On World AIDS Day, Advocates Mark "Tipping Point" Amid Complaints About Drug Prices in US

On World AIDS Day, advocates mark "the beginning of the end" of the pandemic. In the United States, 2014 has been marked by battles between patient advocacy groups and some payers over the price of generic HIV drugs on exchanges under the Affordable Care Act.

Today is World AIDS Day, set aside to draw attention to, and take stock of global efforts to combat human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). There is hope this year among advocacy groups, expressed in this year’s theme, “Focus, Partner, Achieve: An AIDS-Free Generation.”

Worldwide, the President’s Emergency Plan for AIDS Relief (PEPFAR), launched under President Bush and continued under President Obama, has brought antiretroviral therapy to more than 11.7 million in poor and middle-income countries, and has particularly made a dent in the transmission of HIV from mothers to unborn children, according to this week’s issue of the CDC’s Mortality and Morbidity Report, the document that reported the first AIDS cases on June 5, 1981.

There’s been enough progress for a major worldwide advocacy group, ONE, to declare that the public health community has reached a tipping point, “the beginning of the end of AIDS,” marked by the fact that there are more people with access to therapies than are contracting the disease.

AIDS has claimed nearly 648,500 lives in the United States since 1981. CDC reports that 50,000 persons become infected each year, and 1.2 million are living with the disease. Today, most new infections occur in Africa, where AIDS remains a major health threat despite progress in recent years. A difficult challenge in the United States and other developed countries, especially among teens and younger adults who do not remember the frightening early years of the disease, is the complacent attitude about prevention, as better therapies have rendered HIV a chronic condition for many patients.

That care is not without cost, and the major stories about HIV and managed care for 2014 involve the battles between patients and their advocacy groups and health plans that have tried to place generic HIV drugs on higher-priced specialty tiers, creating huge out-of-pocket costs for HIV-positive patients who might be getting insurance for the first time through the Affordable Care Act. Complaints have led to a federal civil rights complaint, and on November 21, 2014, a second Florida insurer, Coventry Health Care, joined Cigna in setting a $200 out-of-pocket cap as part of a settlement to avoid litigation.

On the global front, today AbbVie added 2 HIV drugs to the non-profit Medicines Patent Pool (MPP), which seeks to speed development and distribution of pediatric HIV/AIDS drugs in the developing world. MPP has previously reached agreements with Bristol-Myers Squibb, Gilead Sciences, Roche, and GlaxoSmithKline’s ViiV Healthcare. The agreement covers 102 countries where MPP does not have patents.

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