The Cost Of Hiv Treatment
Forty years ago, HIV and AIDS were unheard of in the United States. The first cases of what was then a mysterious illness were diagnosed in the 1980s, but effective treatments took several more decades to develop.
A cure for HIV doesnt yet exist, but treatments are available to extend the lives of those with HIV and help stop transmission of the virus. Many of the highly active antiretroviral therapies available today work effectively to slow the progression of disease caused by HIV.
But all treatments come with a cost some more than others. Lets take a look at the average costs of HIV treatment and potential ways to save money.
Cost Sharing In The United States
Prescription drug pricing in the United States involves complex systems with varying requirements for mandatory and voluntary discounts, rebates, and reimbursement rates, and much of the pricing information is confidential. Prices can vary depending on the state, purchaser, type of public or private insurance coverage in use, and number of generic competitors to branded drugs . Therefore, providers may find it difficult to navigate payer cost-containment practices, including formulary restrictions, prior authorization requirements, and patient cost-sharing arrangements, such as copayments , coinsurance , and insurance deductible payments.
Maximum allowable copayments on prescription drugs covered by Medicaid can vary by family income, but they are usually nominal. For commercial insurers, cost sharing generally is subject to maximum payment rules under the Affordable Care Act . Manufacturer cost-sharing assistance programs are available for most brand-name ARV products but may be restricted by pharmacy and by state. Manufacturer copay assistance also may be subject to copay accumulator programs implemented by insurers pharmacy benefit managers , whereby manufacturer payments do not count toward a patients deductible or out-of-pocket maximum.
What Drugs Are Approved For Prep
The following medications approved for daily use as PrEP. They are combinations of two anti-HIV drugs in a single pill:
- Emtricitabine 200 mg in combination with tenofovir alafenamide 25 mg is recommended for adults and adolescents at risk for HIV through sex, excluding people at risk through vaginal sex. Descovy® has not yet been studied for HIV prevention for receptive vaginal sex.
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Start Treatment As Soon As Possible After Diagnosis
- HIV medicine is recommended for all people with HIV, regardless of how long theyve had the virus or how healthy they are.
- Talk to your health care provider about any medical conditions you may have or any other medicines you are taking.
- Let your health care provider know if you or your partner is pregnant or thinking about getting pregnant. They will determine the right type of HIV medicine that can help prevent transmitting HIV to your baby.
What if I delay treatment?
- HIV will continue to harm your immune system.
- This will put you at higher risk for developing AIDS. Learn more about AIDS and opportunistic infections.
- This will put you at higher risk for transmitting HIV to your sexual and injection partners.
What are the benefits of taking my HIV medicine every day as prescribed?
How Do You Deal With Side Effects
Some side effects can be hard to deal with. One way to cope with them is to know what to watch out for and have a plan to deal with problems that come up.
That’s why you need to talk to your provider about the risk of side effects from different drugs, before you start therapy.
At the beginning of any treatment, you go through a period of adjustment–a time when your body has to get used to the new drugs you’re taking. Sometimes you’ll have headaches, an upset stomach, fatigue, or aches and pains. These side effects may go away after a few days or a few weeks.
If you notice any unusual or severe reactions after starting or changing a drug, report the side effects to your provider immediately.
More information is available in the .
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What Makes Biktarvy Stand Out As An Hiv Treatment Regimen
BICs resistance profile has led to many medical providers switching patients who had previously been on STRs like Genvoya , Odefsey , and Stribild to Biktarvy in recent years.
Since 2018, Biktarvy has rapidly established itself as a recommended initial combination antiretroviral treatment regimen for patients who are ARV-naive by the Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. In general, studies have shown it to be very well tolerated and just as effective when it comes to viral suppression as other combination HIV treatment regimens.
As with any STR that includes Descovy, one of the benefits of being on Biktarvy is that not only is it effective in slowing down HIV, it is also useful in the treatment of hepatitis B. FTC and TAF, the two medications in Descovy, are effective in combination against hepatitis B.
Having your medical provider check your bloodwork for immunity to hepatitis B or if you may have active hepatitis B will help with this decision. If you do have active hepatitis B, both you and your provider need to know that, as it confirms that Biktarvy will be useful in treating both HIV and hepatitis B. Importantly, its also helpful to know this because sometimes when you stop the medication that is treating hepatitis B, you can experience an acute hepatitis B flare.
The Most Common Sexually Transmitted Diseases
It is crucial to get tested for STDs regularly â especially if you are sexually active. STDs do not always cause symptoms and may be dormant in your body, so it is possible to have an STD without knowing it. If this is the case, the STD may cause long-term damage to your body if left untreated.
Outlined below are some of the most common sexually transmitted infections in the United States:
- Bacterial Vaginosis
Each of these STDs is passed differently. Some are carried in bodily fluids such as semen and blood, while others can be passed from skin-to-skin contact.
Therefore, one of the best ways to treat STIs is to prevent them in the first place. If you are having sex, using protective barriers, such as condoms and dental dams, are among the best safe sex practices to protect you from STD transmission.
