. Hirschel & Dr. A. Calmy:
http://tinyurl.com/lmnjqcf

final wrap up:
http://www.aidsmap.com/page/2693397/

Take home-1: users print this and talk to doc before wonder-drug drop
Take home lesson-2: users can save NOW (on CNS effects and cost)

Let's recalculate cost
Truvada (tm): 650
Generic Efavirenz: 150 * (2/3) = 100
total 750


So... untangle the knot, all ledgit, save your sanity and 25 %

NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF)

Offline mecch

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Re: The price of HIV medication...
« Reply #22 on: August 17, 2014, 05:29:55 AM »
What planet are you beaming this in from Eric.
Individual people don't need to save 25% off 1000 USD - because an individual is NOT paying the 1000 USD to begin with... Some entity is - the govt or the insurance company.

“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: The price of HIV medication...
« Reply #23 on: August 17, 2014, 09:25:13 AM »
And I do believe in the USA one could easily face a sort of 2-tier system with poor citizens being offered crappier regimes
exactly! not all generics are as well tolerated and for some people they don't perform as well. While generics are a nice affordable alternative for many people, there should always be a way to make an exception for patients who don't tolerate the generic or have poorer results.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline zach

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Re: The price of HIV medication...
« Reply #24 on: August 17, 2014, 11:51:41 AM »
eric, seriously man, whats your deal? every couple of weeks you post crap that strikes panic in newly infected. whats with the alarmism? you've been called out on it, but you never address the objections. why not? i know before i step on the line, are you just clueless to the effect of your statistics ramblings, or do you have some sort of agenda?

i'm a big believer in free speech, say what you want i guess. but i sure hope you're taken with a grain of salt
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline CanadianToAmerica

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Re: The price of HIV medication...
« Reply #25 on: August 18, 2014, 02:07:55 PM »
1) P. Staley no longer participates here in any regular sense

2) Evidence of what? When HIV meds will be affordable as generic medications?

3) "When does everyone think we will see cheap and or affordable HIV medication?" -- possibly never. Why? Because there are always a reasonable amount of newer HIV medications being approved with lower side effects profiles, and as long as that occurs doctors and patients will demand those medications at least in resource rich countries.

For example with Atripla, it's well known that it causes more side effects than as a % of patients than the other NIH guideline recommended first line regimens (20% switch). Suicidal ideation is twice thatfound in other regimens. I suspect the day soon approaches when Atripla is removed from the NIH list -- IMO it should be already.

Then look at Truvada, the NRTI-class "cornerstone" of most current NIH first line recommended regimens (~50% of patients use this medication). Also well known that Gilead has been sitting for years on a formulation that is vastly superior in having less side effects (Tenofovir alafenamide fumarate/GS-7340) and yet it's still not FDA approved. It only recently went into Phase 3 trials.

As of last year the intention by Gilead was to only develop this medication in "stand alone" formulations with other drugs and not make it available for combinations containing non-Gilead medication, rendering it useless for a patient such as myself who must take a standard 3-drug HAART regimen plus one extra HIV medication due to my resistance profile. Meaning I would be forced to stay on Truvada for years, possibly, even though a superior medication would be FDA approved.

Note: viread's patents begin expiring in 2018; Gilead has been sitting on GS-7340 for at least a decade.

Thanks for the great info M.P

I'm curious do you think adjusting the laws where if a company has medication that can better suit a community health issue (Such as you where mentioning above with Gileads update) that they should have to release that as it is for the betterment of the community while making what profits exist in that capacity?

Or how do you think it is best to transform the landscape of HIV therapy in order for the best options to be available in most to all circumstances?

And thanks leatherman for the awesome info! :)

 


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