Buyers Clubs Big Business for HIV and HCV Drugs

If you can’t beat ’em, join ’em.

That’s effectively the mindset behind so-called drug “buyers clubs,” many of which are online-based, that offer members access to low-cost, generic HIV and hepatitis C virus (HCV) medications. The concept made famous by the 2013 film “Dallas Buyers Club” is still going strong, with organizations offering patients discounted drugs in many major cities around the world.

Both HIV and HCV treatments are notoriously expensive. Estimates of median lifetime costs associated with HIV management—which includes more than just pharmacotherapy—range in excess of $300,000 among those with healthcare insurance in the United States, and almost twice that for those without coverage. A month’s supply of the combination therapy emtricitabine/tenofovir, used in HIV prophylaxis or “PReP,” costs more than $500, according to media reports.

The costs of HCV treatments arguably present even more of a challenge for those with the virus, with sofosbuvir, a linchpin of HCV treatment, costing as much as $1,000 per day. Direct-acting antivirals (DAAs), the current “gold standard” in HCV treatment, are prohibitively expensive for some.

In recent years, buying groups have offered solutions for patients for whom cost is an issue, reducing out-of-pocket charges by as much as 90% for some medications. In countries such as the UK, where the National Health Service does not provide PReP, they may in fact be the only option for some.

Still, such buying clubs are not without risks. For example, there have been some concerns over the quality of the generic products available, given that many of them are manufactured in countries with varying levels of regulatory control.

However, a study presented in October during the International Congress of Drug Therapy in HIV Infection in Glasgow, Scotland found that in patients taking a generic version of PReP purchased online, drug concentrations 24 hours post-dose were “above [the] established median plasma… cut-offs of 19 ng/mL and 22 ng/mL, respectively.” The study authors wrote, “[C]oncentrations of [the drugs] in generic formulations purchased over the internet were similar to those on the original formulation from [the manufacturer], which have demonstrated high levels of protection against HIV infection in previous clinical trials.”

Similarly, a study presented at the same meeting involving 900 patients with HCV who purchased generic versions of DAAs imported into Australia, the UK, and elsewhere, found that these drugs provided sustained virologic response—the primary success metric for treatment—rates “comparable to those seen in Phase III trials of the same, but more expensive, branded treatments.” The researchers added, “Mass treatment with legally imported generic DAAs is a feasible, low-cost option where high prices prevent access to branded treatment.”

It should be noted, though, that all buyer’s clubs are not the same. According to one review of the concept published online, some are affiliated with advocacy/care organizations for people with HIV/AIDS, and thus may have 501c3 status as non-profits, and some charge members annual membership fees. In general, in the United States anyway, the online review notes, these clubs exist as a result of a loophole in drug importation laws that allows for the importation of drugs needed to treat the terminally ill.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.