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Antiretroviral treatment has transformed HIV from a death sentence to a chronic condition, allowing people with HIV to live longer and healthier lives. However, they face significant barriers to accessing and affording life-saving — but expensive — antiretroviral (ARV) medications. These barriers are particularly severe for low-income patients, and they disproportionately affect racial and ethnic minorities. High ARV prices create pressure for government insurers to contain costs either by rationing care or by restricting eligibility for public programs. Limited funding, coupled with a growing demand for HIV care and treatment, is likely to make programmatic decisions about who is covered become more difficult over time. Therefore, it is important to identify options for reducing the cost of providing ARVs to allow more people to receive treatment. This study examines a variety of options for negotiating lower ARV procurement costs in U.S. markets. A case-study approach is used to assess options that different stakeholders could use in negotiating ARV price discounts with drug manufacturers given the regulatory and market constraints that exist in the United States.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Framework for Understanding How Prices for Antiretroviral Drugs Are Set

  • Chapter Three

    The ARV Market in the United States: Characteristics, Key Players, and Negotiating Mechanisms

  • Chapter Four

    Cross-National Comparisons of HIV Drug Financing

  • Chapter Five

    Policy Options for Negotiating ARV Prices in the United States and Implications of Health Reform

  • Appendix

    Major Changes Under the ACA That May Affect ARV Drug Costs

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The research described in this report was sponsored by the AIDS Healthcare Foundation and was conducted within RAND Health, a unit of the RAND Corporation.

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