BC just lost its last two excuses not to cover the pill that prevents HIV

One of the province’s most respected HIV/AIDS specialists has publicly announced that coverage for an effective HIV-prevention drug doesn’t have to cost BC taxpayers a dime.

Julio Montaner, the head of the BC Centre for Excellence in HIV/AIDS, told a room full of doctors and activists Nov 6, 2017, that his centre has negotiated a deal with generic drug manufacturers that could deliver the treatment without swelling the budget.

“The message is, we’re ready,” Montaner told Xtra following his announcement. “It’s time to do this.”

During this year’s provincial election, now-Premier John Horgan said it was “a mystery” why coverage wasn’t already provided for PrEP, a treatment that effectively eliminates the risk of contracting HIV. But since forming government, the NDP have stalled, citing costs and a need for more review from the Centre for Excellence.

Montaner’s announcement undermines the government’s case for stalling, leaving HIV/AIDS activists and health care professionals wondering what the province is waiting for.

“The ball is pretty firmly in the province’s court now,” says Jody Jollimore, managing director of the Community Based Research Centre in Vancouver.

PrEP, or pre-exposure prophylaxis, is one of the most promising new tools for HIV prevention. Studies show that people who take the pill every day are at almost no risk of contracting HIV.

But the drugs are expensive and unaffordable to most people who could benefit from them. Earlier this year, Health Canada approved generic versions, which would make PrEP more affordable, but still out of reach for many people. Ontario and Quebec both offer some coverage for PrEP under their provincial pharmacare programs.

BC sexual health doctors sent an open letter in August demanding coverage from the province, and last month the Pacific AIDS Network sent another appeal for a PrEP coverage program. Both times, the Ministry of Health responded using outdated cost estimates — based on brand-name drugs that have since been replaced by cheaper generics — to say the drugs were too expensive and required more review.

But coverage, at least in BC, may be coming soon. Two sources who were present for a provincial briefing in October told Xtra that a senior Ministry of Health bureaucrat assured a group of activists that PrEP would be covered by the end of 2017, but then declined to commit on the record. When contacted by Xtra to confirm, the bureaucrat declined to comment.

A spokesperson for the Ministry of Health tells Xtra that the province will make a decision on PrEP coverage by the end of the year.

As the BC government stalls, rates of HIV transmission among men who have sex with men remain stubbornly high, and researchers have noticed troubling upticks in infections among young and non-white bisexual and gay men.

At the rate last calculated by the BC Centre for Disease Control, 46 gay and bisexual men in BC will have become HIV-positive since Horgan was sworn into office in July.

Experts estimate that only about 750 men in the province currently use PrEP, about 500 through private insurance plans and another few hundred who travel across the US border every three months to pick up cheap imported generics from overseas.

Montaner says the Centre for Excellence has worked out a deal with generics manufacturers that would cut the current cost of HIV treatment enough to make room for 1,000 new PrEP prescriptions by the end of 2017 and 2,500 prescriptions by the spring of 2018, without increasing the centre’s drug budget at all. The savings on new generic HIV medications would be enough to pay for the PrEP program for at least the first year.

Montaner would then like to expand to 5,000 free prescriptions by the spring of 2019 with modest budget increases (he wouldn’t say exactly how much the discounted PrEP would cost, but said the province would get at least a 30 percent discount.)

The proposed program would increase the number of men on PrEP in BC more than six fold.

Montaner told Xtra after his announcement that while the province has promised to respond by the end of the year, he hopes to hear much sooner — within weeks or days.