Good news on PrEP

[+ José Soplanucas]

The NIH is sponsoring world wide clinical trials (stage III) of a new drug, cabotegravir. Instead of taking a pill every day, we would get an injection every 8 weeks.

 

http://www.aidsmap.com/Long-acting-cabotegravir-injection-shows-promise-for-HIV-prevention/page/3160501/

https://aidsinfo.nih.gov/drugs/513/cabotegravir/0/patient

[+ oldNbusted]

Options are good, since no one thing will work for everyone. Personally, the marginal effort of a pill a day is almost zero, but people are different.

[+ Gar1eth]

Options are good, since no one thing will work for everyone. Personally, the marginal effort of a pill a day is almost zero, but people are different.

 

You’ve said it!! Options are good to have.

 

It’s remembering to take it every day. Or you miscalculate how many you have left on a vacation. Over the last two year, I was stuck in Dallas twice over the holidays for much longer than I thought I’d be. I had brought my Truvada, but I came to the end of my prescription. My insurance only allows me to get non emergency medication back in my state of residence. I called several pharmacies back home to see about mailing me the medication. None of them would. I was getting a bit worried at the 2 or 3 tablet left stage. I finally discovered there was a hospital outpatient pharmacy that would mail me medications.

 

 

Depending on how convenient it was to schedule the injection, and whether it was a painful injection or not, I might consider it.

 

Gman

[rvwnsd]

You’ve said it!! Options are good to have....

 

So true! Good to see we might have options soon.

 

...It’s remembering to take it every day. ...

 

As my physician and I discussed when he started me on PrEP, my asthma requires the use of an inhaler twice a day every day. One pill after dinner is a piece of cake.

 

 

...Or you miscalculate how many you have left on a vacation. Over the last two year, I was stuck in Dallas twice over the holidays for much longer than I thought I’d be. I had brought my Truvada, but I came to the end of my prescription. My insurance only allows me to get non emergency medication back in my state of residence. I called several pharmacies back home to see about mailing me the medication. None of them would. I was getting a bit worried at the 2 or 3 tablet left stage. I finally discovered there was a hospital outpatient pharmacy that would mail me medications....

I'm surprised a chain could not fill the script. Strange. The same situation could occur if you were out of state when it is time for an injection.

[TruthBTold]

Actually, taking the tablets every day does not bother me. What I find onerous (maybe its shallow) is that, at least under my insurance, I have to speak with a pharmacist assistant who calls every month. The assistant asks different questions and then based on that only a 30 day supply is sent. With my other meds I get a 90 day supply each time. So I guess an injection would become better for me.

[+ ArVaGuy]

Actually, taking the tablets every day does not bother me. What I find onerous (maybe its shallow) is that, at least under my insurance, I have to speak with a pharmacist assistant who calls every month. The assistant asks different questions and then based on that only a 30 day supply is sent. With my other meds I get a 90 day supply each time. So I guess an injection would become better for me.

 

My doctor was not able give me a 90 day supply due to insurance requirements. This is absurd particularly since my insurer constantly promotes 90 day prescriptions as a cost savings.

[rvwnsd]

My doctor was not able give me a 90 day supply due to insurance requirements. This is absurd particularly since my insurer constantly promotes 90 day prescriptions as a cost savings.

It might not be the insurance - it could be the pharmacy benefits manager (PBM). Anthem pushed me into mail-order for Truvada a couple of years ago. After messing up the copay card, ExpressScripts relented and I was back to getting it filled at VONS. Last year, they tried it with Advair. Fine. Doctor sent a 90-day script, they sent one inhaler (30 day supply). Doctor sent another 90-day script, they sent one inhaler. And they didn't accept the copay card. Called Anthem, explained the situation, and voila I could fill my scripts at the retail pharmacy again.

[Rudynate]

Actually, taking the tablets every day does not bother me. What I find onerous (maybe its shallow) is that, at least under my insurance, I have to speak with a pharmacist assistant who calls every month. The assistant asks different questions and then based on that only a 30 day supply is sent. With my other meds I get a 90 day supply each time. So I guess an injection would become better for me.

 

I'm on medicare now, and the truvada, along with my other prescription drugs, would push me into the doughnut hole in two months. For the past year, I've been taking a generic from India that costs 50.00/month.

[+ Gar1eth]

I'm on medicare now, and the truvada, along with my other prescription drugs, would push me into the doughnut hole in two months. For the past year, I've been taking a generic from India that costs 50.00/month.

