Referencing the latest figure from the National Alliance of State and Territorial AIDS Directors (NASTAD), as of February 23, 2012, 4,251 individuals across 11 states are on the AIDS Drug Assistance Program (ADAP) waitlist. These are individuals who are uninsured or underinsured who have received an HIV+ diagnosis, and are unable to properly attain the drugs they need to remain alive, healthy and productive.
In support of the following letter sent to Gilead from the Fair Pricing Coalition, and signed by individual members, the FPC outlines its concerns, and requests specific actions be taken by Gilead. Any interested individual or organization is welcomed, and encouraged to sign on. Please share WIDELY across your networks:
It is essential that Gilead understand the negative impact of their actions on people living with HIV/AIDS (PLWHAs). Since 2009, Gilead has raised prices three times each for Viread and Truvada for a total of 22.1% and 24.5% respectively; twice for Emtriva for a total of 15.3%,and agreed to four price increases on for Atripla, totaling 21%, and agreed to a 7.3% price increase for Complera. These increases are dramatically higher than the rate of inflation. They also come at a time when many people with HIV have lost their jobs, their employer-based insurance coverage and, in many instances, their ADAP coverage, all resulting in desperate patients attempting to access HIV drugs on the open market, a market plagued with constantly increasing drug prices.
As U.S. economic stagnation persists, PLWHAs continue to lose jobs, income, health care benefits and ADAP coverage. At the same time, third party payers are imposing higher premiums as a direct result of escalating drug prices. Some patients have abruptly stopped treatment because they can no longer afford their medications. Although PAPs exist to help people who cannot afford medication, barriers to access are significant. Many people are unaware of the existence of PAPs. Others cannot cope with the labyrinth of multiple forms and requirements. Even with Gilead's PAP eligibility at 500% of the Federal Poverty Level, a PLWHA earning $56,000.00 annually is not PAP eligible and will have to pay $20,000.00 or more to purchase Atripla at retail prices. This figure represents at least two-thirds of their net income.
The pharmaceutical industry's extravagant price increases reverberate throughout the healthcare industry. They come at a time when many ADAPs are covering private insurance payments for their clients and result in ADAPs paying significantly increased premiums as a result of exorbitant price increases. This policy also results in higher premiums for people with HIV who are insured at a time when more and more people have less and less income due to unemployment, underemployment, reduced wages and reduced hours. Moreover, higher healthcare costs mean higher co-pays and pharmacy deductibles for people with private insurance and high share-of-cost plans which also result in increased costs to patients as well as decreased benefits. More restrictive access within insurance plans affects the cost of drugs, but also ancillary services, such as mental health, prevention healthcare, rehabilitation and substance abuse services.
Escalating costs for private and employee healthcare plans occasioned by continuous drug pricing increases will undoubtedly have a deleterious effect on the states as they design their health care exchanges in preparation for the 2014 implementation of the Affordable Care Act (ACA). Many states are likely to set a minimum standard for drug coverage for their "essential health benefits" package that requires only limited coverage of antiretrovirals and other higher cost drug classes. Additionally, with non-preferred generic antiretrovirals entering the marketplace we are concerned that higher drug prices will increasingly result in key coverage decisions being driven by cost rather than the standard of care for HIV treatment.
Much of this crisis is occasioned by irresponsible pharmaceutical industry behavior. We firmly believe that Gilead's price increases are particularly egregious because Gilead currently has the lion's share of the antiretroviral market.
We believe that the best way to begin to address these issues is for industry to change its price increase practices and agree to the following:
- Gilead must agree to take no more than one CPI consistent price increase annually.
- Gilead must use its sales force to disseminate information regarding its PAP and co-pay programs.
- Gilead must contribute to foundations that provide co-pay program access to Medicare Part D clients.
- Gilead must cooperate with the FPC and other stakeholders in designing and implementing a seamless, industry-wide standardized PAP criteria and enrollment process.
Now is the time for Gilead to reconsider its price increase policy and rescind its latest unreasonable price increases. The FPC, its members and the undersigned sincerely hope that Gilead will agree to the above and we look forward to your immediate response.