The Cost of HIV Treatment

Forty years ago, both HIV and AIDS were unheard of in the United States. The first cases of what was then a mysterious illness were diagnosed in the 1980s, but effective treatments took several more decades to develop.

A cure for HIV does not yet exist, but treatments are available to extend the lives of those with HIV and help prevent the transmission of the virus. Many of the highly active antiretroviral therapies currently available work effectively to help slow disease progression caused by HIV.

But all treatments have costs — and some higher than others.

Let’s take a look at the average costs of HIV treatment and potential ways to save money.

Below is a table that contains average estimated costs for both brand-name and generic medications. This is not a comprehensive list of HIV medications. You can talk with a pharmacist to find out the cost of any medication that isn’t included.

These amounts are a snapshot of costs from one day in time, so they’re just a rough estimate.

They can provide a general idea about drug costs, but keep in mind that there are many factors that can make these medications less expensive.

Also, when new drugs reach the market, they are usually expensive. However, older drugs may become more affordable.

The prices listed do not take into account any expense covered by health insurance, prescription drug insurance, or government assistance.

They’re averages based on information from several websites, including the U.S. Department of Health and Human Services and GoodRx.

To find the exact cost for drugs prescribed by your healthcare team, contact a local pharmacy.

It’s important to understand that there are many factors that can affect HIV medication costs. Prescription drugs vary in availability, and prices of medications can change quickly. Several other factors can also affect the cost of a medication, including:

• what pharmacy discounts are available
• whether a person prescription drug insurance
• the availability of generic versions of medications
• what prescription assistance programs are available
• where a person lives

Pharmacy discounts

Some pharmacies and wholesale buyer stores offer loyalty discount programs for customers. These discounts are provided by the pharmacy, not the pharmaceutical company. Shopping pharmacy prices and discount programs can help a person find one that best suits their needs.

Prescription insurance

For someone who has insurance, their cost may be lower than the averages listed in the table above. People without insurance may have to pay the cash price for the medication. Cash prices are often higher.

Generic drugs

Many HIV medications are new. That means pharmaceutical companies still maintain the rights to the medication’s patent, and as a result, a generic option is not available. Generic medications are often less expensive than brand-name drugs.

If a healthcare professional prescribes a brand-name drug, it may be worthwhile to ask if there’s a generic version available instead.

Prescription assistance programs

A variety of prescription assistance programs (PAPs) are available to people taking HIV medications. These programs provide discounts or funds to help cover the cost of HIV treatment. Each PAP maintains its own requirements for participants, such as proof of the need for the medication.

An individual can apply for several PAPs, or they can find one that’s specific to their medication. An example is the Ryan White HIV/AIDS Program, which provides significant assistance in obtaining HIV medications.

Out-of-pocket costs for HIV medication and treatments may be dramatically reduced for those who are accepted to a PAP. Drug manufacturers operate many of these programs.

A good place to start learning about a PAP is by checking out the website for a particular drug that a healthcare professional is recommending or call the drug manufacturer directly.

Location

Medication costs can vary by location. One common reason for this is how Medicaid and Medicare funds are used in the region where a person lives. State governments receive these funds from the federal government, and they can determine how and to whom they administer these funds.

The amount a state reimburses a pharmacy will be higher in states that cover HIV medication costs. As a result, the pharmacy may not charge its customers as much for the medication because of a higher government reimbursement rate for the medication.

A person living with HIV may be able to save a significant amount of money on medication. Understanding how HIV medication costs are set and taking advantage of certain resources can help reduce costs.

Some insurance companies do not cover newer HIV treatments. If a healthcare professional prescribes one of these medications to someone whose insurance will not cover it, the person will have to pay for it out of their own pocket. In this case, finding the best price for their medication may be very important.

For those who do not have private health insurance or whose insurance company does not currently cover the costs of HIV medications, certain programs may help supplement the cost so that they get the treatments they need.

Here are several strategies for finding assistance in paying for HIV treatment:

Reach out to the drug manufacturer

Many drug manufacturers have programs to help offset the costs of these medications. Find contact information by looking at the website of a manufacturer for a particular drug or asking a healthcare professional.

Use a hotline

Contact a state HIV hotline. Hotline operators can explain programs and agencies in each state that provide assistance with paying for medications.

Apply for coverage with Medicaid

Medicaid is a state and federal partnership that provides insurance coverage to low income households, older adults, those with disabilities, and others who qualify. While coverage varies from state to state, Medicaid is an important source of coverage for many individuals living with HIV. To find out more, visit the Medicaid website.

Contact Ryan White HIV/AIDS Program

The Ryan White HIV/AIDS Program is a federally funded program that provides services and support for those living with HIV. Its AIDS Drug Assistance Program provides medications to those with limited or no health insurance coverage.

Search for other programs

Look into programs that provide additional services to select groups. These include the Children’s Health Insurance Program, the American Indian and Alaska Native Programs, and the Department of Veterans Affairs. Each of these organizations offers services to those with HIV.

Visit drug pricing websites

Drug pricing websites such as GoodRx.com have information on the average costs for medications at several different major pharmacies and offer coupons for further savings. In addition, the sites describe how a medication’s cost has averaged over time and how it compares to the cost of other similar medications.

It’s important to remember that cost should not be the only factor considered when a person pursues medication treatment for HIV. The most important thing is their health.

That said, the reality is that cost is a significant issue. And learning about HIV treatment costs without financial assistance can be disheartening, especially for those who are newly diagnosed. However, services are available to help people obtain medications, and many of them will cover a large portion of the cost.

With a little work, people with HIV can typically obtain the treatment they need. Following the tips in this article may help.

Another practice that may help is being open with a healthcare professional about whether a medication they prescribe is affordable. The healthcare professional may be able to advise on other ways to save money on medications.