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Gilead Has Effective HIV Pill, But Few People Know About It

Critics assail lack of promotion

Gilead Sciences, Inc., has come under fire for its lack of promotion of its human immunodeficiency virus (HIV) drug Truvada (emtricitabine/tenofovir) for pre-exposure prophylaxis (PrEP). Although the company doesn’t focus its marketing efforts on PrEP, Truvada brought in $1.79 billion in the U.S. last year, mostly for HIV treatment.

Gilead has responded by indicating that PrEP is not a particularly strong profit area, so its sales force doesn’t spend much time on it. The company says that 42% of PrEP prescriptions written up to March 2014 were for women. Only 7.4% were for men younger than 25 years of age. Generally speaking, PrEP would make sense for young gay males, who have the highest rates of HIV diagnosis each year.

From January 2012 to March 2014, Truvada was prescribed 3.3 million times. Of those prescriptions, only 3,200 were for PrEP.

Other factors contributing to the low use of Truvada for HIV PrEP include the fact that insurance companies often have co-pays as high as $1,300 for the medication. In addition, health care experts cite “peculiarities” related to HIV treatment and maintain that it’s difficult to identify primary physicians who treat HIV infection.

“There’s a circle of pointing fingers,” said Jim Pickett of the AIDS Foundation of Chicago. “HIV specialists are like, ‘I don’t see HIV-negative people,’ and you see a primary care physician, and they say, ‘You need to see a specialist.’”

Some physicians might recommend wearing a condom as opposed to going on a medication that requires regular liver enzyme testing and that may not be reimbursed by insurance, Pickett says. Moreover, general practitioners, who would be most likely to treat non–HIV-infected patients interested in PrEP, are often unaware of the drug.

Truvada was approved for the treatment of HIV infection in 2004. The drug later received approval for expanded use for PrEP. If taken daily, it can prevent HIV infections 92% of the time.

Gilead offers a PrEP medication assistance program for eligible HIV-negative adults in the U.S. who don’t have insurance or who are underinsured. The assistance program offers up to $300 per month.

Truvada works by blocking reverse transcriptase, a protein that allows cells infected with HIV to make copies of the virus.

The nature of the current hubbub is unusual — a pharmaceutical company being criticized for not marketing enough! Gilead “does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP,” company spokeswoman Cara Miller explained in a statement.

Source: BioSpace; February 19, 2015.


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