 

My worry is around quality control and counterfeit drugs when the FDA isn’t inspecting them. I know India has a well developed generic industry. But I remember the counterfeit cough syrup that was really antifreeze that killed children years ago, or the more recent fake heparin (I say recent. I think it was 6 or 7 years ago now) that killed people. Both these were from China I believe.

 

I also remember a program on 20/20 or Nightline years ago about counterfeit Viagra. These tablets looked like the real deal. It took chemical analysis to determine they were fake.

 

Gman

[+ sniper]

My doctor was not able give me a 90 day supply due to insurance requirements. This is absurd particularly since my insurer constantly promotes 90 day prescriptions as a cost savings.

They push it when it's a savings relative to the cost of the drug. A drug that's $30/month, the pharmacist's time is a significant fraction of the total cost for you to get the drug, and when it's for a condition that you will definitely be taking it continuously, then going to 90 days is a significant savings.

When the drug costs over $1000/month, that savings as a fraction of the total is meaningless. Especially compared to the risk you get a 90-day supply then switch insurers or drop your coverage altogether, and they just paid over $2000 they shouldn't have been on the hook for.

[marylander1940]

Actually, taking the tablets every day does not bother me. What I find onerous (maybe its shallow) is that, at least under my insurance, I have to speak with a pharmacist assistant who calls every month. The assistant asks different questions and then based on that only a 30 day supply is sent. With my other meds I get a 90 day supply each time. So I guess an injection would become better for me.

 

For some taking 1 pill a day is troublesome...

 

I don't know if some keep up with an injection every 8 weeks, so many fuckups, but those are good news.

[+ sniper]

I would think 8 weeks is easier to mess up actually if life gets in the way of your scheduled shot. At least with Truvada if you screw up, you know when you had sex and Truvada also confers some level of post-exposure protection so if you are sure to take it after you are likely still protected.

[TruthBTold]

I'm on medicare now, and the truvada, along with my other prescription drugs, would push me into the doughnut hole in two months. For the past year, I've been taking a generic from India that costs 50.00/month.

 

I am not sure of the ramifications of the doughnut hole but in my case the manufacturer pays my copayment and then because the drug is so expensive and the copayment high I use up my out-of-pocket requirement pretty quickly. Then I have to pay nothing for my medications. So Truvada works to my advantage with no know side effects. I sort of do not want to go off it both because I do not want to admit that I probably am not going to have rampant unprotected sex and financially it works in my favor. Also as I mentioned, because I have other medications I am required to take every day it is not hard to recall to take it. It goes in the box with the others.

[Rudynate]

I am not sure of the ramifications of the doughnut hole but in my case the manufacturer pays my copayment and then because the drug is so expensive and the copayment high I use up my out-of-pocket requirement pretty quickly. Then I have to pay nothing for my medications. So Truvada works to my advantage with no know side effects. I sort of do not want to go off it both because I do not want to admit that I probably am not going to have rampant unprotected sex and financially it works in my favor. Also as I mentioned, because I have other medications I am required to take every day it is not hard to recall to take it. It goes in the box with the others.

 

With private insurance, your strategy makes perfect sense. With Kaiser, my co-pay for a 90-day supply of Truvada was $70.00. That was my only OOP cost.

 

Medicare changes everything. Medicare part C doesn't take into account the preponderance of drugs such as antivirals and biologics that cost tens of thousands per year. So a huge number are pushed into the doughnut hole where you have to cover nearly 100% of the cost of your prescription drugs. In 2018, you need to spend $5000.00 OOP while you are in the doughnut hole, before you get to the other side that qualifies you for catastophic prescription coverage, which covers nearly your entire cost.

 

I'm getting almost all of my prescription drugs from India. I take one drug that retails in the US for $300.00 per month. I get the same drug from India for $50.00 for a 90-day supply. I take one drug that I could get from India, but it would be a huge hassle. That one I get from Kaiser. A year's supply of that one drug retails for almost $4k, so it alone will almost get me into the doughnut hole by the end of the plan year. Fortunately, everything resets at the beginning of the new plan year.

Edited March 9, 2018 by Rudynate

[TruthBTold]

With private insurance, your strategy makes perfect sense. With Kaiser, my co-pay for a 90-day supply of Truvada was $70.00. That was my only OOP cost.

Medicare changes everything. Medicare part C doesn't take into account the preponderance of drugs such as antivirals and biologics that cost tens of thousands per year. So a huge number are pushed into the doughnut hole where you have to cover nearly 100% of the cost of your prescription drugs. In 2018, you need to spend $5000.00 OOP while you are in the doughnut hole, before you get to the other side that qualifies you for catastophic prescription coverage, which covers nearly your entire cost.

