tested
In order to keep my prescription for Truvada, which I get through my work insurance at no cost, my doctor kind of gently insisted that I keep with basic policy that I come for an in-person appointment every three months in order to get the next three months' worth of the prescription filled. I suppose the bottom line is an abundance of caution because I am Slut McSlutty.
I get that prescription at no cost to myself, by the way, even though -- and Shobhit is obsessed with this -- it costs the insurance company a whopping $1,761.33 per 30-capsule bottle. Even though insurance pays it for us, he can't stop complaining about how insanely expensive that is for anyone at all, even insurance companies which frankly I feel are hardly deserving of sympathy, generally speaking -- although, to be fair to Aetna, I sure as shit appreciate it, even though the practice is still clearly self-serving on Aetna's part. Shobhit seems to refuse to let this part sink in, but let's say, just for the sake of argument, that I contracted HIV -- which the taking of Truvada 99% guarantees will not happen; combining that with condoms, contracting it would be basically unheard of. But if I did have to take HIV medications, there is no question whatsoever that Aetna would be having to shell out a shit ton more than $1,761 a month for the resulting medications I would need. As would I for out-of-pocket expenses, no doubt.
Maybe I should present more hard evidence for this argument for once. What is the average cost of HIV medication, then? Let's consider this web page by the CDC. It estimates average annual cost of ART (anti-retroviral treatment) "was estimated to be $19,912 (in 2006 dollars; $23,000 in 2010 dollars)." Using an online inflation calculator, I extrapolate that to be nearly $25,000 in 2018 dollars. $25,000 divided by 12 would be . . . $2,083 per month.
. . . Uh. Okay, that's all of a $322 difference per month. Chump change to an insurance company. Wait, what the hell? That was way closer than I expected. Whose cost is this CDC estimate referring to, anyway?
Well, here's a page that offers a relatively simplified, but different picture of cost comparisons: "The annual cost of healthcare, including antiretroviral drugs, for a person living with HIV is around double that of the annual cost of providing PrEP. People need to take HIV treatment for the rest of their life but PrEP will generally be needed for a much shorter period." The paragraph prior to that does essentially make the case that PrEP medications are indeed price-gouged by virtue of patents:
The cost of PrEP will change substantially when the drugs are no longer protected by patent. Tenofovir will come off patent in late 2017 and emtricitabine may lose its patent protection sometime between 2017 and 2021. This means that the pharmaceutical company which originally developed the drugs will no longer have the exclusive right to manufacture them. Rival companies will be able to produce cheaper versions, which could be up to 80% less expensive.
Now, that particular page shows actual monetary figures in British pounds, so there may be some variances comparing Britain to the U.S., but I would assume the scenarios to be parallel. That said, the same website has a much more complex analysis of comparative costs to communities using PrEP -- and using it consistently and correctly, a very key element -- versus receiving antiretroviral treatments for HIV. This poz.com article offers a relatively more accessible explanation of that same analysis. The general consensus seems to be that, in spite of overall agreement that PrEP medications are indeed far too expensive currently, it is still at least cost effective, and still potentially a money saver, to use it as an HIV prevention measure, rather than risk having to spend the rest of your life on HIV treatment medications.
Which is to say, effectively, that my original conclusion still stands. In all likelihood, Aetna did their own analysis, and concluded that it is absolutely worth covering 100% of the cost of Truvada rather than be exposed to costs of lifetime HIV treatment costs. (It should also be noted that another significant factor in its cost-effectiveness is that many people only use PrEP for specific periods of time when risk would otherwise be higher; once HIV infection occurs, however, you could become completely celibate and you still have to take the medications for the rest of your life, thereby increasing the costs exponentially.)
I guess my conclusion, after working through all of this, is that in a way -- as is often the case -- Shobhit and I are both right. It's in the insurance company's best interest to pay for the PrEP medication, but the price is still exorbitant -- and at no fault of the insurance company. Whoever is the patent holder for PrEP, they really are getting rich by exploiting those who use it. And being resentful of that fact is pretty understandable.
Anyway! That was a kind of unexpected tangent.
The appointment itself was fine, although I had to get two shots -- well, to clarify, one shot and one blood draw. As I said to the nurse (or whatever the title is of the woman who takes my blood pressure), "A needle's a needle." I learned for the first time yesterday that the Hepatitis B vaccine, which I had to go through three rounds of shots to get well over a decade ago, "is not a perfect vaccine," and evidently I was due for yet another "booster" shot. This because whatever they test for in blood work for this was in the "gray zone." So, after I was done with my new-ish, young doctor, the woman came in again and I had to take my shirt halfway off so she could jab my upper arm with it.
I saw on her name tag early on in the appointment that her first name was "Giao." Knowing full well I would never in a million years guess it correctly, I just asked her how it's pronounced. Phonetically, her name was Yow. A quick Google search just now suggests it's Vietnamese.
Hey, speaking of which! Shobhit and I watched the tenth and final episode of The Vietnam War, the documentary series, last night, and it predictably focused largely on the fall of Saigon (now called Ho Chi Minh City). What astonished me most though came in the sort of post-script segments, detailing how ten, twenty and thirty years later, returning U.S. veterans would be met with incredible friendliness by the Vietnamese -- even those who had been North Vietnamese troops, the ones who had been our enemy in that war. Can you imagine how it would be if the tables were turned? Americans would be beyond hateful. A lot of them are by default as it is.
Now we just need to watch Apocalypse Now, which I have from Netflix. It will be very interesting to see that movie right after this documentary deep-dive into the war.
But I digress -- back to the doctor appointment! Dr. Brandon was pleasant as ever, and confirmed that my prescription would go through Aetna Specialty Pharmacy rather than Aetna Home Delivery -- having made the mistake a couple of weeks ago with Shobhit's prescription, which they then charged him for, and delivered to his old West Hollywood address. It was a big mess and now Shobhit has to fill out paperwork just to get it all corrected and properly refunded.
I got the requisite oral and rectal swabs, which was about as fun as you might guess. It was after that when Giao came back in to give me the booster vaccine shot, and then I went two floors down to the sixth floor for my blood draw and to leave the urine sample. I was glad to get to that point as I really needed to pee.
I took a calculated risk yesterday and did not take my umbrella to work. I knew there was rain in the forecast for early evening but thought I might still be fine without it. I really should have brought it; there was no conveniently timed buses when I left and I wound up walking the mile or so home in the rain without it. Then Shobhit and I had the kidney beans and rice he made for dinner and we watched The Vietnam War.
We also took a quick walk the two blocks up to Trader Joe's, for some last minute produce for the big dinner we're preparing this week, to offer Scott and Noah from work this Saturday. Shobhit has quite the spread planned, I think five dishes, and that's not even counting the samosas or the aloo parathas. Shahi paneer; eggplant squash; okra (I told him to make that one spicy -- I know Scott likes spicy, and okra's not my favorite); garbanzo beans are already soaking in water as we speak. Oh, and he's going to fry up some pumpkin. I don't think it's quite the same as the conventional pumpkin you think of that's used for Halloween Jack-o-Lanterns though. He got it at the Indian grocery store in Kent just like nearly all the other produce.
I was only able to help a tiny bit with a couple of things last night -- rinsing the garbanzo beans; mashing potatoes for the aloo parathas -- but was otherwise too tired and went to bed. I won't be able to do a whole lot tonight as I'm seeing a movie. But, I should have pretty much the rest of the week to help out, and have no set in stone plans until after Saturday.
[posted 12:41 pm]