The Biktarvy List Price vs. The Patient's Price
It is crucial to differentiate between a drug's list price and what a patient actually pays. The list price, also known as the wholesale acquisition cost, is the official price set by the manufacturer. For Biktarvy, manufacturer Gilead Sciences lists a 30-day supply at $4,216. However, this figure is primarily relevant for insurers and is not the cost that most patients pay directly out of pocket. Insurers negotiate discounts, and manufacturers offer assistance programs, both of which drastically lower the patient's final expense.
Biktarvy Cost with Commercial Insurance
For commercially insured individuals (those with insurance through an employer or a private plan), the cost of Biktarvy is often minimal due to a manufacturer-sponsored co-pay program. With the Gilead Advancing Access® co-pay coupon card, eligible patients may pay as little as $0 to $5 per month. This program can cover up to $7,200 in annual cost-sharing, which typically removes the burden of deductibles and high co-pays. The specific amount an individual pays will still depend on their plan's formulary, deductibles, and other coverage details.
Cost with Government Insurance (Medicare and Medicaid)
Patients with government insurance, such as Medicare or Medicaid, also face significantly lower costs. For those in the Medicare Part D Extra Help Program, co-pays can range from approximately $4 to $9 per month. Similarly, state Medicaid programs often have low or no co-pays for Biktarvy. The Gilead Advancing Access program cannot be used by those with government insurance, but patients can seek assistance from independent non-profit foundations to help cover out-of-pocket expenses.
Biktarvy Cost Without Insurance
For uninsured individuals, the retail price of Biktarvy is very high. Reports suggest a monthly cash price can range from around $4,000 to over $7,000, varying by pharmacy and discount usage. While discount cards from services like GoodRx can lower the price, the total cost remains substantial for those paying out-of-pocket. The average price for 30 tablets using a GoodRx coupon was reported as around $4,120.
Patient Assistance and Support Programs
Financial assistance is available for patients struggling to afford Biktarvy:
- Gilead Advancing Access® Patient Assistance Program (PAP): Uninsured or underinsured patients who meet certain eligibility criteria may receive Biktarvy at no cost. The program requires enrollment and proof of residency in the U.S. or its territories.
- State AIDS Drug Assistance Programs (ADAPs): Funded by the federal government, ADAPs help cover medication costs for low-income individuals with HIV. Eligibility and covered medications vary by state, so patients must check their local program for specific details.
- Independent Co-pay Foundations: For those with government insurance who face out-of-pocket costs, non-profit foundations can provide financial support.
How Cost Factors Differ: Insurance vs. Uninsured
The table below highlights the dramatic difference in cost for a 30-day supply based on a patient's insurance status and access to assistance programs.
| Cost Factor | Commercially Insured (with Gilead Coupon) | Medicare/Medicaid (with potential assistance) | Uninsured (Retail / Discount Card) |
|---|---|---|---|
| Monthly Out-of-Pocket | Typically $0 - $5 | Typically $0 - $9 | Varies, high retail cost can be over $4,000 |
| Manufacturer Assistance | Yes, Gilead Advancing Access co-pay coupon covers up to $7,200 annually | Not eligible for manufacturer coupon, but independent foundations may help | Yes, Gilead Advancing Access PAP may provide free medication |
| Other Assistance | No, program restrictions apply | Yes, ADAP programs and independent foundations | Yes, ADAP programs and discount cards like GoodRx |
| Coverage Limits | Subject to annual maximums and eligibility terms | Coverage varies by specific plan and state program | Dependent on discount card terms and program eligibility |
Conclusion
The high list price of a 30-day supply of Biktarvy can be intimidating, but it is not representative of the final cost for most patients. The expense for this essential HIV medication is a complex issue driven by a patient's insurance status and their utilization of available financial assistance programs. For commercially insured patients, manufacturer co-pay programs can reduce the monthly cost to almost nothing. Likewise, those with government insurance like Medicare or Medicaid typically face minimal co-pays, with additional support available from other organizations. Uninsured individuals face the most significant challenge, but even in these situations, assistance programs from the manufacturer and government initiatives like ADAP offer critical pathways to receiving the medication for free or at a substantially reduced cost. The key for all patients is to actively research and enroll in the programs for which they are eligible to ensure access to treatment without facing insurmountable financial barriers. Gilead Advancing Access offers a starting point for exploring these options.