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Who Is At Risk For Hiv
Although transmission factors are the same for everyone, some groups are more at risk for HIV than others. If you fall into one of the following categories, consider talking to your doctor about specific ways you can reduce your HIV risk.
While anyone is able to contract HIV, gay and bisexual men are more at risk than other gender groups. They accounted for 70 percent of all new HIV diagnoses in 2017, notes the CDC. Another important factor within this demographic is age – also according to the CDC, in 2010, gay and bisexual men aged 13 to 34 accounted for 64 percent of those new infections.
Due primarily to sharing needles, intravenous drug users are at a higher risk of acquiring HIV than non-users. HIV is also most commonly transmitted via sexual intercourse and sex workers often engage in sexual activity with many different partners, which can increase the risk of HIV. Mixing these two activities further increases the risk, according to the CDC.
Some ethnic and racial groups see relatively high concentrations of the virus in their communities. African-Americans are the most affected group in America, making up 43 percent of all new cases in 2017, according to the CDC. Hispanics/Latinos are also disproportionately affected, accounting for 26 percent of new diagnoses in 2017. Although smaller in size than other ethnic groups, the CDC notes that American Indians, Alaska and Hawaii natives, and Pacific islanders all experience higher rates of infection than Asians or whites.
Make Best Use Of Adap Benefits
The AIDS Drug Assistance Program has long been considered the first-line resource for HIV medications for low- to middle -income Americans. Since its inception in 1987, the scope of the program has expanded considerably, with some states now integrating medical care, lab tests, insurance assistance, and even HIV preventive therapy into their benefits schedule.
As with other federally funded programs, eligibility is based largely on income, the thresholds of which can vary considerably from state to state. Proof of residency and documentation of HIV status are required.
While most states will limit eligibility to U.S. citizens and documented residents only, some like Massachusetts, New York, and New Mexico have now extended ADAP assistance to undocumented immigrants, as well.
Meanwhile, six U.S. states restrict benefits to individuals or families whose personal net assets fall beneath a specific threshold, ranging from less than $25,000 in New York State to less than $4,500 in Georgia.
The current ADAP income eligibility thresholds are outlined as follows:
ADAP is typically considered a payer of last resort, meaning that, unless you qualify for Medicaid or Medicare, you will need to enroll in some form of private or employer-based insurance.
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Complete And Submit The Prescription Request Form
The patient’s physician must complete and submit an HIV medication Prescription Request form in the following circumstances:
- New patient, not previously treated in BC .
- Previously treated patients who have been off therapy for more than 6 months or who are returning to BC after living outside the province.
- Change in HIV drug regimen, including: Addition of new drug, discontinuation of previous drug, dosage changes which affect drug indication .
For prescribing assistance, physician consultation is available 7 days a week. Pharmacist consultation is available Monday- Fri day 8 am-5 pm. After hours, a pharmacist is on call for emergency situations.
Complete the prescription request:
Any physician licensed to practice in BC may prescribe HIV medication however, new medication regimens must first be approved by a BC-CfE affiliated physician. Complete the HIV Drug Treatment Program Prescription Request form :
Submit the prescription request:
Fax or mail the prescription form and enrolment form, if required to the BC-CfE HIV Drug Treatment Program office.
What Are Drug Interactions
Your HIV medications can be affected by other medicines, including other prescription drugs you are taking and drugs you buy over the counter at a pharmacy. Even herbal therapies, nutritional supplements, and some things found in common foods can affect your HIV medicines.
When one drug affects how another drug behaves, this is called a drug-drug interaction. For example, some drugs become less effective or cause side effects when they are taken with certain other drugs.
When something in food affects how a drug behaves, it is called a drug-food interaction. For example, grapefruit juice, taken at the same time as certain drugs, can boost the amount of these drugs in your bloodstream to an undesirable level. Everyone taking HIV drugs needs to be very careful about these interactions. Luckily, many of these interactions are well known to your provider and can be managed.
Your provider can give you a list of drugs and foods to avoid, depending on what treatment you are taking. Ask for this information for each drug that you are taking.
Also, be sure that you tell your provider about every single medication, drug, supplement, and herb you are taking–whether you got them by prescription or not.
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What Kinds Of Drugs Are Available
HIV drugs are also called antiretroviral drugs or antiretrovirals . A whole treatment regimen is called antiretroviral therapy, or ART. The ARVs work because they attack the HIV virus directly–they cripple the ability of the virus to make copies of itself. Usually an ART regimen consists of 3 different medicines from at least 2 classes of drugs. This is because it takes a powerful combination of medicines to suppress the HIV virus.
There are 5 main classes of HIV drugs:
- Nucleoside Reverse Transcriptase Inhibitors
- Non-Nucleoside Reverse Transcriptase Inhibitors
- Integrase Inhibitors
- Protease Inhibitors
- Entry Inhibitors
Each group attacks HIV in its own way and helps your body fight the infection. Most of these drugs come as tablets or capsules. Several of these drugs may be combined into one tablet to make it easier to take your medications. These are known as fixed-dose combinations or single tablet regimens.
