[chimeracoder]

> 30-day supply of generic PrEP costs ~$2,500

Er, no, generic Truvada costs $30-$60/month, although it was not available as a generic in 2019, which is when the mandate for free PrEP without cost-sharing was first issued. (The mandate was issued in 2019, but it did not fully go into effect until 2021).

That said, the drug costs aren't the only (or even biggest) costs associated with PrEP - the doctors' vists and labwork are much more. Under the ACA, those were required to be covered for free on all insurance plans, but a judge in Amarillo, TX blocked that as part of a ruling on a lawsuit against abortion care.

> and for potential liver and kidney damage

They aren't checking for liver damage. They do check for indications that the drug isn't being absorbed correctly, which is done via a test for kidney functioning, but kidney issues for both Truvada and Descovy as PrEP are extremely rare. And there are no liver concerns associated with either one.

[mathewsanders]

I guess I don't fully understand U.S. healthcare system (I'm an immigrant from a country with universal healthcare, and this is the first time in my life that I've had a medication prescribed other than short-term antibiotics).

I pay a $10 co-pay for generic with my insurance, but when I pick up from pharmacy the receipt says "you insurance saved you $1888" (you're right it's not ~$2500/month - I just checked and that's a different prescription I have that I get filled at the same time).

[chimeracoder]

> I guess I don't fully understand U.S. healthcare system

Yes, it's confusing.

> I pay a $10 co-pay for generic with my insurance, but when I pick up from pharmacy the receipt says "you insurance saved you $1888" (you're right it's not ~$2500/month - I just checked and that's a different prescription I have that I get filled at the same time).

As a rule, the "your insurance saved you $X" is a meaningless statement.

It's actually worse than meaningless - it's effectively an advertisement for health insurance, not an actual statement of fact. It's calculated based on the difference between what you paid and the list price for a drug, which almost nobody is paying (and your insurer is definitely not paying).

Your insurance pays some other negotiated rate for drugs - they will basically never pay list price. Even if you were getting it without insurance, you still would likely not be paying list price. If you were paying out of pocket, you'd probably be using a discount coupon (which usually works as a third party functioning as a pseudo-PBM, a ridiculous concept which I will not bother to try to explain in this post). Or your doctor would explicitly prescribe the branded version ("dispense as written") and you'd be using the Gilead copay assistance coupon to pay for it.

Since there's no situation in which the list price is what you'd be paying, it's completely meaningless to say "you saved $X off the list price". I'm half of the mind that these statements should be banned by the FTC as a deceptive trade practice - that's how misleading they are.

[Clamchop]

I'm completely of the mind that it should be banned. With recent (though deeply flawed) efforts toward transparency in pricing, we might even see it some day!