But then, doesn't that mean everyone with coverage pays for it?Insurance pays for it, and everyone with coverage pays for these high costs through high premiums -- public healthcare in Canada doesn't pay for drugs, and even without insurance the cost of those drugs tends to be substantially cheaper, at least in the few scenarios I've been exposed to.

Insurance doesn't pay $1400 either.

I mean 225,000 Americans are on it, and multiply that by 1400 x 12, and you're already way past Truvada's global annual revenue. The numbers don't work out.

Americans do subsidize European and African prices though, there's no doubt about that.

More likely it means you pay (or more appropriately, your insurance company pays) the negotiated rate, which is often far, far less than the published retail cost of a medication.

Those big monthly $$s get investors excited tho.

This is to say nothing of the public / private debate.

> Worth noting that no one pays $1400 a month

There are millions of people with deductibles that are in the $2000 - $8000+ range, and even higher for family plans. Those people are certainly paying $1400 for several months until their insurance kicks in. Then, in the next coverage year, they get to spend that $1400 several times again, and they continue that pattern each year.

If their insurance doesn't cover it, they're also paying $1400.

Money still has to come from somewhere.

If you are insured and look at medical bills in the US you generally see an obscene top line cost, a very large discount that the insurance company negotiates, and your personal copay. That discount doesn’t really seem to come from somewhere.