Health insurer Pacific Blue Cross is no longer covering a controversial medication that can prevent the spread of HIV, the virus that leads to AIDS.
Letters went out in late April to fewer than 10 people who had been receiving $900 per month in extended health coverage for the once-a-day pill called Truvada, confirmed Joanne Jung, director of pharmacy services for the not-for-profit insurer. The letters said Blue Cross paid for the medication in error and later determined it is not eligible as a pre-exposure prophylaxis or PrEP under the contracts in question.
The drug, which combines two anti-viral agents, was originally developed to treat HIV infections, but was approved by Health Canada in February as a preventive measure when taken by people who do not have HIV but are exposed to it through sex. Some doctors earlier prescribed it for that purpose on an off-label basis.
When used for prevention, Truvada is considered a supplemental drug — as are birth control pills, vaccines, and medications to enhance sexual function — and are not covered under all drug plans, Blue Cross says.
“We sincerely apologize if the letter created any confusion for those members,” Jung added in an emailed statement.
Douglas McClelland, 61, says he took the medication for 18 months, covered by his extended health care plan with Blue Cross, because his partner is HIV positive.
“At $900 a month, I won’t be able to take it anymore,”says McClelland. “My plan gives me medication for high blood pressure to prevent heart attacks. I’m on cholesterol medication to prevent heart disease. So preventive medication is part of the whole suite of drugs that you get as you’re getting older.”
Critics of Truvada and PrEP in general say it can encourage unsafe sexual practices such as not using condoms.
At $900 a month, I won’t be able to take it anymore.
Rates of gonorrhea and syphilis in B.C. have been on the upswing in recent years. The B.C. Centre for Disease Control says there were 761 cases of syphilis in 2015, nearly 40 per cent higher than 2014. Eighty per cent of those were among gay, bisexual and other men who have sex with men, and about half were HIV-positive.
Brian Chittock, executive director of AIDS Vancouver, says those numbers can’t be blamed on Truvada because so few people take it due to its high price and limited availability.
He slams the decision to pull coverage for a medication that should be another weapon in the arsenal to prevent the transmission of HIV. The insurance company used by AIDS Vancouver, for instance, allows Truvada to be claimed as a preventive medication, he says.
“For them to cover it and (then) stop is criminal. This is a breakthrough in prevention around HIV. It’s not 100-per-cent guaranteed, but it does reduce the individual’s chances of contracting HIV.”
Greg Oudman, executive director of the Health Initiative for Men in Vancouver, says he’s part of a national movement to have provinces cover Truvada under public health plans, something only Quebec does at the moment. Right now, funding varies depending on each private plans and the insurer backing the plan.
“We are huge advocates of Truvada being available and accessible as a prevention tool.”
He likens the debate over Truvada to the one that predated the widespread availability of birth control pills for women.
“There was a value judgment attached, that people were going to become more promiscuous. And our belief is that people should be allowed to engage in the sexual practises that they want to engage in and that they should have the preventive technologies available to them to ensure the sex is healthy sex.”
Gilead, the manufacturer of Truvada, is actively supporting groups seeking more access to the medication in Canada. Truvada has been approved as a preventive medication since 2012 in the U.S. The company’s patent runs out in 2017 at which time cheaper generic versions will likely become available. Generics made in India are already being sold for $50-$100 US per month online.
Another criticism of widespread use of Truvada is that it can lead to treatment-resistant cases of HIV if people don’t take it regularly or somehow become infected despite the medication. One such case has already surfaced in Toronto.
The B.C. Centre for Excellence in HIV/AIDS said Wednesday it has no one available to comment on Truvada. The centre released survey results in March saying about one-third of gay men in Vancouver were aware of PrEp as a technique for AIDS prevention. The survey was conducted between Feb. 2012 and Feb. 2014.
