In an open letter published Aug 14, 2017, more than a dozen BC doctors and public health groups are calling on Premier John Horgan to immediately cover the costs of a drug that has been shown to effectively prevent the transmission of HIV.
Studies show the drug, referred to as a pre-exposure prophylaxis (PrEP), works as well as condoms for preventing HIV infection, but it can cost nearly a thousand dollars a month and is only inconsistently covered by private health insurance plans.
Before the BC election in May, Horgan endorsed the idea of covering PrEP.
In a Facebook live interview with Xtra on Jan 24, 2017, Horgan called the Liberal government’s refusal to cover PrEP “a mystery,” and said that if the province gave “people the medical devices that they need to protect themselves. . . you’re going to reduce costs over time.” He also said he could not see why British Columbia should not follow the example of Quebec, which subsidizes PrEP through its provincial drug plan.
In an interview with Xtra on Jan 24, 2017, Horgan said it was a “mystery” why PrEP was not already covered in BC (watch his full answer at 17:16). Credit: Angelina Cantada/Xtra
The letter, signed by doctors at Vancouver’s Spectrum Health Clinic, as well as advocates at the Health Initiative for Men, the Community Based Research Centre and other groups, points out that new HIV diagnoses among men who have sex with men have not dropped for years, even as HIV infections decline in other populations. And among young gay and bisexual men, ages 20 to 24, infection rates nearly doubled between 2012 and 2014.
In all, men who have sex with men remain over-represented among new HIV cases in BC, accounting for nearly 58 percent of the all new diagnoses in 2014, according to the BC Centre for Disease Control’s most recent HIV surveillance report.
Free PrEP, the letter says, could help stem new infections in communities where it is needed most.
“When it comes to eliminating HIV, this is a no-brainer. It’s the next step,” says Jody Jollimore, director of the Community Based Research Centre in Vancouver.
“It should have been covered a long time ago,” he says. “People have been passing the buck on this from agency to agency, and really we know that if we have a provincial government that is willing to take leadership on this, we will see change immediately.”
The letter also argues that free PrEP would be cost effective, saving the province millions in long-term health care costs. Researchers in 2011 estimated that each new HIV diagnosis in Canada costs $250,000 in health care alone — the equivalent of nearly 30 years on PrEP at full price. That’s before counting over half a million dollars in lost economic productivity, and nearly half a million dollars in lost quality of life.
Exactly the same drugs as those used for PrEP, tenofovir and emtricitabine, are used to treat HIV, and are already covered for free through BC’s HIV drug treatment program — but only for patients who have already contracted the virus. That’s a bitter irony for some men who can’t afford to access PrEP, but could get it for free only after they were already infected.
Some people have taken the quasi-legal route of ordering cheap generic PrEP from overseas and importing it to Canada from post office boxes in the United States. Joss de Wet, a doctor at Vancouver’s Spectrum Health Clinic and a signatory to the letter, says the majority of his patients have to import their PrEP to afford it. That’s not an option, he says, for the most vulnerable patients who need PrEP the most — those without passports, credit cards or transportation to cross the border.
“The sooner we get this, the better for our communities, the better for our province, the better for the tax man,” de Wet says. “In fact, I think it is embarrassing that the province of British Columbia, which has been a leader in HIV care, is not a leader in HIV prevention.”
A stroke of the pen from the provincial government, de Wet believes, could prevent dozens of new HIV infections this year and save millions down the road.
“We don’t need more studies,” he says. “We need action. We need to get the drug to the people, and we will stop infections.”
Generic PrEP was also recently approved for sale in Canada, but has so far only cut costs by a few hundred dollars a month. Prices are expected to drop further as more generics enter the market, likely easing the cost of a provincial PrEP program over time. A provincial program would also likely lower prices further by bargaining for the drug in bulk.