{"id":563362,"date":"2026-04-04T03:30:19","date_gmt":"2026-04-04T03:30:19","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/563362\/"},"modified":"2026-04-04T03:30:19","modified_gmt":"2026-04-04T03:30:19","slug":"netflix-pricing-model-could-make-hiv-prevention-drug-far-more-accessible","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/563362\/","title":{"rendered":"\u2018Netflix pricing model\u2019 could make HIV prevention drug far more accessible"},"content":{"rendered":"

Figure 2<\/a> from the PURPOSE-1 trial<\/a> changed the world. <\/p>\n

Between gray and red bars representing the study\u2019s background HIV incidence and the arms randomized to receive oral pre-exposure prophylaxis (PrEP) was white space filled only by a previously unimaginable number: zero. Zero infections over one year among the 2,134 cisgender adolescent girls and young women who received the novel long-acting injectable antiretroviral lenacapavir.<\/p>\n

The PURPOSE-2 study<\/a>, published in 2024, showed the twice-yearly shot\u2019s practically perfect protective efficacy extended to men and gender-diverse people. The end of the HIV epidemic felt within reach.<\/p>\n

Then the bottom fell out.<\/p>\n

In 2025, funding for both domestic<\/a> and global<\/a> HIV care and research was suddenly and senselessly slashed<\/a>. Soon after, the price of lenacapavir was announced: $28,218 per person per year.\u00a0<\/p>\n

Those of us working in HIV immediately feared that lenacapavir would become another medical miracle whose impact on the epidemic would be delayed for years while access slowly expanded and prices gradually fell. History has taught us this pattern well. But history also offers another path: subscription pricing<\/a>.<\/p>\n

\t\t\t\"\"\t\t<\/p>\n

\t\t\t\t\"\"\/
\n\t\t\t\tSTAT Plus: The decades-long journey to Gilead\u2019s twice-a-year HIV prevention drug lenacapavir<\/a><\/p>\n

The need for subscription pricing for lenacapavir is made clear looking back upon the implementation challenges faced by two other recent infectious disease breakthroughs, cabotegravir PrEP and hepatitis C antivirals.<\/p>\n

Cabotegravir was the first long-acting injectable PrEP medication. Like lenacapavir, cabotegravir is both preferred by patients<\/a> over and more effective<\/a> than oral PrEP<\/a>. Yet, due to the drug\u2019s $21,000 per year price, insurers erected coverage barriers.<\/a> Additionally, many clinics and pharmacies cannot float the capital required to keep the drug in stock. As a result, four years after approval, the shot, administered once every two months, accounts for less than 3% of PrEP use in the United States<\/a>.\u00a0<\/p>\n

Less than a decade ago, high prices similarly slowed the uptake of hepatitis C antivirals. The cure was initially priced at $84,000<\/a>. In response, almost all insurers rationed the drug\u2019s distribution via prior authorizations and coverage denials (a problem that persists today<\/a>).<\/p>\n

However, Louisiana, Washington state, and Australia opted for a more innovative strategy. They implemented subscription pricing in which government insurers paid manufacturers a fixed fee in exchange for unlimited access to the drugs.<\/p>\n

The structure was aptly nicknamed the \u201cNetflix model<\/a>.\u201d Like the streaming service that revolutionized how the world watches movies, insurers negotiated a subscription payment to manufacturers in exchange for unlimited access to the cure. Because pricing is divorced from manufacturing costs, manufacturers can maintain profits while insurers pay a stable, predictable amount and per-patient costs fall. Analyses show the experiment succeeded at expanding access and controlling costs<\/a> without bankrupting health systems or pharmaceutical firms. In Louisiana, hepatitis C cure prescriptions increased fivefold<\/a>. In Australia, deaths from hepatitis C were almost halved<\/a> compared with counter-factual estimates, and the program was found to be cost-saving over time. By comparison the impact in Washington state was minimal, likely due to generous hepatitis C cure coverage policies already in place prior to the implementation of their subscription pricing program. \u00a0\u00a0\u00a0<\/p>\n

Subscription pricing has several advantages over the two other commonly proposed solutions. Mandating insurance coverage for the drug provides no incentive for pharmaceutical firms to moderate prices. Government price negotiation could lower costs, but even if lenacapavir\u2019s price were cut in half, the marginal cost would still remain in the tens of thousands of dollars per patient \u2014 levels likely to sustain insurer restrictions. Further, aggressive price controls could dampen future PrEP innovation.<\/p>\n

Finally, neither strategy adequately addresses the capital requirements that prevent many clinics and pharmacies from stocking injectable PrEP.<\/p>\n

Lenacapavir is particularly well suited for subscription pricing. Its manufacturing costs are estimated to be as low as $25 per year<\/a>. Current access is severely restricted, demand can be reasonably estimated, and the public health payoff of widespread availability is enormous. Subscription agreements could be negotiated by private insurers\u2019 pharmacy benefit managers, state Medicaid programs, at the federal level, or through cross-payor \u201ccarve-outs.\u201d<\/p>\n

\t\t\t\"\"\t\t<\/p>\n

\t\t\t\t\t\tWith a promising new plan to pay for pricey cures, two states set out to eliminate hepatitis C. But cost hasn\u2019t been the biggest problem<\/a><\/p>\n

Boosting feasibility, lenacapavir\u2019s manufacturer was a principal participant in the subscription agreements for hepatitis C drugs. And in a polarized political era, subscription pricing has a history of bipartisan appeal<\/a> given its alignment of public health goals with market realities. Further, the Trump administration has emphasized the optimization of lenacapavir\u2019s implementation as a cornerstone of efforts to end the HIV epidemic<\/a>. No policy could accelerate lenacapavir\u2019s implementation more than one that eliminates the drug\u2019s marginal cost.\u00a0<\/p>\n

As Australia showed with hepatitis C, other high-income countries, including those with government-negotiated drug prices, can also benefit from subscription pricing. While immediate access to generic lenacapavir has been granted to most low- and lower- middle-income countries, negating a need for subscription pricing, it could expand lenacapavir access in many upper-middle-income countries that otherwise cannot afford the medication.<\/p>\n

Cabotegravir and hepatitis C remind us that, under the status quo, lenacapavir may never achieve the profound potential revealed to the world in PURPOSE-1\u2019s now-famous Figure 2. Subscription pricing offers a different path \u2014 one in which rapid, scaled implementation of lenacapavir helps put the end of the HIV epidemic back within reach.<\/p>\n

Michael Rose is an internist and pediatrician at Johns Hopkins University School of Medicine investigating ways to improve HIV treatment and prevention. \u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"Figure 2 from the PURPOSE-1 trial changed the world. Between gray and red bars representing the study\u2019s background…\n","protected":false},"author":2,"featured_media":563363,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[43961,43850,97,13300],"class_list":{"0":"post-563362","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-drug-pricing","9":"tag-global-health","10":"tag-health","11":"tag-hiv-aids"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/563362","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=563362"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/563362\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/563363"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=563362"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=563362"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=563362"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}