I'm getting almost all of my prescription drugs from India. I take one drug that retails in the US for $300.00 per month. I get the same drug from India for $50.00 for a 90-day supply. I take one drug that I could get from India, but it would be a huge hassle. That one I get from Kaiser. A year's supply of that one drug retails for almost $4k, so it alone will almost get me into the doughnut hole by the end of the plan year. Fortunately, everything resets at the beginning of the new plan year.

 

OMG! Actually I am so glad that you brought that up. I was counting down the days that I had left until I am able to get on Medicare because of the large amount I have to pay for insurance but I really did not take into account the amount I will eventually have to pay for prescription drugs. Actually, most of my current prescriptions (as far as I am aware - except for Truvada) are old time drugs that I believe Medicare will cover. Then it believe it will be whether I want to incorporate other drugs into my daily routine. Any way thanks again for the heads up.

[Rudynate]

OMG! Actually I am so glad that you brought that up. I was counting down the days that I had left until I am able to get on Medicare because of the large amount I have to pay for insurance but I really did not take into account the amount I will eventually have to pay for prescription drugs. Actually, most of my current prescriptions (as far as I am aware - except for Truvada) are old time drugs that I believe Medicare will cover. Then it believe it will be whether I want to incorporate other drugs into my daily routine. Any way thanks again for the heads up.

 

Actually, the member services guy that I talked to at Kaiser before I went on Medicare looked at my scripts and said I might actually be money ahead if I could stay with conventional coverage. From describing it, it sounds like I'm hopelessly ill, but I'm not. I take a handful of things for asthma and allergies. The only thing I take that is semi-exotic, besides Truvada, is one of the new-generation blood thinners, called direct thrombin inhibitors, for a clotting problem. I think it's sad that I have to buy meds offshore, but I don't mind it too much. I'm just glad there's an alternative.

 

So, if you expect your part C coverage to actually pay for your prescription drugs, you have to stick with old tried-and-true standbys and generics. No Truvada or any of those exotic biologics that they advertise on prime-time TV

[TruthBTold]

Actually, the member services guy that I talked to at Kaiser before I went on Medicare looked at my scripts and said I might actually be money ahead if I could stay with conventional coverage. From describing it, it sounds like I'm hopelessly ill, but I'm not. I take a handful of things for asthma and allergies. The only thing I take that is semi-exotic, besides Truvada, is one of the new-generation blood thinners, called direct thrombin inhibitors, for a clotting problem. I think it's sad that I have to buy meds offshore, but I don't mind it too much. I'm just glad there's an alternative.

So, if you expect your part C coverage to actually pay for your prescription drugs, you have to stick with old tried-and-true standbys and generics. No Truvada or any of those exotic biologics that they advertise on prime-time TV

 

So far (and unfortunately I tend not to pay too much attention to the state of the market) I have really old state of the art drugs for epilepsy and blood pressure. I hate asking my doctor anything about treatment and its correlation with money. I am sure they get sick of hearing about insurance. But those days are over. It is such a big part of everyone's life that there is always a balance involved. I am in the boat with you and Truvada is the only "exotic" thing I take (that I'm aware of). I guess as I get closer to going on Medicare I will have to have a discussion with my primary about which of the meds are "new fangled" and which ones not. God save us all. I wonder how they do things in Britain, France, Italy, etc?

[Rudynate]

So far (and unfortunately I tend not to pay too much attention to the state of the market) I have really old state of the art drugs for epilepsy and blood pressure. I hate asking my doctor anything about treatment and its correlation with money. I am sure they get sick of hearing about insurance. But those days are over. It is such a big part of everyone's life that there is always a balance involved. I am in the boat with you and Truvada is the only "exotic" thing I take (that I'm aware of). I guess as I get closer to going on Medicare I will have to have a discussion with my primary about which of the meds are "new fangled" and which ones not. God save us all. I wonder how they do things in Britain, France, Italy, etc?

 

Sometimes the docs don't know. When I told mine I was taking a generic to Truvada that I got from India, he asked me if I had difficulty affording the branded drug. I told him how much cost and he was shocked.

