In the early days of the AIDS epidemic, people were desperate for a treatment. No AIDS medication price would have been too high. Unfortunately, there were no medications available for the first many years of the epidemic, and many people died from HIV.
This virus became a priority for research funding, and effective HIV treatments were developed. Now, a diagnosis of HIV is no longer a death sentence. In fact, many people live long lives with the virus, as long as they’re diligent about taking their medications.
Although these medications are certainly lifesaving, many people worry about being able to afford them. The average annual cost of HIV treatment is fairly high, and can be out of reach for some people. Fortunately, there are resources available to help with this.
Why are HIV drugs so expensive?
Antiretroviral medications, sometimes known as the “HIV cocktail” or “AIDS cocktail,” generally cost a fairly significant amount of money. The specific HIV drug prices can vary in different parts of the country, in different pharmacies, and even from day to day, because each pharmacy sets its own prices for prescription drugs. However, the annual cost of HIV treatment can easily be many thousands of dollars.
This is in part because of the huge amount of scientific research that was needed to develop these drugs. Drug companies want to recoup the costs of this effort. In addition, many HIV drugs don’t yet have generic versions. This keeps the prices high, since only one company is allowed to sell the drug until it goes off patent and cheaper generic versions can be manufactured. Additionally, patients generally need to take multiple different medications in order to keep the virus under control, and they must take these daily for the rest of their lives. The costs for all of these different drugs add up.
While all of these factors play into the cost of HIV medication, the truth is that prescription drug prices in the US are very complex, and specific prices are often confidential. Many people are concerned about the high average cost of HIV treatment, and are working to address the problem and ensure that treatment is accessible to everyone who needs it.
Does insurance cover HIV medication?
Under the Affordable Care Act (ACA), health insurance is required to cover certain services, including all medically necessary care for people with HIV. This includes ART to keep the viral load at a low level. Before the ACA, HIV could be considered a preexisting condition, and so sometimes people with HIV found that their treatments weren’t covered by their insurance. The ACA prevents insurers from denying coverage for preexisting conditions, and so people with HIV will have their treatment covered.
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Is HIV medication free?
Although it’s mandatory for health insurance to cover HIV medication, this doesn’t mean that the medications are free. Even with insurance, there are usually co-pays and deductibles, and so the medications will generally not be entirely free. There will be some cost to the patient. Keep in mind that taking ART diligently can allow you to have a normal lifespan even with HIV, so it’s absolutely worth paying the cost of these medications. If you don’t take ART, then your HIV will almost certainly eventually progress to AIDS, and the cost of AIDS treatment can be very high, not to mention the lost years of life.
For the uninsured, particularly those of low income, the price of HIV medications may simply be out of reach. Fortunately, there is help available. A program called the Ryan White HIV/AIDS Program helps to provide HIV medications for people with low incomes. Medicaid is also an option for many low-income people, and it will cover the HIV/AIDS medicine cost.
Is HIV PrEP free?
If there was an HIV/AIDS vaccine, price would be no issue. Many people would be willing to pay a high price to be protected against this virus. Unfortunately, despite many years of research, we don’t yet have an HIV vaccine, although progress is being made.
The closest thing we currently have to a vaccine is pre-exposure prophylaxis, or PrEP. This involves an HIV-negative person taking HIV medications, and it has been shown to reduce transmission rates by 99%. For people at high risk for HIV infection (such as HIV-negative people whose partners are HIV-positive), taking PrEP is strongly recommended.
In 2019, the US Preventive Services Task Force issued the highest level of recommendation for PrEP for certain people at high risk for HIV infection. Because the Affordable Care Act requires that insurers cover preventative care at no cost to patients, this recommendation means that PrEP is required to be provided for free to people who meet the requirements.
In order to qualify, you will need to get an HIV test to prove that you’re currently HIV-negative. This test is not necessarily covered, so you may need to pay for it. HIV tests can be performed in a clinic, or at home using a small blood sample obtained through a fingerprick.
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Sources
The Affordable Care Act and HIV/AIDS. US Department of Health and Human Services (2022). https://www.hiv.gov/federal-response/policies-issues/the-affordable-care-act-and-hiv-aids. Accessed 24 March 2022.
Cost Considerations and Antiretroviral Therapy. US Department of Health and Human Services (2021). https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/cost-considerations-and-antiretroviral-therapy. Accessed 24 March 2022.
Owens DK, Davidson KW, et al. Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA 2019 Jun 11;321(22):2203-2213. doi: 10.1001/jama.2019.6390.
Paying for HIV Care and Treatment. US Department of Health and Human Services (2022). https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment. Accessed 24 March 2022.
PrEP Facts & HIV Prevention. Society of Behavioral Medicine (2022). https://www.sbm.org/healthy-living/prep-facts–hiv-prevention. Accessed 24 March 2022.
Progress Toward an HIV Vaccine. National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov/sites/default/files/hivvaccineinfographic.pdf. Accessed 24 March 2022.
Way MT, Ingle SM. Life expectancy of HIV-positive adults: a review. Sex Health 2011 Dec;8(4):526-33. doi: 10.1071/SH11046.
