St. Augustine doctor: HIV could end if ‘Big Pharma,’ health insurance weren't so greedy

It happens much too often. Someone is exposed to HIV and we have 72 hours to get their medication started. Post-exposure prevention can stop HIV from taking hold if it’s started in time. In Florida, pharmacists can start this medication, so people don’t have to wait to see a provider or spend the money on an office or emergency room visit.

Pharmacists can order the HIV testing as well. So why do people still have difficulty getting their treatment started so they can avoid catching HIV in the first place?

Large pharmaceutical manufacturers are the first culprit. The medications for post-exposure prevention are made by Gilead Sciences, Viiv and Merck. Only half of the two-pill treatment comes in a generic formula, so people must pay brand-name prices.

They are also incredibly expensive, ranging from $2,000 to over $3,500 per month.

These are life-saving, emergency medications but "Big Pharma" companies refuse to make them available at an affordable price. That means people must choose between wiping our their savings, maxing out their credit cards (if they have enough savings or available credit) or getting an illness that will kill them.

Additionally, it’s often impossible to get the medication within the necessary 72-hour window. The pharma companies sell these medications to pharmacies in 30-units that must be dispensed all together. This means that pharmacies can’t keep a few individual doses on hand to get someone started on time while insurance is straightened out or the remaining course of treatment is delivered.

It’s too expensive for pharmacies to keep these medications on hand if they may expire before they can be dispensed. However, manufacturers won’t let pharmacies exchange these meds for some that won’t expire and transfer the older ones to be used at a busier pharmacy that is sure to dispense it quickly.

Health insurance doesn’t help either, requiring patients to pay the $2,000 to $3,000 out-of-pocket as part of the deductible. Even if their deductible is met, there is still a substantial copay. These medications are necessary, life-saving and preventive. Health insurance should cover them with no deductible or copay.

Apparently, they’d rather let people get HIV first, then incur all the costs of testing and treatment going forward, which makes health insurance costs go up.

National and state leaders must make a conscious decision to end the HIV epidemic . Every state should allow pharmacists to order labs and dispense the post-exposure prevention medication without the patient needing to visit a provider.

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The federal government should also take over these medications, all of which were developed with substantial support from the CDC and federal grants to university researchers. Additionally, the pharmaceutical industry must be regulated and required to make these meds available and affordable.

Every pharmacy must be able to have enough medication on hand to get people started on the treatment while getting the full course of medications delivered to the pharmacy. Then every person exposed to HIV can get the life-saving medication they need within the 72-hour window necessary for it to be effective.

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Plus, health insurers should be required to cover the cost of these medications (which should be markedly less than they currently are) with no deductible or copay.

Let’s end this epidemic so we no longer need to worry about it. Making pre-exposure prevention (daily pills or bimonthly shots to prevent HIV) affordable and available through pharmacies, telehealth and health departments, as well as post-exposure prevention, will allow us to move forward with HIV in our rearview mirrors.

Julie Graves, M.D., family medicine physician, St. Augustine

This guest column is the opinion of the author and does not necessarily represent the views of the Times-Union. We welcome a diversity of opinions .

This article originally appeared on Florida Times-Union: St. Augustine doctor: HIV could end if ‘Big Pharma,’ health insurance weren't so greedy