When Unrestricted Capitalism Meets the Pharmaceutical Industry
The True Cost of HIV Treatment Drugs in the U.S.
The United States has a long and vast history of inaccessibility of HIV treatment drugs. Since the beginning of the AIDS crisis, activists have fought to be able to get treatment how and when they want. One of the most famous examples is when ACT UP effectively closed the Center for Disease Control (CDC) headquarters on October 11, 1988 in protest. ACT UP stands for the AIDS Coalition to Unleash Power which was a direct activism group founded in 1987 in New York City. At the time, there were only two drugs approved for patients: AZT for AIDS patients, and Bactrim for PCP, which is an opportunistic infection that is frequently found in HIV patients. The group asked for the CDC to speed up the drug testing process, as people were dying of AIDS while waiting for drugs to be approved. One of the biggest goals of the group was to get “drugs into bodies.” ACT UP took matters into their own hands and demonstrated outside the CDC headquarters to send a message. Their “healthcare is a right” message was heard and shortly after, more drugs were approved for treating people with HIV (1).
Since the mid 1990s, there has been an FDA approved multiple antiretroviral therapy for people with HIV. With the right “pill cocktail,” an HIV patient’s t-cell count can be kept at a low level indefinitely so the person’s t-cell count never drops below 200 cells per microliter of blood and develops into AIDS. This was an enormous breakthrough in the medical field and in the PWA (person with AIDS) community. However, in the United States, it is incredibly expensive to be on this regimen. Each of the medications alone can cost upwards of $4000 a month and users can be on multiple different kinds at once (2). This makes these incredibly effective treatments inaccessible to many people.
As of 2015 in the United States, approximately 9% of the US population is uninsured (3). Of those under care for their HIV, about 14% are uninsured (4). However, only 37% of people with HIV are in care for it, and only a third have been prescribed an antiretroviral treatment for it (5). For many, the obstacle of cost makes it impossible to even see a doctor in the first place, which is why some people may be unknowingly spreading the virus. Even pre-exposure prophylaxis medication (PrEP) -which prevents HIV negative users from contracting HIV- costs about $1300 a month if not covered by insurance (6).
The cost of these pharmaceutical drugs is astronomically high in the United States, but what are other countries paying for the same drugs? The United States has some of the highest out-of-pocket payments for medical treatment. In India, the government pays for antiretroviral treatment for HIV patients at a per person cost of between $75 and $450 USD per year (7). Compare that to the average US HIV treatment cost of between $24,000 and $60,000 (8).
The real question is what is causing such a disparity in price? Why does the US charge more for the same medicine? The reason is not particularly simple, but it can largely be boiled down to an issue of our broken insurance system and capitalism.
The first problem in the drug cost equation is insurance. The American insurance system is convoluted and largely privatized. Many people get insurance through their work, and some get it through government assistance programs like Medicaid. However not every person has insurance, and until the individual mandate requirement was introduced with Obamacare, having health insurance was not required.
Many European countries have single payer healthcare, a system where everyone is guaranteed healthcare through their government by paying into the system through their tax dollars. Countries such as Great Britain, France, Sweden, Denmark, Germany, and Italy (to name a few) all provide healthcare for no out-of-pocket cost to their citizens. This means that in most of the industrialized world, healthcare is a right, however this is still not the case in the United States. Without easy and affordable access to basic healthcare needs, many people die before they’re able to get see a doctor about their ailments. Then if the person does get seen while uninsured, they can expect to pay for the services out-of-pocket which can cost hundreds or even thousands of dollars for a visit with a provider and testing.
The second piece of the equation in pharmaceutical pricing is that the United States does not limit how much a drug company can charge for medications. Medications can cost a few cents to manufacture but be sold for over $100 per pill. This is because the drug companies who are making these pills are not regulated for pricing. The companies producing them often have a monopoly on certain medications, if there isn’t a generic version. This is the case with many HIV drugs such as PrEP -brand name Truvada- and Atazanavir -brand name Reyataz- When drug manufacturers set the pricing, they can pick any price they’d like to sell it for because they have no competition if they own the patent on the medication (9).
