When Gilead Sciences announced that a generic version of its HIV prevention pill, Truvada as pre-exposure prophylaxis (PrEP), would be available in 2020—a year earlier than expected—folks got excited. After all, a month’s supply of PrEP now costs between $1,600 and $2,000 in the United States. Since generics are cheaper than brand-name drugs, more people at high risk for HIV will be able to access PrEP next year, right? 

Not quite, say some activists, who point out that under the deal Gilead struck with Teva Pharmaceuticals, which is set to manufacture the generic, Teva may enjoy exclusive rights to PrEP for a year. That’s because Truvada contains two drugs, emtricitabine and tenofovir disoproxil fumarate, or TDF, and only the patent on TDF has expired. (Emtricitabine’s patent expires in 2021.) Without any competition, Teva will have no incentive to lower the price of its generic PrEP. And although Gilead offers a co-pay assistance program for PrEP, Teva is under no obligation to do the same, which means many of those who could most benefit from PrEP, including Black men and transgender women, may still be unable to afford the drug. 

That’s why W. David Hardy, MD, chair of the HIV Medicine Association, says, “More immediate actions also are needed to significantly reduce the price and associated medical costs of PrEP, in addition to investments in provider education and capacity building in medically underserved urban and rural areas—particularly in the Southern region of the country.”