Bracing for generics to big-selling HIV prevention drug Truvada, Gilead Sciences is working to switch patients to its new option, Descovy. But the new med's additional benefits aren't worth the huge premium over cheap Truvada copies, researchers say.
Payers shouldn't cover more than $9,000 of Descovy's $16,600 list price, their study found, though Gilead disputes their methods.
For the study, experts from Massachusetts General Hospital and the Yale School of Public Health calculated Descovy's cost-effectiveness based on publicly available data. They aimed to determine how much of a premium the drug should command over Truvada generics, which are expected to launch in September.
The group made assumptions in favor of Descovy but “found no plausible scenario under which [Descovy] would be cost-effective compared to generic [Truvada], except perhaps for the vanishingly small number of persons with exceptionally high risk of bone or renal disease," lead author Rochelle Walensky said in a statement.
The team acknowledged they don’t know the price of generic Truvada yet, but they suggested a markup for Descovy of $670—at most—over the Truvada generic. They say insurers shouldn’t pay more than $8,970 per year for Descovy, compared with its sticker price of $16,600.
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Gilead "strongly believes that the analysis … is flawed, leading to inaccurate conclusions that severely underestimate the value of Descovy," a spokesman said.
The drugmaker faulted the group's methods and said the researchers used "incomplete clinical data" and made assumptions around pricing for generic Truvada. Together, the work is "inadequate to enable a sufficiently robust analysis," Gilead's spokesman said.
Following Descovy's approval in October to prevent HIV in men who have sex with men and transgender women, Gilead has been recommending doctors switch patients to the newer option by touting better safety data, the researchers say.
The group is worried that the company’s push to market Descovy as the better PrEP option might discourage use of Truvada once it goes generic, ultimately hurting uptake. A lot in sales are at stake as well; Truvada generated $2.6 billion in the U.S. last year.
Tim Horn, a study co-author, said the generic launch is a “golden opportunity to expand access to PrEP in some of the most difficult-to-reach segments of the at-risk population." Teva Pharmaceutical is set to launch a Truvada generic in September thanks to a patent deal with Gilead.
Gilead pushed back at the notion that another option will hurt access.
"Increasing options for those considering PrEP would be important to support higher uptake among individuals at risk, and higher PrEP use among those at risk for HIV will move us closer to our shared goal of ending the HIV epidemic," the company's spokesman said.
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So far, Gilead has had success converting patients to its newer option. Data through the end of February show the company “has already converted over 27% of the PrEP market to Descovy, and the trends indicate Gilead may be able to reach its higher-than-expected goal of 40% to 45% conversion,” RBC Capital Markets analyst Brian Abrahams wrote in a Friday note to clients.
Gilead has also partnered with the Department of Health and Human Services on a free drug program after agreeing to donate 2.4 million bottles of PrEP medicines annually for 10 years.