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Comment by chimeracoder | Hacker News Reader

> but in the United States it remains quite expensive if you don’t have insurance.

Not really - Gilead provides assistance programs for people who have private insurance, for people on public insurance, and for people who are uninsured (there are three separate assistance programs). The plan for people who have private insurance is the best (you end up paying $0/year for PrEP), and the plan for people who are uninsured is pretty good (not $0/year, but still pretty affordable).

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I have personally paid $1700 out of pocket for a month’s supply of PrEP, despite insurance AND membership in Gilead’s “advancing access” co-pay assistance program.

Gilead intended the program to cover about $300/mo, in order to cover your co-pay until your deductible is satisfied. That worked fine until this year, when UnitedHealthcare decided to re-class my card from co-pay assistance to a “manufacturer’s coupon” — thus accepting Gilead’s money while it lasted but still expecting me to pickup the full tab until my deductible.

The prices were similar here in Australia, friends who are on it were given instructions by their doctor on websites in South Africa and a particular brand name to purchase along with a prescription to get around it. Generic version but equally as effective. I believe now it is on the PBS here!

Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us.

> Ah perhaps I have stale information then. Last I heard retail truvada will run you north of $1,500 per month in the us.

The sticker price is meaningless. Because of the assistance programs, nobody needs to pay it, whether you're on private insurance or uninsured.

Serious question: what's the point of the sticker price then? Surely someone must be paying it, right?

If not, why not lower it for -- at a minimum -- a PR boost?

The manufacturer charges a higher price to the insurer and pays for the consumers copay so they are not impacted by price sensitivity. Kind of like business travels tend to spend more because it is the companies money vs their own. If the copay is too high, consumers might shop for cheaper alternatives instead of the "latest and best".

The sticker price is negotiating leverage for use against organisations with money, the insurance companies and Medicaid and Medicare. They don’t pay the sticker price either but they come much closer because they’re price insensitive. All costs get passed on, on average to the actuarial customer.

In addition to what other commenters have said, when you write off donated units, they're worth more at that time if their price is higher.

It might be used as a starting point for negotiation with private insurers.

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