Gilead Sciences ($GILD) is no stranger to criticism. Consider the years-long outcry over HIV and hep C drug prices. But now the California-based company finds itself in a strange--yet somehow familiar--spotlight. At a time when the pharma industry is drawing fire for marketing its drugs to doctors, Gilead is drawing fire for not marketing enough.
The issue is Truvada, Gilead's HIV treatment that's also approved to prevent infection with the virus. It's the only drug blessed by the FDA for that use. It's backed by the U.S. Centers for Disease Control and Prevention (CDC) for pre-exposure prophylaxis, or PrEP.
But more than two years after that much-publicized approval, a year after the CDC recommended its routine use, few at-risk people are actually taking Truvada. In fact, as Bloomberg reports, only 3,200 Truvada scripts were written for prevention through March 2014.
For that, you can blame Gilead, or so say some AIDS community activists. Truvada is costly, with high copays for many patients--that's an obvious barrier. But Gilead chose not to market the drug for preventive use. So, not only do many primary care doctors have no idea about Truvada-as-prevention, but those doctors also don't know about Gilead's patient assistance program, which helps most Truvada users get their monthly costs down to about $25.
So, as Bloomberg notes, it's patients and community activists who are educating docs about preventive Truvada use, and that's a catch-as-catch-can process.
HIV specialists are the backbone of Gilead's prescriber base. Its sales force focuses on those docs. But using Truvada to prevent infection means prescriptions would go to patients who don't see HIV specialists--because they're not infected. And Gilead has decided not to trot out its Truvada promotions for primary care docs.
Gilead "does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP," spokeswoman Cara Miller told the news service.
Gilead does fund educational efforts in the community, but advocates figure PrEP would spread faster if Gilead took the story to primary care docs. Its sales reps can reach providers who aren't "in the HIV bubble," said Jim Pickett of the AIDS Foundation of Chicago. "[A]nd if they would engage with them around Truvada as PrEP, we'd have a lot more providers aware and educated."
So there you have it. A drugmaker in the dock for backing away from marketing its product. Yes, Gilead has done so for business reasons--and that may have as much to do with the fact that preventive Truvada is still somewhat controversial as it does with the cost of fielding a sales force at the primary care level. In fact, some skeptics have gone so far as to lobby CDC to stop supporting PrEP and return to pushing condoms. Some activists figure Truvada users would just stop using condoms altogether.
- read the Bloomberg piece