[Rudynate]

So far (and unfortunately I tend not to pay too much attention to the state of the market) I have really old state of the art drugs for epilepsy and blood pressure. I hate asking my doctor anything about treatment and its correlation with money. I am sure they get sick of hearing about insurance. But those days are over. It is such a big part of everyone's life that there is always a balance involved. I am in the boat with you and Truvada is the only "exotic" thing I take (that I'm aware of). I guess as I get closer to going on Medicare I will have to have a discussion with my primary about which of the meds are "new fangled" and which ones not. God save us all. I wonder how they do things in Britain, France, Italy, etc?

 

In the UK, the NHS will not pay for Prep. So they do what I do. HIV/AIDS service orgs in the UK are recommending the generic Truvada from India.

[+ sniper]

$5000/year? It sounds like a lot, but isn't private individual health insurance far more expensive from a premium dollar perspective than medicare B plus a medigap policy? If you go from paying $!8000/year in premium to $8000, you may still be ahead in overall dollars. It's just a question of when you spend them in the year.

[+ Gar1eth]

Actually, the member services guy that I talked to at Kaiser before I went on Medicare looked at my scripts and said I might actually be money ahead if I could stay with conventional coverage. From describing it, it sounds like I'm hopelessly ill, but I'm not. I take a handful of things for asthma and allergies. The only thing I take that is semi-exotic, besides Truvada, is one of the new-generation blood thinners, called direct thrombin inhibitors, for a clotting problem. I think it's sad that I have to buy meds offshore, but I don't mind it too much. I'm just glad there's an alternative.

 

So, if you expect your part C coverage to actually pay for your prescription drugs, you have to stick with old tried-and-true standbys and generics. No Truvada or any of those exotic biologics that they advertise on prime-time TV

 

Sigh-I’m 8 years away from Medicare. And if I survive with this myasthenia gravis (I’ve gotten a lot worse since I first talked about it. Nothing life threatening but daily symptoms like not being able to always eat either because food gets stuck at the back of my throat, or I can’t chew. The latest thing is hand weakness. It took me two hands, and I could only barely pull out a knob on a washing machine. Plus I can’t hold a pen tightly enough to write. And my texting thumbs are really weak.)-I won’t be able to afford the biologics.

 

So I’m on 60 mg of prednisone daily right now. That’s nothing cost wise. But to reduce or get me off that eventually to decrease steroid side effects, I have to either move to transplant anti-rejection medications, a few cancer drugs, or the new biologics.

 

Gman

[+ VictorPowers]

I am not sure of the ramifications of the doughnut hole but in my case the manufacturer pays my copayment and then because the drug is so expensive and the copayment high I use up my out-of-pocket requirement pretty quickly. Then I have to pay nothing for my medications. So Truvada works to my advantage with no know side effects. I sort of do not want to go off it both because I do not want to admit that I probably am not going to have rampant unprotected sex and financially it works in my favor. Also as I mentioned, because I have other medications I am required to take every day it is not hard to recall to take it. It goes in the box with the others.

Multi-V, Fish Oil, Truvada. Daily regiment!

[Rudynate]

Multi-V, Fish Oil, Truvada. Daily regiment!

 

 

And the results are outstanding. I guess I'd better do the same.

[FTM Zachary Prince]

The generic of Truvada from India is good. At Indian pharmacies it retails for $35/30 pills. It’s called Tenvir-EM. As long as you have a trustworthy company handling the export, it should be the real deal. The drugs in Indian pharmacies are good. ANYONE can buy drugs from pharmacies here without a prescription. But a company charging Americans to export drugs overseas COULD be running a scam, selling fake drugs to increase their profit margin. Your $35 drugs that they’re only charging $50 for could be earning them a $15 profit on the real thing or a $45 profit on a fake bottle. So that’s the major concern with buying from Indian pharmacies online. If you can make it to India yourself or get a friend to bring you the meds from India, that’s one way to be very sure that the drugs are legit. Or if you have a good working relationship with an online pharmacy and you know their drugs are real, then stick with the company you know and trust. There is a risk of getting fake drugs and it’s the middle-men who are to blame in this case, not the actual pharmacies on the ground in India. The more you know...

[FTM Zachary Prince]

I already take testosterone injections intramuscularly every 3 weeks. So dealing with syringes and needles, plus knowing how to inject intramuscularly at home, are already on my plate. I would love to switch to an intramuscular injection for Truvada instead of a daily pill. Not sure if I would feel the same way if I wasn’t already doing intramuscular injections regularly tho. Intramuscular injections hurt like hell for a few days post-injection if the muscle is not used to being injected into. After about a year of injecting into my quad muscles, tho, they’ve really gotten used to it, and I hardly experience any post-injection pain at all now. So for me it would be a relatively painless and convenient option.