A federal program that ensures certain government-funded health-care providers receive drugs at reduced prices will be a key element of President Donald Trump’s plan to end HIV by 2030.

Providing the drugs through the 340B discount program, which is already being used by facilities like community health centers that receive government funding, will help put HIV prevention medication into the hands of patients at a discounted rate, Department of Health and Human Services Assistant Secretary for Health Brett Giroir said at a Kaiser Family Foundation event April 22.

The president’s plan to end the HIV epidemic in the next decade, reducing new infections by 75 percent in five years and 90 percent in 10 years, relies on preventing the spread of the immunodeficiency disease. To do that, a minimum 50 percent to 60 percent of people who are at high risk of becoming infected with HIV need to take the preventive medication, Giroir said.

Truvada is currently the only drug for HIV prevention, or pre-exposure prophylaxis (PrEP), on the market in the U.S. It can run about $1,600-$1,700 for a 30-pill bottle, which is about a month’s supply.

“We feel many people coming into this will not have insurance coverage,” Giroir said. “Community health centers leveraging the 340B program, where we get highly competitive prices, are really the way to go.”

Of the more than 1 million individuals who could benefit from using HIV prevention medication, only 10 percent use it, according to the Centers for Disease Control and Prevention, although estimates differ. Gilead Sciences Inc., which makes Truvada, estimates about 202,000, or closer to 20 percent of people who need PrEP, currently use the drug.

Of the $291 million Trump requested for the program from Congress in fiscal year 2020, $50 million would go directly to community health centers to support PrEP services.

Existing Solution

Focusing on community health centers and their ability to get Truvada at a reduced price is more about improving the current system than reinventing the wheel.

It’s not that the 340B program couldn’t be used already, but it’s to mobilize community health centers to take advantage of it more often, Jen Kates, vice president and director of global health and HIV policy at KFF, said after leading discussions with Giroir and a panel.

Community health centers in general aren’t thinking about PrEP, Kates said, but they could be used to provide the medication to a wider group of people and to communities that don’t currently have access to PrEP.

“Part of this is to change their culture a little bit and say ‘you are a front-line provider for many people at risk for HIV where PrEP would be indicated. Start providing it,’” Kates said.

That impact could be felt nationwide. More than 11,000 community health center locations exist in the U.S., in all 50 states and territories, according to the National Association of Community Health Centers.

Community Options

The emphasis on 340B is “definitely going to help,” Kendra Johnson, director of the STD and HIV office in the Mississippi Department of Health, said after the event April 22.

“It’s just educating providers that 340B is available because it will allow them to provide those drugs at such a reduced cost,” Johnson said. Mississippi is one of seven states on which Trump’s plan will initially focus. The seven states and 48 counties are considered “hot spots” for HIV infections across the country.

In addition to 340B, the Mississippi Health Department is also taking its own unique approach to accessing PrEP: telemedicine. Under the “tele-PrEP” program, patients from rural communities can go to county health departments to do video consultations with physicians to get access to the prevention medication, Johnson said.

The department is looking to expand that program to local universities that have already established telemedicine services, she said.

Price Negotiations

HHS Secretary Alex Azar recently said the administration is negotiating with Gilead to reduce the cost of Truvada. While Giroir couldn’t comment on the outcome of the negotiations, he said good news may be on the horizon.

“We’re very hopeful we will have some very positive things to say in the near future,” Giroir said of the negotiations.

Giroir downplayed recent claims by HIV activists that a patent on Truvada for PrEP owned by the CDC could be used to leverage a lower price with the drugmaker. The HHS could sue Gilead for royalties, but that could take years to lower pricing, Giroir said.

That timing is important because generic Truvada should go on the market in 2021 when Gilead’s exclusivity expires.