Rochelle Walensky, MD, MPH: The Future for HIV Drug Prices

Rochelle Walensky, MD, MPH, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School: I think they're still gonna go up. I mean that is where we are, and I think there has to be major policy overhauls for this to happen but I would also say that we should take some responsibility in the academic world, and in the guidelines. One of the examples that I brought up this morning is that if you search the guidelines, be it breast cancer, sepsis guidelines, diabetes, hypertension, whatever it may be, almost all of them are silent on the issue of costs. That is that the guidelines are really written for what could be the best thing for this patient at this point and that I believe, and everybody sort of says to me well what wouldn't you want your mother to have the best thing and that is true, however, it's not perfect policy because in fact when you treat the patient in front of you with the best, most expensive drug, what you're not considering is that by doing so, you may have limited access to a lot of other patients who aren't in front of you. So from a public health perspective, I think we as guideline organizations need to recognize that cost have to be a part of this or the cost will continue to rise. As long as the guidelines continue to recommend the most expensive drugs as first-line therapy, the doctors will continue to prescribe them and the costs will continue to rise.