Lately I been noticing a trend in relationship to HIV medications which I find disturbing. I first noticed this two to three years ago when several patients were finding it to be more expensive 2 get older preparations of anti-retroviral therapy combinations such as Atripla. Since that time, insurance companies, for patients who do not want to switch medications, offer generic versions of the original preparations. In addition, some insurance companies are actually beginning to suggest strongly which medications they are willing to pay for versus others.
To me this is an extremely dangerous precedence that is being set. Of all the diseases that are out there today, we have known for decades that compliance is very important when it comes to managing HIV. For instance, for people with high blood pressure, if you have 60 to 70% compliance with taking your medication, you are considered well-managed. In HIV disease, anything less than 90% compliance could make the patients susceptible to developing resistance.
Unfortunately, generic drugs can vary up to 20% when it comes to active versus inactive ingredients. Potentially this can be a problem, especially if patients are unknowingly taking 20% less of the prescribed medication. In most instances, this is not a problem, but in dealing with HIV, potentially 20% could be the difference between remaining undetectable and having detectable viral loads which potentially could cause resistance. I have already seen this happen in two patients since they switched to generic forms of their anti-retroviral therapy.
Another disturbing trend that has come to light lately is that some insurance companies are limiting the choices of what anti-retroviral therapy a patient may receive. One-size-fits-all approach to medicine does not work in general and is much worse when addressing HIV. Minimizing options for patients with HIV could be disastrous for certain individuals, especially if they cannot tolerate formulations that they are limited to. Potentially worsening side effects will have these patients discontinue their medications, leaving them with little, or no options. This could be disastrous going forward, especially considering how much advancement we have made with this disease over the past two decades.
In managing patients with HIV, it is important to have more options , not fewer. With compliance being such an important issue, 20% variation may not seem like much, but it could be catastrophic when dealing with patients with HIV. I believe that the HIV community and the Pharmaceutical industry need to voice their concerns about some of these practices. Anything less and we are playing with fire.
