OBJECTIVES: The cost of antiretroviral treatments (ARV) for HIV remains a significant patient access barrier in the United States. Strict patents and evergreening have contributed to extortionate list prices which have become a major burden for Medicaid. The current study assesses the dynamics of both rising list prices of ARVs and changes in HIV prevalence in the USA between Dec-2017 and June-2020, and what budget impact effect they have had.

METHODS: The HIV positive patient population (USA) and ARV treatment rate was calculated using data from Epiomic™. Five of the top ARV selling drugs were used to calculate the average 30-day expenditure on treatment. These were Stribild, Complera, Genvoya, Odefsey & Trizivir. All five treatments have only one dosage type and are once-a-day tablets. 30-day costs were calculated via Federal Supply Schedule pack prices.

RESULTS: The total population of HIV+ treated with ARVs increased by only 1.1% between 2017-2020, an increase of roughly 5000 individuals, whilst the incidence of yearly diagnoses fell. The cost of the average 30-day complete regimen between the five products, however, rose by 41% between Dec 2017 and June 2020. The total pharmaceutical expenditure on ARVs subsequently rose by 42.6% over just 2.5 years. Price hikes therefore accounted for 97.4% of the change in pharmaceutical expenditure on ARVs.

CONCLUSIONS: Over the 2.5-year period, the treatment population stayed relatively flat, but price changes rose significantly. Price rises in ARVs are, therefore, the majority driver of HIV pharmaceutical expenditure surges. This is also reflected in Medicaid expenditure increases, in which ARVs are consistently amongst the costliest drug classes. Unwarranted price increases may cause further patient access barriers and expand the population of HIV+ individuals who do not receive regular treatment.