An ongoing dialogue on HIV/AIDS, infectious diseases,
March 10th, 2009
Unwelcome Visitor: Cost of HIV Meds
Those of us who practice HIV medicine in Taxachusetts (warning, click link at your peril) live a pretty charmed life, at least so far as getting HIV medications paid for. Due to an incredibly generous AIDS Drug Assistance Program (ADAP), rare is the patient who faces financial barriers getting his or her drugs.
(By the way, we abbreviate it “HDAP” here, not ADAP. And we treat early syphilis with two shots of penicillin, not one. And we voted for McGovern. And we drive on the left.)
But the recent downturn in the economy has changed this usually comfortable situation in the Bay State.
A patient of mine called to tell me that his co-pay for a 3 month supply of his antivirals is now nearly $2000. Another one has simply stopped coming to appointments, as his wife’s insurance has such a large deductible that he will only agree to blood tests, not an actual office visit. A third asked me whether he would be better off stopping enoxaparin or his HIV meds, since he couldn’t afford both.
I am sure things are much worse in other States — after all, Houston’s Joe Gathe initially tried lopinavir/r monotherapy since he reasoned that some ART was better than none, and his patients couldn’t afford triple-therapy.
Where is this headed? It’s tough to make predictions (especially about the future), but I suspect that when 3TC and saquinavir become generic, we might be turning to them more often than we’d previously thought.
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
Learn more about HIV and ID Observations.
FROM NEJM — Recent Infectious Disease Articles- Shock Not Advised April 25, 2026A physician offers to help in a medical emergency on a transatlantic flight. Though she faces limits of bureaucracy, equipment, and ultimately biology, she discovers her physicianhood is inescapable.
- Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock April 24, 2026In children with septic shock, no significant difference was seen in the incidence of death, new renal-replacement therapy, or persistent kidney dysfunction with balanced fluid as compared with 0.9% saline for fluid resuscitation.
- Tuberculosis Cases and Deaths Averted by PEPFAR April 23, 2026Tuberculosis remains a leading cause of death worldwide among persons with HIV. In this report, the effect of the PEPFAR program on incident cases of tuberculosis and related deaths is presented.
- Case 12-2026: An 86-Year-Old Woman with Anorexia, Weight Loss, and Liver Lesions April 23, 2026An 86-year-old woman with a history of diabetes and breast cancer was admitted to the hospital with anorexia and weight loss. Imaging revealed multifocal liver lesions. A diagnosis was made.
- Same Pill, Different Impact — Reassessing the Efficacy of Nirmatrelvir–Ritonavir April 23, 2026The first cases of Covid-19 were reported at the end of 2019, and from January 20, 2020, to May 5, 2023, Covid-19 was considered to be a public health emergency of international concern. The total number of cases worldwide exceeded 1 million by early April 2020. In the United States,...
- Shock Not Advised April 25, 2026