4 ms·

> Longer term, it is likely there will be a shift to a twice yearly injectable (Gilead’s Lenacapavir) That's debatable. Injectable PrEP has been around for yea

> Longer term, it is likely there will be a shift to a twice yearly injectable (Gilead’s Lenacapavir) That's debatable. Injectable PrEP has been around for years already (Lencapavir is not the first, just the most recent). Lencapavir has also not yet been tested on all at-risk groups, so unlike other forms of PrEP, it's not a universal solution because it cannot be prescribed to all candidates. Given the price, which is quite high even with the programs Gilead has said that it will issue to reduce the cost, it remains to be seen how widely-used Lencapavir becomes outside of specific markets.

borski 2y ago
I’m confused. The parent comment said “longer term,” and you went on to discuss how it is not going to be used in the short term, due to the need for more testing and cost. Cost comes down over time, and more testing occurs over time, somewhat by definition. So… what specifically is debatable about the longer term?
- chimeracoder 2y ago
  > Cost comes down over time, and more testing occurs over time, somewhat by definition. Truvada has been around for over twenty years, and generic for 4-5 years. It still costs $2000/month list price. More testing doesn't just magically happen either. Gilead has chosen for years not to pursue testing, let alone approval, for Descovy in various groups excluded from the original clinical trials. They've decided it's not profitable enough for them. The same could very easily happen with lencapavir, and in fact there's good reason to suspect it will.
  - borski 2y ago
    Why is it so expensive? And is it covered by insurance? If so, then I'm not sure the list price matters all that much from a 'to most people' perspective, even if there is a moral argument to be had here (in which we'd probably agree). I'm not entirely sure what the argument is, though - is it just the cynical argument of "well, these companies don't care about solving problems, just profit, so they're never going to do anything with it"? If so, then at least I understand your argument, even if I don't necessarily agree. But I tend to be an optimist.
nerdjon 2y ago
The problem I think really comes down to there being a generic Truvada. Insurance for a bit seemed fine with covering Descovy but it seems that is less of a case now since it’s so much more. I would expect the same with a shot like this. However I would hope that the added benefit of not needing to worry about adhering to taking it every day could outweigh that financial cost for insurance. I recently switched insurance companies and my new one covers Truvada completely, not even a copay. It’s honestly kinda wild I pay more for my Adderall than I do prep. Obviously I don’t know for sure but I have wondered if it is related to it being preventative and the potential alternative cost makes it smarter to remove any barriers.
- chimeracoder 2y ago
  > The problem I think really comes down to there being a generic Truvada. Truvada has been generic for about six years now. > I recently switched insurance companies and my new one covers Truvada completely, not even a copay. It’s honestly kinda wild I pay more for my Adderall than I do prep. That's because under the ACA, insurance companies are legally required to cover PrEP at no out-of-pocket cost, without any cost-sharing, copays, or deductibles applied. This also applies to associated labwork and outpatient office visits. Unfortunately, many insurance companies ignore this requirement, and it's very difficult as an individual to get them to comply.
- argonaut 2y ago
  Almost all health insurance companies in the USA are required to fully cover PrEP, including Descovy. This doesn't stop health insurance companies from trying to deny you, of course. You would have to appeal the denial all the way up to your state's department for health insurance, but you would definitely win. EDIT: I was mistaken, this only applies in California.
  - nerdjon 2y ago
    That… is good to know. I knew they were required but figured generic Truvada was the requirement. Well kinda irrelevant. My previous insurance loved to deny things, it’s why my company changed. I worked with my doctor, tried multiple times to get them to cover Descovy (I struggled with the larger pills, I finally just forced myself to get used to it) and was never successful. Just gave up.

borski 2y ago

I’m confused. The parent comment said “longer term,” and you went on to discuss how it is not going to be used in the short term, due to the need for more testing and cost. Cost comes down over time, and more testing occurs over time, somewhat by definition. So… what specifically is debatable about the longer term?

chimeracoder 2y ago
> Cost comes down over time, and more testing occurs over time, somewhat by definition. Truvada has been around for over twenty years, and generic for 4-5 years. It still costs $2000/month list price. More testing doesn't just magically happen either. Gilead has chosen for years not to pursue testing, let alone approval, for Descovy in various groups excluded from the original clinical trials. They've decided it's not profitable enough for them. The same could very easily happen with lencapavir, and in fact there's good reason to suspect it will.
- borski 2y ago
  Why is it so expensive? And is it covered by insurance? If so, then I'm not sure the list price matters all that much from a 'to most people' perspective, even if there is a moral argument to be had here (in which we'd probably agree). I'm not entirely sure what the argument is, though - is it just the cynical argument of "well, these companies don't care about solving problems, just profit, so they're never going to do anything with it"? If so, then at least I understand your argument, even if I don't necessarily agree. But I tend to be an optimist.

nerdjon 2y ago

The problem I think really comes down to there being a generic Truvada. Insurance for a bit seemed fine with covering Descovy but it seems that is less of a case now since it’s so much more. I would expect the same with a shot like this. However I would hope that the added benefit of not needing to worry about adhering to taking it every day could outweigh that financial cost for insurance. I recently switched insurance companies and my new one covers Truvada completely, not even a copay. It’s honestly kinda wild I pay more for my Adderall than I do prep. Obviously I don’t know for sure but I have wondered if it is related to it being preventative and the potential alternative cost makes it smarter to remove any barriers.

chimeracoder 2y ago
> The problem I think really comes down to there being a generic Truvada. Truvada has been generic for about six years now. > I recently switched insurance companies and my new one covers Truvada completely, not even a copay. It’s honestly kinda wild I pay more for my Adderall than I do prep. That's because under the ACA, insurance companies are legally required to cover PrEP at no out-of-pocket cost, without any cost-sharing, copays, or deductibles applied. This also applies to associated labwork and outpatient office visits. Unfortunately, many insurance companies ignore this requirement, and it's very difficult as an individual to get them to comply.
argonaut 2y ago
Almost all health insurance companies in the USA are required to fully cover PrEP, including Descovy. This doesn't stop health insurance companies from trying to deny you, of course. You would have to appeal the denial all the way up to your state's department for health insurance, but you would definitely win. EDIT: I was mistaken, this only applies in California.
- nerdjon 2y ago
  That… is good to know. I knew they were required but figured generic Truvada was the requirement. Well kinda irrelevant. My previous insurance loved to deny things, it’s why my company changed. I worked with my doctor, tried multiple times to get them to cover Descovy (I struggled with the larger pills, I finally just forced myself to get used to it) and was never successful. Just gave up.