Treating and Preventing HIV with Generic Drugs — Barriers in the United States

CHIPTS member Erika G. Martin, Ph.D., M.P.H., and Bruce R. Schackman, Ph.D.

Combination antiretroviral therapy (ART) has dramatically improved survival rates among people with HIV and is a mainstay of HIV prevention; evidence shows that durable viral suppression prevents the transmission of infection. In addition, preexposure prophylaxis (PrEP) is an emerging approach to preventing HIV acquisition for certain high-risk groups. Generic ART medications offer the potential for treating and preventing HIV with fewer resources. Generic versions of lamivudine, abacavir, and efavirenz became available in the United States within the past 6 years at prices lower than their brand-name counterparts, a generic version of PrEP (emtricitabine and tenofovir disoproxil fumarate) was approved in 2016, and generic versions of tenofovir disoproxil are expected later in 2018. Yet most of the discussion about the availability of generic HIV drugs focuses on low- and middle-income countries.

Costs for a 30-Day Supply of ART Regimens Recommended by the Department of Health and Human Services.

ART accounts for 60% of the projected $326,500 discounted lifetime medical cost of HIV treatment in the United States.1 A 2013 study estimated nearly $1 billion in savings in the first year if all eligible U.S. patients for whom brand-name was prescribed efavirenz at the time (when it was a component of a leading ART regimen) switched to a regimen with generic efavirenz.2 Our analysis of four regimens currently recommended by the Department of Health and Human Services (HHS) shows in more detail the potential cost savings associated with switching to generic regimens (see table). For example….


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Dr. Erika Martin is an Associate Professor of Public Administration and Policy at the Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York as well as a Core Scientist in our Policy Impact core. For more information about this post, you can contact her at emartin@albany.edu