Cost Will Be Massive Barrier in Access to Lenacapavir After Approval in the US: Gordon Crofoot, MD, PA

Cost could make lenacapavir (Sunlenca; Gilead) inaccessible for people who would like to use it as a means of pre-exposure prophylaxis (PrEP) in the prevention of HIV, explained Gordon Crofoot, MD, PA, president and principal investigator at The Crofoot Research Center. Although the treatment is nearly 100% effective, the price point could make rollout slow in vulnerable populations.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

Will there be barriers to accessing lenacapavir in the United States?

The biggest problem with lenacapavir involving...the use of the drug is finances. We have this huge barrier of finances to using PrEP. This drug, twice a year, costs for treatment in the United States $40,000 to $42,000. $40,000 to $42,000 for this drug. That's a huge barrier. It's a barrier when the drug is approved on [June] 19.

I'd like to say it's approved on [June] 19, and we'll have thousands of people on the drug by the next day. Not going to happen. It's not going to be covered by insurance. A lot of insurance companies won't look at it quickly. Some insurances don't even look at a new drug for 12 months. And yeah, this is 100% effective. That means maybe you ought to look at it, but the insurance companies aren't going to look at it quickly.

Depending on how the FDA approves it, they may say, "Okay, we're not going to pay for this. You have to use Truvada [emtricitabine/tenofovir; Gilead] first, and then if you can't use Truvada correctly, you might get infected, but if you can't use it correctly, then maybe we'll consider giving lenacapavir as an option. But it's too expensive. We're not [going to] approve it now." Getting it approved is [going to] be a problem. Getting it approved for the general population is going to be a problem even though it's 100% effective.

Many countries in the world will be able to access this fabulous drug [that is] twice a [year] injection that works great without worrying about adherence. In those countries, they work well. That's not going to happen in the US quickly. I don't know; it's going to be a problem for me as a provider. It's going to be a problem.

I love the drug. I've loved the drug from the beginning. I love the way it works. I love that it's easy to use, [is] long acting, [and] doesn't have side effects, but it's going to be hard for me to use this drug for PrEP initially, with the finances at $40,000 [to] $42,000 a year. That's going to be the biggest problem to getting this drug going.