February 19, 2015
By Mark Terry, BioSpace.com Breaking News Staff
Foster City, Calif.-based Gilead Sciences, Inc. has come under fire recently for it’s lack of promotion of its HIV drug for pre-exposure prophylaxis (PrEP). Although it doesn’t focus its marketing efforts much on PrEP, Truvada brought in $1.79 billion in the U.S. last year, mostly for HIV treatment.
Gilead has responded by indicating that PrEP is not a particularly strong profit area, so its sales force doesn’t spend much time on it. The company says that 42 percent of PrEP prescriptions written up to March 2014 were for women. Only 7.4 percent were for men younger than 25. Generally speaking, PrEP would make sense for young gay males, who have the highest rates of HIV diagnosis each year.
From January 2012 to March 2014, Truvada was prescribed 3.3 million times. Of those, only 3,200 were for PrEP.
Other factors are that insurance companies often have copays as high as $1,300 for the medication. Peculiarities related to HIV treatment and who are the primary physicians treating it is also a factor.
“There’s a circle of pointing fingers,” said Jim Pickett, director of prevention advocacy and gay men’s health at the AIDS Foundation of Chicago in a statement. “HIV specialists are like, ‘I don’t see HIV-negative people,’ and you see a primary care physician, and they say, ‘You need to see a specialist.’” Some physicians might recommend wearing a condom as opposed to going on a medication that requires regular liver enzyme testing and may not be reimbursed by insurance.
But apparently a major factor is general practitioners, who would be most likely to treat non-HIV infected patients interested in PrEP, are often unaware of the drug.
Truvada was approved for HIV treatment in 2004. The drug received approval for expanded use for PrEP. If taken daily, it can avoid HIV infections 92 percent of the time.
Gilead offers a PrEP Medication Assistance Program for eligible HIV-negative adults in the U.S. who don’t have insurance or who are underinsured. The assistant program offers up to $300 per month.
Truvada works by blocking reverse transcriptase, a protein that allows cells infected with HIV to make copies of the virus. An epidemiologist at the University of California San Francisco, Susan Buchbinder, who works with the San Francisco Department of Public Health, indicates that the female users of Truvada for PrEP are possibly married to HIV-positive partners and are trying to get pregnant.
The nature of the criticism is unusual—a pharmaceutical company being criticized for not marketing enough. Gilead “does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP,” said Gilead spokeswoman Cara Miller in a statement.
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