How can HIV patients afford Biktarvy costs?

Biktarvy is a fairly new and very expensive medication used to manage HIV (human immunodeficiency virus). A combination of three different drugs, Biktarvy works alone; patients taking the medication as antiretroviral therapy will not have to combine this drug with another, as can be the case with alternative HIV drug therapies. The FDA approved this drug in 2018, and it has no generic alternative.

HIV medications, especially those still on patent, are frequently very expensive. With an average retail price of almost $4,000, Biktarvy is no exception. Drug companies constantly churn out new HIV medications. In a logical world, this might lead to product competition, thus driving drug prices down. This is not the case. In a 2019 study, the Kaiser Family Foundation found that antiretrovirals, which treat both hepatitis C and HIV/AIDs, are the most expensive outpatient drugs for those covered by Medicaid. The HIV medication market (much like the market for multiple sclerosis medication) is booming.

Sources: Average U.S. Retail Price calculated based on pricing on GoodRx.com. PharmacyChecker U.S. Discount Card Price based on availability at pharmacies near Riverside County, California. Lowest Accredited International Pharmacy Price based on prices listed on PharmacyChecker.com.

At accredited international online pharmacies -- verified by the PharmacyChecker Verification Program -- Biktarvy costs 69% less than it does at U.S. pharmacies. For the uninsured HIV patient, the cost is still difficult to swallow.

There are a few programs in place to lift the financial burden, but you most qualify for those programs. Gilead Sciences has a program titled Gilead Advancing Access that provides financial support to patients who meet the criteria. This support comes in the form of a co-pay coupon card (which is limited to patients with commercial insurance) and a patient assistance program (which is specifically designed for uninsured patients). Bear in mind that Medicare Part D generally bars patients from benefiting from drug company-operated assistance programs, as they violate the anti-drug kickback statute.

The federal government also offers assistance to HIV patients via the Ryan White HIV/AIDS program. Through this program, states can operate AIDs Drug Assistance Programs (ADAPs). Find an ADAP that fits your needs at the ADAP directory here. Each state will have different criteria patients must meet in order to be eligible for an ADAP.

Related: How can I save money on Truvada?

What is Biktarvy?

Biktarvy is a combination of bictegravir, emtricitabine, and tenofovir. Each of these active pharmaceutical ingredients are inhibitors; bictegravir is, according to the National Institute of Health, an integrase inhibitor,. Biktarvy is effectively the HIV drug Descovy (emtricitabine/tenofovir) with the addition of bictegravir. According to Biktarvy’s website, the three medications work to lower the “viral load” in patients with HIV. Its website claims patients can lower their viral load to undetectable levels in just 8 to 24 weeks.

Does insurance cover Biktarvy?

Yes. ExpressScripts’ formulary lists Biktarvy as the preferred alternative to the antiretroviral Stribild (elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate). Stribild is more expensive than Biktarvy, though not by a lot. If your insurance uses the ExpressScripts formulary, you will get coverage for Biktarvy, though not for Stribild, if that is what you seek. The FDA approved Stribild in 2012 and has a U.S. average retail price of $4,344.33 per 30 tablets. Like Biktarvy, it does not have a generic alternative.

CVS Caremark covers Biktarvy, but with caveats: The formulary places a quantity limit on the drug, and, if a patient exceeds this limit, prior authorization may apply. According to GoodRx, with commercial insurance, you will pay between $37 and $77 as a co-pay for Biktarvy.

I can’t afford Biktarvy. Can I switch medications to something generic?

Talk to your provider about switching medications if you cannot afford your current prescriptions. Your provider will also likely have resources available at their office to deal with financial hardship related to prescription drugs.

Are there any efforts being taken to make HIV drugs less expensive?

There are a number of bills on deck which pledge to fight drug prices, including the Elijah Cummings Lower Drug Costs Now Act. Senator Bernie Sanders introduced one in 2019 titled the Prescription Drug Price Relief Act. The 2020 Covid-19 crisis has placed these bills (along with a host of other legislation) on hold.

What’s the deal with Gilead Sciences?

Okay, Seinfeld. Gilead Sciences is a pharmaceutical company based in California with a bit of a reputation. Most recently, in 2020, Gilead Sciences filed for Orphan Drug status of the experimental COVID-19 treatment remdesivir. The company relinquished this designation after the public rightfully vilified the company. (The orphan drug status would have given the company market exclusivity of the drug for seven years. This meant the drug likely would have been expensive, as Gilead would hold a monopoly over it and remdesivir would be in very high demand.)

In other news, Gilead Sciences is currently embroiled in a legal battle with the U.S.Centers for Disease Control and Prevention over patents for the HIV prevention drug Truvada, a form of pre-exposure prophylaxis (PrEP). The gist of the legal battle is this: Gilead claims it lent compounds for Truvada to the CDC for research purposes, and the CDC allegedly signed a contract promising to notify Gilead if the department applied for any patents related to the resultant research. In November of 2019, the HHS (Department of Health and Human Services) sued Gilead for damages, claiming that the company infringed on HHS patents for Truvada and Descovy, another HIV drug. A press release from the HHS reads as follows:

“In the complaint, HHS alleges that Gilead has willfully and deliberatively induced infringement of the HHS patents. The complaint further alleges that, as a result of such infringement, Gilead has profited from research funded by hundreds of millions of taxpayer dollars and reaped billions from PrEP through the sale of Truvada® and Descovy®.”

Effectively, HHS is stating that the government owns the patents for these drugs, as the government did the research for them.

In 2020, Gilead sued right back, claiming breach of contract. The important part of this battle is this: If HHS owned the patents to Truvada and Descovy, both drugs would be cheaper. As Gilead fights this legal battle, it can still charge higher prices. Thanks, Gilead!

Where is Biktarvy manufactured?

According to packaging published by the National Institute of Health, Biktarvy sold in the U.S. is manufactured for Gilead Sciences in Germany.

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