How more Ontarians could gain access to a '99.9%' effective HIV-prevention drug
Experts hope price will come down as more generic drugs hit the market in coming weeks
A generic version of an effective HIV-prevention drug has come on the market in the past week, but experts say the medication is still far too expensive for many people who need it, and they're hoping other generic versions being released in the coming weeks will be sold at a much lower price.
The original drug is sold by pharmaceutical giant Gilead under the brand name Truvada. It costs $1,000 a month and is not covered by the province for prevention purposes, although it is included in some insurance plans.
The once-daily pill is called pre-exposure prophylaxis, or PrEP, and it can dramatically reduce the risk of contracting HIV as well as treat those who already have the virus. Health Canada has approved the sale of generic versions of the drug, which are first tested to confirm they are high grade and effective.
The first generic version of the drug now available for purchase is made by Canadian pharmaceutical company Apotex, but to the disappointment of Toronto pharmacist Dr. Michael Fanous it's only marginally less expensive at $750 a month.
"HIV medications are incredibly expensive. Those that are HIV positive should be able to access the medication at an affordable price, as they do in many provinces," Fanous told CBC Toronto.
"Ontario is behind other provinces in that HIV meds are not 100 per cent covered for those that are HIV positive, meaning that there are some challenges and gaps for treatment, and for that reason ... there are over 1,000 people diagnosed as HIV positive in Ontario every year."
Experts say it's important that as many people as possible get access to the drug, because it could help save a lot of lives.
"The effectiveness is excellent," said Barry Adam, senior scientist specializing in HIV prevention at the Ontario HIV Treatment Network. If the drug is used as prescribed, he said "we're somewhere in the range ... of 99.9 per cent, which is as good as it gets for any drug."
Fanous, who owns the pharmacy practice Medsexpert as well as researches and counsels in gay men's health, started selling Apotex's generic product July 28. Zahid Somani, pharmacist and owner of The Village Pharmacy on Church Street, said they began dispensing it last Wednesday.
Three more generic PrEP options expected in coming weeks
On July 26, Health Canada also approved generic versions of Truvada for use in Canada from Mylan Pharmaceuticals, Pharmascience Inc. and Teva Canada Limited. Fanous expects to see those on the market in the next two weeks.
In an email response to CBC Toronto, Teva Canada Limited said it anticipates its generic version of the drug "will be available in all provinces in the next several days." As for the price, the company says it is "under review" but the medication "will be less expensive than current brand pricing."
Sean Hosein, science and medicine editor at Catie.ca, a resource for HIV and hepatitis C information, said the generic brands need to be priced much lower for people to buy them more easily.
"There are a couple people that I talked to who've been wavering about it, and I think it will make a difference for them, but these people have good jobs," he said. "That's not the case for a lot of young people who may be making minimum wage ... and have rent to pay."
The best thing that could be done is for the drug to be subsidized by the province, Hosein said, since prevention is much cheaper than treatment.
"I wish something like this was available in the 1980s ... It could've saved so many lives," he said. "But you know what, it's here now, and let's work together to prevent new HIV infections."
HIV cases in Ontario men under 30 on the rise
Prevention is even more important right now, according to Adam, who for the first time in years has noticed an increase in the number of Ontario men contracting HIV. The majority of that group is men who have sex with men.
"We saw the rates decline from five to three years ago, but now they're edging up again from three years ago up until now," he said. "It seems that the increase is happening among younger men, which is a very worrisome trend."
Those statistics will be part of a report released in the coming weeks by the Ontario HIV Epidemiology and Surveillance Initiative (OHESI) on new diagnoses of HIV in Ontario.
To Adam, the numbers show the province could be doing more.
"We're not ... on the cutting edge," he said, adding you also can't pick up an at-home HIV test in Canada. "There's other places that are moving forward making PrEP available, and we're a bit tied up in bureaucracies about who's going to approve what and pay for what."
If the new generic additions aren't bringing the price down in the coming weeks, Fanous said he'll have some tough questions for the companies.
"There's a lot of interest in the generic for one reason and one reason only and that is the cost and accessibility to PrEP," he said.
"No one is looking to purchase a generic which is almost the same price as the brand name."