Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Limitations to Treatment Safety and Efficacy

Cost Considerations and Antiretroviral Therapy

Last Updated: November 26, 2018; Last Reviewed: October 25, 2018

Table 17. Monthly Average Prices of Commonly Used Antiretroviral Drugs

Prescription drug pricing in the United States involves complex systems of negotiations, rebates, discounts, and reimbursement rates. Much of the information used to determine drug prices is confidential, and prices can vary depending on the purchaser, the type of public or private insurance coverage in use, and the number of generic competitors. In addition, price increases that exceed rates of inflation can trigger additional rebates for Medicaid and 340B Drug Discount Program entities. Table 17 includes three benchmark prices, rounded to the nearest dollar, for commonly used antiretroviral (ARV) drugsa as a general reference for health care providers when considering the cost of HIV treatment. Health care providers should contact patients’ pharmacies or payors regarding actual prices, comparative cost savings, and related formulary restrictions.

Wholesale acquisition cost (WAC) is the list price published by manufacturers for prescription drugs or biologics sold to wholesalers. The WAC price approximates what retail pharmacies pay wholesalers for single-source (e.g., brand-name) drugs. There is a range of WAC prices for generic ARVs, as these are multiple-source products with variable list prices. With increasing competition, actual transactional prices of generic drugs among wholesalers and pharmacies decrease substantially. Average wholesale price (AWP) has historically been used as the basis for setting public (e.g., Medicaid) and private (e.g., commercial insurer) reimbursement rates for pharmacies. Neither WAC nor AWP include variable price concessions along supply and payment chains, including discounts and rebates to wholesalers, pharmacies, federal purchasers (e.g., the Veterans’ Administration), pharmacy benefit managers, commercial insurers, Medicaid, 340B pharmacies, and AIDS Drug Assistance Programs. The availability of these discounts and rebates depends on product demand, market competition, and WAC price increases set by manufacturers.

Maximum prices are assigned to generic products with three or more therapeutically and pharmaceutically equivalent products, as determined by the Food and Drug Administration. This federally established price is the federal upper limit (FUL). Federal Medicaid will reimburse state Medicaid programs up to this limit for multiple-source drugs (plus the dispensing fee); commercial insurers set their own reimbursement upper limits with pharmacies. Whereas WACs and AWPs are generally set annually, FULs are adjusted monthly, particularly for multiple-source drugs with fluctuating pharmacy acquisition costs. In the table below, the FUL for a drug is described as “pending” if a generic drug currently lacks the competition required to trigger a FUL.