The following is a short description of how each group of drugs works.
Early Treatment Better Outcomes
The effectiveness of healthcare and ART for an HIV-positive person depends on three main factors:
- How advanced the infection is when they are diagnosed: Unfortunately, the fact that HIV symptoms often disappear for a long duration leads many people to delay being evaluated.
- The quality of the initial healthcare they receive
- How soon they begin ART and how effective the therapy is
According to Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, “We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later.”
So while early diagnosis and treatment comes with greater care financial costs, the benefits are undeniable. Dr. Fauci’s statement is supported by numerous studies.
In one, researchers followed 4,685 HIV-positive adults, all of whom began the study with a normal CD4 count above 500 cells/mm. The adults were placed in two groups: one began ART immediately, while the other group delayed ART until their CD4 counts dropped below 350 cells/mm.
After three years, researchers found that the adults who began ART immediately were 72% less likely to develop serious AIDS-related events and 57% less likely to die as a result of them.
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Interaction With Medicare And Medi
If you are on Medicare Part D and ADAP, ADAP is still the payer of last resort. To stay eligible for ADAP, you must enroll in Medicare Part D if you are eligible. You should make sure you go to a pharmacy that participates in your Part D plan as well as ADAP. In general, Part D plans will pay for most of your HIV/AIDS drugs. This is because antiretrovirals are one of the categories of drugs that Part D plans must cover fully. You have to apply for Part Ds Low Income Subsidy before ADAP will pay. ADAP pays for copayments, deductibles, co-insurance, and may cover other prescription drug costs. If you have both Part D and ADAP, you can also apply to have your Part D premium paid for.
If you are on Medically Needy Medi-Cal with a Share of Cost , that means that you have to spend a certain amount of money each month before Medi-Cal starts to pay. The money spent on drugs that are paid for through ADAP can count towards your SOC. If youre on Medi-Cal and Medicare Part D, it will be difficult to spend down your SOC because the only drugs that arent covered by either Part D or Medi-Cal are Xanax and Atavan.
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What Is The Cost Of Hiv Treatment Drugs In India
Answered by: Dr Chandra M Gulhati | Editor, MIMS, New Delhi
Q: What is the cost of HIV treatment medication in India. Currently I am in USA and it costs me $2000 per month.
A:We presume your enquiry is concerning the cost of drugs and not cost of treatment that will include non-drug charges for consultations, laboratory tests etc. Drugs are definitely cheaper in India due to the lower purchasing power of the population, lower cost of manufacture and absence of research expenses involved in the discovery of drugs. The cost of drugs will depend upon the medicines being consumed. As an illustration, we give below the prices of major anti-retroviral agents: Lamivudine 150 mg + zidovudine 300 mg: 10 tablets, Indian Rs. 274/- Lamivudine 150 mg: 10 tablets, Rs. 235/-Nevirapine 200 mg: 60 tablets, Rs. 1200/-Zidovudine 100 mg: 100 tablets, Rs. 2040/-Stavudine 30 mg: 10 tablets, Rs. 105/-Etavirenz 600 mg: 30 tablets, Rs. 2940/- Current exchange rate: US$ 1 = Indian Rs. 49/-
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Current Prescription Drug Costs
Below is a table that contains an average of estimated costs for both brand-name and generic medications. This isnt a comprehensive list of HIV medications. Talk to a pharmacist to find out the cost of any medication that isnt included.
These numbers are a snapshot of costs from one day in time, so theyre just a rough estimate. They can provide a general idea about drug costs, but keep in mind that there are many factors that can make these medications less expensive. Also, new, cheaper drugs come on the market from time to time.
The prices listed dont take into account any expense covered by health insurance, prescription drug insurance, or government assistance. Theyre averages based on information from several websites, including the U.S. Department of Health and Human Services and GoodRx.
To find the exact cost for drugs prescribed by a healthcare provider, contact a local pharmacy.
Its important to understand that there are many factors that can affect HIV medication costs. Prescription drugs vary in availability, and prices for medications can change quickly. Several other factors can also affect the cost of a medication, including:
- what pharmacy discounts are available
- whether a person has prescription drug insurance
- the availability of generic versions of medications
- what prescription assistance programs are available
- where a person lives
Reasons For High Antiretroviral Therapy Prices
Excessive patent protection may also be attributed to evergreening, or methods to extend patents that are about to expire. Drug companies may extend patents well beyond their original expiration date by making slight modifications to their drug, preventing antiretroviral drugs from attaining reduced prices. For example, GSK added a secondary patent for abacavir with only minor changes and was able to effectively extend its patent of the drug by eight years in Ukraine. As such, the price of ABC in Ukraine has been as high as $277.40 per patient per year while other countries with the equivalent generic drug offered them at $123.42 per patient per year . The brand name drug Truvada, which provides the WHO recommended treatment of TDF/FTC, has also been able to extend its original patent expiry year of 2017 to 2026 through minor modifications to the drug.
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