This week the Trump administration's Department of Health and Human Services (HHS) unveiled a new plan to provide 200,000 people with free access to PrEP pills -- but no way for those people to safely take them.
The program is called "Ready, Set, PrEP," and while it will provide HIV prevention medication, it also places the burden of obtaining a prescription and blood testing onto patients. Those costs are estimated to be around $1,000 per year per person.
What's more, the pills themselves are hardly free. Taxpayers will give drug manufacturer Gilead a reported $200 for each bottle of 30 pills, which the company says is the cost of moving each bottle through the supply chain to pharmacies. Dr. Rochelle P. Walensky, who has analyzed the cost of numerous HIV prevention programs, told the New York Times that she was "having a hard time understanding" where that $200 figure came from.
The pills are part of a program that Gilead announced earlier this year in which the company pledged to provide the government with 2.4 million free bottles of Truvada. PrEP4All co-founder James Krellenstein called the donation "a publicity gimmick."
"Basically Gilead is charging the U.S. government $6 million to distribute that donation to just 4,000 people for just half a year," he told Out in November. "They are charging so much money to distribute their donation that it costs literally 40 to 60 times what it would cost if we just bought that drug and distributed it through the normal system. ... This is just a tax write off."
It's estimated that each pill costs about $6 to make, and bottles include 30 pills. Gilead typically charges around $1,600 per month in the United States, claiming to own a key patent related to PrEP. The same treatment costs $8 per month in Australia, $32 per month in Germany, and is free in France and Norway, where there is no patent.
The United States is able to pay far less for generic PrEP drugs, just not for American citizens. Through international HIV/AIDS programs, the United States pays $6 per month to cover PrEP for residents of other countries.
But the US government is currently suing Gilead for damages related to what federal lawyers say is "infringement of HHS patents" on PrEP treatment. According to that lawsuit, the government holds four patents on the research that led to both Truvada and Descovy, the drugs used for PrEP. Last year, Gilead made $3 billion from Truvada sales.
Gilead says it won't make any money from the Ready, Set, PrEP program, claiming it will use the $200 per bottle payouts to reimburse unspecified vendors. The company says that they'll claim a tax write-off for the cost of manufacturing, not the cost of the drug's sales.
As taxpayers hand up to $6 million to Gilead, HHS secretary Alex M. Azar II suggested that local health clinics should shoulder the cost of blood tests necessary for patients to safely take the pills. Without monitoring, Truvada can cause kidney, liver, or bone damage. Azar said HHS hoped to obtain $291 million for clinics in a handful of high-risk areas, but there's no guarantee that funding will come through.
While some major cities have programs in place to provide that testing, many smaller communities, particularly in the South, do not.
The Trump administration claims the donated pills will be available to up to 200,000 HIV-negative people who lack insurance. Those people will need to obtain a prescription somehow, at which point they can apply for free Truvada or Descovy by calling 855-447-8410 or at getyourprep.com.
According to the Centers for Disease Control and Prevention, around 1.2 million Americans could benefit from PrEP, but only about 270,000 are currently taking HIV-prevention medication.