Table 17. Monthly Average Prices of Commonly Used Antiretroviral Drugs
ARV Drug (Generic and Brand Names) Strength, Formulation Tablets, Capsules, or mLs per Month WAC (Monthly)b AWP (Monthly)b FUL (As of 9/1/2018)c
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Abacavir
• Generic 300 mg tablet 60 tablets $150 to $482 $579 to $603 $44
• Ziagen 300 mg tablet 60 tablets $559 $670
Emtricitabine
• Emtriva 200 mg capsules 30 capsules $537 $644 N/A
Lamivudine
• Generic 300 mg tablet 30 tablets $75 to $343 $429 to $430 $83
• Epivir 300 mg tablet 30 tablets $416 $499
Tenofovir Disoproxil Fumarate
• Generic 300 mg tablet 30 tablets $58 to $922 $110 to $1,216 Pending
• Viread 300 mg tablet 30 tablets $1,140 $1,368
Zidovudine
• Generic 300 mg tablet 60 tablets $36 to $54 $54 to $365 $13
NRTI Combination Products
Abacavir/Lamivudine
• Generic 600 mg/300 mg tablets 30 tablets $185 to $1,116 $1,395 $356
• Epzicom 600 mg/300 mg tablets 30 tablets $1,292 $1,550
Tenofovir Alafenamide/Emtricitabine
• Descovy 25 mg/200 mg tablet 30 tablets $1,676 $2,011 N/A
Tenofovir Disoproxil Fumarate/Emtricitabine
• Truvada 300 mg/200 mg tablet 30 tablets $1,676 $2,011 N/A
Tenofovir Disoproxil Fumarate/Lamivudine
• Cimduo 300 mg/300 mg tablet 30 tablets $1,005 $1,207 N/A
Zidovudine/Lamivudine
• Generic 300 mg/150 mg tablet 60 tablets $134 to $578 $878 to $932 $47
• Combivir 300 mg/150 mg tablet 60 tablets $901 $1,082
Abacavir Sulfate/Zidovudine/Lamivudine
• Generic 300 mg/300 mg/150 mg tablet 60 tablets $1,391 $1,738 Pending
• Trizivir 300 mg/300 mg/150 mg tablet 60 tablets $1,610 $1,932
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Efavirenz
• Generic 600 mg tablet 30 tablets $894 $1,118 Pending
• Sustiva 600 mg tablet 30 tablets $981 $1,177
Doravirine
• Pifeltro 100 mg tablet 30 tablets $1,380 $1,656 N/A
Etravirine
• Intelence 200 mg tablet 60 tablets $1,296 $1,523 N/A
Nevirapine
• Generic 200 mg tablet 60 tablets $10 to $45 $648 to $651 $37
• Viramune 200 mg tablet 60 tablets $855 $1,026
• Generic XR 400 mg tablet 30 tablets $246 to $565 $678 to $706 $231
• Viramune XR 400 mg tablet 30 tablets $793 $951
Rilpivirine
• Edurant 25 mg tablet 30 tablets $1043 $1,252 N/A
Protease Inhibitors (PIs)
Atazanavir
• Generic 200 mg capsule 60 capsules $878 to $1,264 $1,580 to $1,668 Pending
• Reyataz 200 mg capsule 60 capsules $1,463 $1,756
• Generic 300 mg capsule 30 capsules $870 to $1,252 $1,565 to $1,652 Pending
• Reyataz 300 mg capsule 30 capsules $1,449 $1,739
Atazanavir/Cobicistat
• Evotaz 300/150 mg tablet 30 tablets $1,605 $1,927 N/A
Darunavir
• Prezista 600 mg tablet 60 tablets $1,581 $1,897 N/A
• Prezista 800 mg tablet 30 tablets $1,581 $1,897 N/A
• Prezista 100 mg/mL suspension 200 mL $878 $1,054 N/A
Darunavir/Cobicistat
• Prezcobix 800 mg/150 mg tablet 30 tablets $1,806 $2,168 N/A
Lopinavir/Ritonavir
• Kaletra 200 mg/50 mg tablet 120 tablets $1,024 $1,229 N/A
Tipranavir
• Aptivus 250 mg capsule 120 capsules $1,578 $1,894 N/A
Integrase Strand Transfer Inhibitors (INSTIs)
Dolutegravir
• Tivicay 50 mg tablet 30 tablets $1,658 $1,989 N/A
• Tivicay 50 mg tablet 60 tablets $3,315 $3,978 N/A
Raltegravir
• Isentress 400 mg tablet 60 tablets $1,500 $1,800 N/A
• Isentress HD 600 mg tablet 60 tablets $1,500 $1,800 N/A
Fusion Inhibitor
Enfuvirtide
• Fuzeon 90 mg injection kit 60 doses (1 kit) $3,586 $4,303 N/A
CCR5 Antagonist
Maraviroc
• Selzentry 150 mg tablet 60 tablets $1,511 $1,813 N/A
• Selzentry 300 mg tablet 60 tablets $1,511 $1,813 N/A
• Selzentry 300 mg tablet 120 tablets $3,022 $3,626 N/A
CD4-Directed Post-Attachment Inhibitor
Ibalizumab-uiyk
• Trogarzo 200 mg vials 8 vials $9,080 $10,896 N/A
Coformulated Combination Products as Single Tablet Regimens
Bictegravir/Tenofovir Alafenamide/Emtricitabine
• Biktarvy 50 mg/25 mg/200 mg 30 tablets $2,946 $3,535 N/A
Darunavir/Cobicistat/Tenofovir Alafenamide/Emtricitabine
• Symtuza 600 mg/150 mg/10 mg/200 mg 30 tablets $3,482 $4,178 N/A
Dolutegravir/Abacavir/Lamivudine
• Triumeq 50 mg/600 mg/300 mg tablet 30 tablets $2,805 $3,366 N/A
Dolutegravir/Rilpivirine
• Juluca 50 mg/25 mg 30 tablets $2,579 $3,095 N/A
Doravirine/Tenofovir Disoproxil Fumarate/Lamivudine
• Delstrigo 100 mg/300 mg/300 mg 30 tablets $2,100 $2,520 N/A
Efavirenz/Tenofovir Disoproxil Fumarate/Emtricitabine
• Atripla 600 mg/300 mg/200 mg tablet 30 tablets $2,724 $3,269 N/A
Efavirenz/Tenofovir Disoproxil Fumarate/Lamivudine
• Symfi 600 mg/300 mg/150 mg tablet 30 tablets $1,634 $1,961 N/A
• Symfi Lo 400 mg/300 mg/150 mg tablet 30 tablets $1,634 $1,961 N/A
Elvitegravir/Cobicistat/Tenofovir Alafenamide/Emtricitabine
• Genvoya 150 mg/150 mg/10 mg/200 mg tablet 30 tablets $2,946 $3,535 N/A
Elvitegravir/Cobicistat/Tenofovir Disoproxil Fumarate/Emtricitabine
• Stribild 150 mg/150 mg/300 mg/200 mg tablet 30 tablets $3,090 $3,708 N/A
Rilpivirine/Tenofovir Alafenamide/Emtricitabine
• Odefsey 25 mg/25 mg/200 mg tablet 30 tablets $2,681 $3,217 N/A
Rilpivirine/Tenofovir Disoproxil Fumarate/Emtricitabine
• Complera 25 mg/300 mg/200 mg tablet 30 tablets $2,681 $3,217 N/A
Pharmacokinetic Enhancers (Boosters)
Cobicistat
• Tybost 150 mg tablet 30 tablets $219 $264 N/A
Ritonavir
• Generic 100 mg tablet 30 tablets $222 $278 Pending
• Norvir 100 mg tablet 30 tablets $257 $309
a The following less commonly used ARV drugs are not included in this table: delavirdine, didanosine, fosamprenavir, indinavir, nelfinavir, saquinavir, and stavudine.
b Source: IBM Watson Health. Micromedex Red Book [database]. 2018. Available at: https://www.micromedexsolutions.com
c Source: Medicare & Medicaid Services. Federal Upper Limits—September 2018 [database]. 2018 September 1. Available at: https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html.

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