The world of HIV prevention medications is still relatively new. In 2004, Truvada roared onto the scene and drastically changed the future of HIV. While the medication was initially used to treat HIV, in 2012 the FDA approved its use as a form of pre-exposure prophylaxis (PrEP), a daily prescription medication that prevents HIV infection.
Some Background on PrEP
When taken as prescribed, Truvada is 99% effective at preventing sexually transmitted HIV infection. It has been shown to potentially cause decreased kidney function and a small amount of bone loss in some individuals. Though studies indicate these side effects are slight, they present a barrier for people with pre-existing renal and bone density issues. Descovy, an updated form of PrEP, was introduced last year with research showing kidney and bone safety improvements over Truvada.
Truvada and Descovy are both patented and manufactured by Gilead Sciences. Both are considered highly effective, safe, and well-tolerated by most PrEP users. While Descovy is less likely to cause unfavorable changes in kidney and bone blood tests, Truvada has been shown to have a more favorable impact on blood fat levels and lead to less weight gain. The FDA has not yet approved Descovy for cisgender women or transgender men—more studies are still needed. Those who are uncertain which medication is right for them should discuss the options with their healthcare provider.
For more on PrEP, read “All about PrEP for HIV Prevention.”
A New Milestone for PrEP
This October, a generic version of Truvada became available in the United States for the first time. Why the delay? When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. Now that Truvada’s exclusivity period has ended, manufacturers with generic alternatives may seek approval from the FDA.
Teva Pharmaceuticals was the first manufacturer to receive FDA approval for a generic version of Truvada. More generic versions will likely follow in 2021, increasing competition and driving down the price.
Curious about how medication versions work? Read “What’s the Difference between Generic and Brand-name Medications?”
What Does This Mean for PrEP Users?
By lowering the cost of PrEP, the emergence of generic Truvada will ultimately put less strain on the U.S. healthcare system and help make PrEP more widely accessible to those at risk of HIV infection. Those who switch to generic Truvada will likely see their out-of-pocket costs decrease; however, there may be consequences for people who prefer Descovy—the newer formulation of PrEP.
In the wake of generic Truvada’s arrival, some insurance companies have decided to stop covering Descovy due to higher costs. While the two forms of PrEP may well be interchangeable for many patients, Descovy is not identical to Truvada. A small subset of people may have less desirable outcomes if compelled to switch versions by their insurers. People who need or prefer Descovy, especially because of preexisting renal or bone density issues, will likely need to obtain prior authorization approval and could face higher out-of-pocket costs.
At Alto, we specialize in handling prior authorizations and performing thorough cost savings investigations. If we notice a change in your out-of-pocket cost, we’ll let you know, and we can work to identify ways to save you money. Here’s a closer look at how your pharmacy, healthcare provider, and insurance company work together to manage your prescriptions.
How Insurance Companies Manage Medication Costs
Unsurprisingly, insurance companies tend to favor the cheapest version of a medication with similar efficacy. One way insurers encourage less expensive alternatives is through prior authorizations—a restriction that requires doctors to request that the insurance company cover certain medications. Not every prescription is subject to a prior authorization, but it’s commonly used when a doctor prescribes a brand-name drug with a generic available. The doctor must prove to the insurer why the specific version they prescribed is medically necessary.
In most cases, prior authorizations are intended to ensure the safest and most cost-effective medication is used. However, they often require extensive paperwork and multiple phone calls from doctors’ offices, which can become a drain on time and resources for busy offices and clinics or cause delays in getting your prescription.
For more on how the process works, read, “What is a Prior Authorization?”
Alto is on Your Side
Finding out that you need a prior authorization can feel daunting, but the right pharmacy partner will navigate the complexities for you. At Alto, we proactively file prior authorizations when they’re needed, taking the weight off the shoulders of both you and your doctor. We have a dedicated support team that works closely with your doctor’s office to obtain approval from your insurance company, and we’ll keep you updated throughout the whole process.
After securing approval, we’ll conduct a thorough price investigation to identify sources of financial assistance and ensure you're getting the lowest possible price. We do all of this at no cost to you—we believe everyone should have access to the medications they need at an affordable price.
If you’re concerned about continued coverage for your preferred form of PrEP, we’re here to offer support. Our HIV specialists and care team are available to answer your questions 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends. Download the mobile app for secure messaging or call 1-800-874-5881.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
