> To put this in perspective, transmission of HIV could be virtually eliminated in the US if some of those antiviral drugs were made available to at-risk populations.

No, the biggest issue with preventing HIV transmission is stigma of the disease

Besides, Gilead, much like every other large pharmaceutical company, has patient access programs to ensure that anyone who needs their medications can get them: https://www.gilead.com/purpose/medication-access/us-patient-...

> Besides, Gilead, much like every other large pharmaceutical company, has patient access programs to ensure that anyone who needs their medications can get them

Not if they're on Medicaid or Medicare[1], which some providers through those programs only very recently began to cover the medications due to lawsuits against them.

Also, the co-pay coupon card only covers up to $7,200 in co-pays per year[1].

There is also the income gap where someone could make too much money to qualify for their program, despite having no insurance, bad insurance or catastrophic insurance plans. A contractor responsible for their own health insurance might find themselves in that income gap.

And this program is at the discretion of Gilead, who can deny, change or discontinue it at any moment.

[1] https://www.truvada.com/how-to-get-truvada-for-prep/truvada-...

The existence of "patient access programs" are symptoms of the problem, not cures for the problem.

Remdesivir isn't approved anywhere for use, it's still treated as an experimental drug. Are you referring to Kaletra (lopinavir/ritonavir) that is also effective against COVID-19?

Remdesivir is the drug that is mentioned in the OP, but I am specifically talking about emtricitabine/tenofovir and tenofovir alafenamide, the only two drugs in the US approved for prevention of HIV tranmission, both of which are manufactured by Gilead and cost $2k for a 30-day supply.

The only reason these drugs exist is because companies like Gilesd developed them in the first place. You can’t pay $40 for a drug that doesn’t exist.

What we should be pushing for is a change in circumstances that get those in other countries to pay their fair share so Americans don’t bear the entire burden of incentivizing bringing drugs to market.

Preserving incentives matters.

The US is only 4.29% of the global population. Massively over paying for medication in the US has limited impact on research budgets as much of that is eaten up by advertising etc.

According to this chart[0], world healthcare spending was $7.7 trillion in 2016, of which $3 trillion (39%) was spent by the USA. The USA really does do most of world healthcare spending, disproportionate to its population.

[0] https://www.emergobyul.com/resources/worldwide-health-expend...

Revenue on it’s own is meaningless in this context. All those US drug advertisements are paid for with US heathcare spending along with endless paperwork, insurance profits etc.

(I object to you calling revenue meaningless when you brought up country population.)

World medicine spending[0]: $1.2 trillion

US prescription drug spending[1][2]: $348 billion (29% of world spending)

US drug advertising[3]: $30 billion (1% of US drug spending)

Health insurance net earnings[4]: $23 billion (0.8% of US drug spending)

[0] https://www.statista.com/statistics/280572/medicine-spending...

[1] Median estimate from https://www.healthaffairs.org/do/10.1377/hblog20180726.67059...

[2] Another source puts the US proportion of pharmaceutical revenue at 33%: https://www.statista.com/statistics/784420/share-of-worldwid...

[3] https://www.seattletimes.com/business/us-medical-marketing-r...

[4] https://naic.org/documents/topic_insurance_industry_snapshot...

~$30 billion / 348 Billion is not (1% of US drug spending) Of note prescription drugs are not the only medical advertising, but they do represent a rather large share.

Population creates limits for the amount of useful medication that can be provided, inefficiency is practically unbound. It’s not that on it’s own say Heath insurance overhead and profit is that expensive it’s simply yet another implementation detail unrelated to actually providing heathcare.

If the price of a drug then is 50x in the US (as in this case), and the US buys it at the same rate as the rest of the world, then sales to the US would account for ~70% of the revenue. To attain the same revenue with a constant global price, would require an increase of just over 3x of that lower non-US price point. The original characterization ("What we should be pushing for is a change in circumstances that get those in other countries to pay their fair share so Americans don’t bear the entire burden of incentivizing bringing drugs to market.") doesn't seem particularly incorrect.

Prices and consumption are linked. US drug companies spend a lot on Advertising to promote pill popping, but that’s not free. Further, they rarely collect the full sum from insurance companies or Medicare.

It’s the odd case of people in the US avoiding heathcare due to costs, where others seek it out when unnecessary.

Six months ago, the drug that costs $2k now cost $1800 for a 30-day supply. A year ago it was $1600, and about two years ago it was $1400. The patent expires this year.

Gilead did not develop or discover emtricitabine, university research through NIH grants did. Tenofovir was discovered via university research in Prague.

discovery != bringing a drug to market