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> 30-day supply of generic PrEP costs ~$2,500

Er, no, generic Truvada costs $30-$60/month, although it was not available as a generic in 2019, which is when the mandate for free PrEP without cost-sharing was first issued. (The mandate was issued in 2019, but it did not fully go into effect until 2021).

That said, the drug costs aren't the only (or even biggest) costs associated with PrEP - the doctors' vists and labwork are much more. Under the ACA, those were required to be covered for free on all insurance plans, but a judge in Amarillo, TX blocked that as part of a ruling on a lawsuit against abortion care.

> and for potential liver and kidney damage

They aren't checking for liver damage. They do check for indications that the drug isn't being absorbed correctly, which is done via a test for kidney functioning, but kidney issues for both Truvada and Descovy as PrEP are extremely rare. And there are no liver concerns associated with either one.

I guess I don't fully understand U.S. healthcare system (I'm an immigrant from a country with universal healthcare, and this is the first time in my life that I've had a medication prescribed other than short-term antibiotics).

I pay a $10 co-pay for generic with my insurance, but when I pick up from pharmacy the receipt says "you insurance saved you $1888" (you're right it's not ~$2500/month - I just checked and that's a different prescription I have that I get filled at the same time).

> I guess I don't fully understand U.S. healthcare system

Yes, it's confusing.

> I pay a $10 co-pay for generic with my insurance, but when I pick up from pharmacy the receipt says "you insurance saved you $1888" (you're right it's not ~$2500/month - I just checked and that's a different prescription I have that I get filled at the same time).

As a rule, the "your insurance saved you $X" is a meaningless statement.

It's actually worse than meaningless - it's effectively an advertisement for health insurance, not an actual statement of fact. It's calculated based on the difference between what you paid and the list price for a drug, which almost nobody is paying (and your insurer is definitely not paying).

Your insurance pays some other negotiated rate for drugs - they will basically never pay list price. Even if you were getting it without insurance, you still would likely not be paying list price. If you were paying out of pocket, you'd probably be using a discount coupon (which usually works as a third party functioning as a pseudo-PBM, a ridiculous concept which I will not bother to try to explain in this post). Or your doctor would explicitly prescribe the branded version ("dispense as written") and you'd be using the Gilead copay assistance coupon to pay for it.

Since there's no situation in which the list price is what you'd be paying, it's completely meaningless to say "you saved $X off the list price". I'm half of the mind that these statements should be banned by the FTC as a deceptive trade practice - that's how misleading they are.

I'm completely of the mind that it should be banned. With recent (though deeply flawed) efforts toward transparency in pricing, we might even see it some day!

For a rich person by global standards, HIV is a solved problem in the US right?

PreP for people trying to inhibit both progression and transmission of HIV and PeP for those that don't have it

The article talked about a new 3 month lasting version of PeP as well

when we’re not talking about uninsured and poor people, this is done now, right?

cishet men dont have anything near the vulnerability surface as other populations, if I’m understanding correctly. just test and move on or react accordingly. anybody that was subject to the traumatic sex-scare education of the 80s to early 2000s should just get updated education.

It doesn't help that heterosexual use of prep is virtually unheard of.

I hear of it, but typically it's only taken by those who engage in high risk activities. There are potential issues with the liver and kidney that make it not worthwhile if one isn't at moderate to high risk.

More than 1/5 of HIV transmissions are heterosexual in the US. Additionally, prep requires quarterly testing to monitor any potential issues you mentioned (Which are pretty rare), and they also run an STD panel.

Just having a quarterly panel would be a huge boon to anyone with more than one partner. Normalizing prep for anyone who thinks they might need it would be a major step forward.

Yes, I don't disagree. It's just that most of the people that I know that have multiple partners are only on prep if those partners are seeing untested other folks.

Said differently, those I know on prep are taking it because they cannot account for the extent of the sexual network of their partners. Those that aren't on prep have multiple partners, but they all test and have complete information on the status of everyone involved in the sexual network graph.

I see it as a good choice if you cannot attest for accurate, recent results of every possible connection in your sexual network.

Rather depressing that we're subsidizing wanton sexual indulgence to the tune of $30k/year/person.

Just to dispel some myths here:

1. Many people who use PrEP have only one partner. They're using PrEP because their partner has HIV.

2. The alternative is letting people get AIDs. This is more expensive than PrEP.

3. Insurance doesn't pay the full list price of drugs, they pay a lower, negotiated rate. CostPlus Drug Company charges about $20/month for PrEP. This is probably closer to what insurance companies actually pay.

Good comment. I concede if it's really ~$20/month it's a rounding error and an obvious policy win.

So queer people should remain celibate?

Other methods of protection fail. People lie about the status. People don't know their status.

Know what's ridiculous is that these drugs cost so much money and companies like Gilead can engage in "revenue maximization" schemes at the cost of the health of US citizens... and then apparently win lawsuits with their Big Pharma war chests.

If the 30k per figure was accurate (I don't think it is?) it would be certainly unreasonable for the rest of the society to subsidize it.

So I guess, no. But they shouldn't expect other people to finance their sex lives.

The options aren't shell out $30k/year or let people get AIDs. There's a missing third option: don't let drug companies charge so much money, especially when the government paid for the development of the drug!

There's wide, wide middle ground between celibacy and the debauched status quo.

And where in that middle ground are you trying to insert yourself?

I don't think that attending "100% bareback, no loads denied" orgies regularly is a good idea, yet a bunch of my queer friends do exactly that on a fairly regular basis.

I know it's not popular, but AIDS is just what we have now. If people continue living like this, there will be another, and it might be worse. Hell, we probably already dodged a bullet with Monkeypox due to concomitant COVID precautions.

Lol, no one was observing COVID precautions at that point. It was dodged because people got vaccinated for it and observed spacing requested in a responsible manner.

Hell, in the UK heterosexual cases of AIDs overtook homosexual cases because of adherence to medication and good practice. [1]

1. https://www.tht.org.uk/news/heterosexual-hiv-diagnoses-overt...

What motivated you to share this?

Dude.

Have a heart.