A major health insurer has notified policy holders that it will no longer cover Gilead Sciences’ drug Descovy for pre-exposure prophylaxis, or PrEP, and will instead require them to switch to Truvada, starting September 1.
UnitedHealthcare sent the notice to members July 31, MedCity News reports. Descovy and Truvada are both made by Gilead, but Descovy, a newer drug, has been shown to have fewer side effects. The Minnesota-based insurer also noted that a generic version of Truvada will be available September 30, and it will be covered with no out-of-pocket cost.
It will make exceptions for Descovy coverage if plan members get prior authorization, but there may be some increase in cost, the notice said.
The move may affect Gilead’s bottom line. The drugmaker had reported that Descovy sales rose from $700 million in the first half of 2019 to $875 million in the same period this year, all due to U.S. sales for use as PrEP after the drug was approved for that purpose last October. The increase helped make up for decreases in other sales in the second quarter of 2020, Gilead reported.
Gilead officials told MedCity News they do not comment on specific arrangements with insurers but released this statement: “Attempts to reverse or interfere with decisions already made by patients and providers may further complicate an individual’s decision to use PrEP and jeopardize ongoing efforts to curb new HIV infections and end the epidemic.”
However, a doctor told the site that the action may result in wider use of PrEP, given that there will be no out-of-pocket cost for generic Truvada. “If I had to make a choice, and I had a bucket of money to spend to prevent HIV in the United States, and I’m the New York City health department or New York Medicaid or any other struggling healthcare payer, I think that from a population perspective, offering more people a lower-cost drug at zero cost sharing is a trade-off I’d be willing to make for this change,” said Dr. Mark Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design.
He added, however, that “there will be some people, because the drugs are not identical, who will not have desired outcomes that they would have achieved on the branded drug.”