Drug companies argue that in order to be able to perform higher risk trials and encourage more innovation within the field, they need to have high profit margins. However, many drug companies spend far more on padding their CEOs pockets than they do on research and development. In 2016, the CEO of Astrazeneca Pascal Soriot took home $16.3 million dollars, while the company itself spent only a third of that amount on researching and developing new drugs for the market (10; 11). Stock prices on pharmaceutical companies continue to rise as do the markups on drugs. The price on brand name drugs has increased 127% between 2008 and 2014. There are more profits than ever to be had and the people that are suffering are the ill.
What can be done about this? How can we make medications more accessible? How can we prevent massive pharmaceutical companies from taking advantage of the free market and killing people in the process? First is that we need to view healthcare as a basic human right and not a privilege for the wealthy. ACT UP’s message of “healthcare is a right” is still relevant today. Become involved in politics in the best way you can. Vote for candidates who believe in health care reform. Call your congresspeople and ask what their views are and see if they’re being paid out by drug companies for campaign funding. Find out if your congressperson supports wage caps on CEOs so that profits made from drugs can actually go to research and development of new ones as opposed to buying an executive a new sports car.
Spread the word of how ridiculously overpriced necessary drugs like HIV antiretroviral treatments are. When drug companies get bad publicity for their malpractice they are inclined to lower pricing to combat that. Use your voice however you can. The AIDS crisis may technically be over, however there are still over 18,000 new AIDS diagnoses every year (12). If we change how our country views medicine and healthcare to make it more accessible for all people, we can lower that number.
References:
1. ACT UP/New York FDA Action Handbook 9–12–88. Accessed April 24, 2018. http://www.actupny.org/documents/FDAhandbook1.html.
2. “Cost Considerations and Antiretroviral Therapy Limitations to Treatment Safety and Efficacy Adult and Adolescent ARV.” National Institutes of Health. October 17, 2017. Accessed April 23, 2018. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/459/cost-considerations-and-antiretroviral-therapy.
3. "National Center for Health Statistics.” Centers for Disease Control and Prevention. March 15, 2018. Accessed April 25, 2018. https://www.cdc.gov/nchs/nhis/releases.htm
4. Kates, Jennifer, and Lindsey Dawson. “Insurance Coverage Changes for People with HIV Under the ACA.” The Henry J. Kaiser Family Foundation. February 27, 2017. Accessed April 24, 2018. https://www.kff.org/health-reform/issue-brief/insurance-coverage-changes-for-people-with-hiv-under-the-aca/.
5. The Aids Institute. HIV in the United States: The Ryan White Fact Sheet.
6. Costa-Roberts, Daniel. “8 Things You Didn’t Know About Truvada.” PBS. April 12, 2015. Accessed April 24, 2018. https://www.pbs.org/newshour/health/8-things-didnt-know-truvadaprep.
7. Times, Sanchita Sharma Hindustan. “AIDS Treatment Is Cheapest in India.” Https://www.hindustantimes.com/. December 02, 2011. Accessed April 26, 2018. https://www.hindustantimes.com/delhi-news/aids-treatment-is-cheapest-in-india/story-u2PTiO7sZ41EmopTo3X00M.html.
8. Aguirre, Jessica Camille. “Cost Of Treatment Still A Challenge For HIV Patients In U.S.” NPR. July 27, 2012. Accessed April 24, 2018. https://www.npr.org/sections/health-shots/2012/07/27/157499134/cost-of-treatment-still-a-challenge-for-hiv-patients-in-u-s.
9. “How the U.S. Pays 3 Times More for Drugs.” Scientific American. Accessed April 23, 2018. https://www.scientificamerican.com/article/how-the-u-s-pays-3-times-more-for-drugs/.
10. “AstraZeneca CEO Soriot Counts up £13.4M in 2016 Pay, a 68% Hike.” FiercePharma. March 08, 2017. Accessed April 24, 2018. https://www.fiercepharma.com/pharma/astrazeneca-ceo-soriot-counts-up-ps13-4m-2016-pay-a-68-hike.
11. AstraZeneca. 2017 AstraZeneca Fiscal Report. February 2, 2018. Raw data.
12. “HIV/AIDS Statistics at a Glance.” Centers for Disease Control and Prevention. November 29, 2017. Accessed April 26, 2018. https://www.cdc.gov/hiv/statistics/overview/ataglance.html.
