Rochelle Walensky, MD, MPH: HIV Costs, Present and Future

Rochelle Walensky, MD, MPH, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School: It's interesting, right now in the US $34,000 a year is a very cost effective intervention for HIV, and that is because you take people who would otherwise die of this disease, quite literally, young people you put them on an expensive, relatively expensive, regimen and they live very good, very productive, very healthy lives, that is a very cost effective intervention. When you think about introducing alternatives, like something that might work a little bit less well but much less costly, like maybe a generic intervention, then all of a sudden your generic regimen looks very cost effective and your branded regimen looks not as cost-effective. The problem is we've never been in a space where it has been a policy to suggest a branded regimen. So right now antiretroviral therapy is in fact very cost effective. It's cost effective here, it's cost effective in resource-limited settings where the prices are much less but with an alternative that's a cheaper regimen, we've never been sort of tried on that.

This is a complex situation when you sit in a room with the Fair Pricing Coalition and Medicaid officials and patent attorneys. If trying to understand how drugs are priced nevermind nationally, but how those vary by state is really complex and humbling I will say. So this is not gonna be an easy fix, and I would also note 1 point that I made in the talk was about 340b programs. So we in HIV actually benefit a bit, or a lot, from 340b programs. So 340b programs are programs that allow clinics that take care of vulnerable patients to buy antiretroviral drugs at a very decreased cost, get reimbursed by the insurance company at the full cost, and sort of benefit from the margin. That margin is often used to fund caseworkers, social workers, extra care for our patients, and without that margin we in fact might very well not be doing as well by our patients. So we are in a way feeding the problem, by benefiting from the 340b program. So before we sort of say we really need prices to go down, let's really look at what's gonna happen to us, and our patients, and our clinics, and maybe we are actually part of the problem here as well.