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Why are there so few generic HIV drugs? How am I supposed to cut costs?

Answered by Rebecca Farley | Reviewed by a licensed U.S. pharmacist | Posted October 07, 2019

HIV/AIDS is one of the most harrowing and complicated epidemics in medical history. Particularly, many African countries were devastated throughout the 1990s and early 2000s – and the struggle to treat millions continues. According to amfAR, 1.1 million adults are currently living with HIV in the United States. As of 2019, though, the condition is quite manageable with medication. However, the treatments are often very expensive medications. The Queer Eye personality Jonathan Van Ness, who revealed that he was diagnosed with HIV in September 2019, took to Twitter to explain just how costly his HIV meds were:

“It cost $3500 to replace [my medication] out of pocket with ‘amazing’ platinum level insurance,” Van Ness wrote, explaining that he’d misplaced his medication and had had to replace it. “Healthcare shouldn’t be for profit ever, it’s a human right.”

HIV can be treated with a wide-range of medications, but even the most prevalent medications are very expensive. Tenofovir, an antiretroviral medication that is usually the first-line prescription for those diagnosed, has a $936.72 average cash price for 30 tablets, according to the website GoodRx. With coupons, the drug can be as cheap as $35 for 30 tablets, but that is still a steep cost for a life-saving medication. Bear in mind that HIV medication is usually taken every day: This is not a 30 tablet bottle that will last longer than a month.

Part of the reason these medications are so expensive is because many HIV drugs do not have generic counterparts. HIV, though it is manageable with medication, still does not have a cure. Simply speaking, the reason so many of the drugs are not generic is because of patent laws that allow one company only to sell the drug. On top of that, most HIV medication works in tandem with other medications. A treatment plan for this virus can be as many as three pills a day, each one a different expensive brand-name drug.

The cocktail of pills used as HIV treatment is usually tailored directly to the person taking the pills, which makes it difficult to obtain only the cheapest prescription drugs. Not to mention, when prescribing such a delicately balanced treatment plan, physicians are unlikely to prescribe generic medication due to outdated fears of the generic’s viability, according to a report published in The New England Journal of Medicine.

This doesn’t mean that there aren’t shortcuts and discounts to obtaining HIV medication. Read ahead for the best discounts you can find on HIV medication.

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What are all the possible treatments for HIV?

Those diagnosed with HIV usually take a combination of medications that, together, are called “antiretroviral therapy.” Among these combinations, there are seven classes of drugs, according to the National Institutes of Health. These categories are as follows:

    •    nucleoside reverse transcriptase inhibitors (NRTIs)
    •    non-nucleoside reverse transcriptase inhibitors (NNRTIs)
    •    protease inhibitors (PIs)
    •    fusion inhibitors
    •    CCR5 antagonists
    •    post-attachment inhibitors
    •    integrase strand transfer inhibitors (INSTIs)

These medications interact to help decrease the “viral load” of a patient diagnosed with HIV. See a full list of FDA-approved treatments for HIV here:

FDA APPROVED HIV MEDICINES

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Which ones have generic counterparts?

Lamivudine, tenofovir, and abacavir, both NRTIs, as well as efavirenz, an NNTRI, have all recently debuted generic versions. Tenofovir’s generic was introduced as recently as 2017.

The FDA also recently approved a generic version of pre-exposure prophylaxis (PrEP), a drug for people to prevent HIV infection by taking a pill every day.

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What is the easiest way to make my HIV treatment plan less expensive?

Talk to your provider about switching to generic medications. This may mean swapping out a single pill routine for a routine of multiple pills. The drug Truvada is a popular treatment for HIV, but it is technically two medications in one. Truvada also  doesn’t have a generic counterpart. A 30-tablet bottle of Truvada will cost $1,748, according to GoodRx. The FDA approved a generic version of Truvada in 2017, but it has yet to appear on the market.

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Are HIV medications cheaper abroad?

Yes. In fact, the cost of HIV medications abroad is puzzling to many, because the price differences are so vast. According to a 2018 report from the New York Times, a year’s worth of new triple-therapy HIV drug cost a whopping $39,000, while in Africa, the same amount cost $75.

According to PharmacyChecker’s price comparison, one accredited pharmacy, through which orders placed are shipped from Canada, India, and Turkey, will have the lowest-cost Truvada per pill at $11.72 per unit. This same online pharmacy sells Tenofovir (the generic version) for a mere $1.83 per unit. Abacavir, another generic NRTI, will be $1.78 per unit from the same online pharmacy.  

Discount Prices for HIV/AIDS Medications in the U.S. and Abroad

Drug Name Strength (Quantity) Average U.S. Retail Pharmacy Price PharmacyChecker U.S. Discount Card Price Accredited International Online Pharmacy Price
Triumeq 600/50/300 mg (90 tablets) $10,615.56 N/A $3,718.64
Symtuza 800mg/150mg/200mg/10mg  (90 tablets) $14,114.64 $11,680.62 N/A
Juluca 50mg/25mg (90 tablets) $10,308.54 $8,488.80 $3,672.51
Stribild 150mg/150mg/200mg/300mg (90 tablets) $12,504.60 N/A $3,630
Genvoya 150mg/150mg/200mg/10mg (90 tablets) $11,724.3 N/A $4,016.70
Atripla 600mg/200mg/300mg (90 tablets) $ 11,235.84   N/A $3,929.95
Complera 200mg/25mg/300mg (90 tablets) $10,799.49 N/A $4,799.97
Odefsey 200mg/25mg/300mg (90 tablets) $10,050.54 N/A $4,649.97
Biktarvy 50mg/200mg/25mg (90 tablets) $ 11,167.86 N/A $ 4,379.97
Prices collected October 2019
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Are there any programs that can help?

Yes. The high cost of HIV meds is a pressing issue, so much so that the federal government has a series of programs, the AIDS Drug Assistance Programs, which will help those diagnosed get financial assistance. Find a directory for these programs here:

AIDS Drug Assistance Programs

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Read more on Ask PharmacyChecker

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Updated November 20, 2019

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