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  • 1.  TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-17-2020 09:07
      |   view attached
    ​Hello members of the community!

    The Pharmacist Committee had an interesting discussion about TAF/FTC vs TDF/FTC for PrEP, taking into consideration the anticipated differences in cost once TDF/FTC is available as generic.  Wanted to share a recent article and open the discussion up to the Open Community to hear thoughts of providers across the country.

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    Agnes Cha
    Northwell Health
    New Hyde Park NY
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    Attachment(s)



  • 2.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-18-2020 08:57
    Thanks for sharing, Agnes

    Personally, I'm interested in LA PrEP including implant devices and how this will fit into the cost discussion. There is not doubt among young people LA PrEP will be preferred and heavily requested. Then what? Cost will be a barrier, thoughts?

    The discussion about TDF/FTC vs. TAF/FTC is interesting, thanks again

    Michelle

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    Michelle Ogle
    Bronx NY
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  • 3.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-18-2020 08:58
    The difference in price and the lack of data in women and heterosexual males would likely make TDF/FTC the preferred option for sometime. The difficulties will be among heterosexuals with renal and bone density problems, this is an area where providers will end possibly considering off label use of TAF/FTC. My experience suggests very poor uptake of PrEP among heterosexuals in the developed world where GILEAD hopes to reap its maximal financial benefits. Data on PrEP in heterosexuals is key but has less financial value. 

    Only my thoughts, this assessment may be wrong. 


    Sent from Yahoo Mail for iPhone





  • 4.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-19-2020 09:15
    Thanks for sharing your thoughts, Leonard!

    This is a safe space and I think it's important to get different perspectives so there's no such thing as wrong...In my opinion. 

    There are clinical trials underway for the use of TAF/FTC in women, so I anticipate the data will support it as a good option for PrEP in women. The problem with poor uptake in women and communities of color lies with clinicians. Black women are being denied PrEP because providers don't see them as "at-risk" especially educated women. Women overall and women of color are also less likely to approach a male provider about PrEP because stigma still exists when it comes to women and sex. I really think we need to look at the healthcare system and our role in the lack of PrEP uptake in heterosexual, at-risk populations. 

    I agree with comments on the future of TDF/FTC, who knows? I still think the gold is in LA PrEP devices. I believe that will be a game changer for women and people of color. 

    Love sharing everyone's perspective.

    Michelle O

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    Michelle Ogle
    Bronx NY
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  • 5.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-19-2020 10:05
    Hello All,
    In Iowa we are mainly using Truvada, my opinion is that if the patient is already taking their medications I am nervous switching-I don't see the benefits if they are otherwise healthy. It is too confusing. But, If I were to have a new PReP patient I would not have a problem using the Descovy. ​

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    Shannon Stewart
    Sioux City IA
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  • 6.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-20-2020 10:10

    In MS we aren't switching all patients. We are educating patients on the differences. Descovy has a longer half life, less decreases in bone mineral density, and is smaller in size. I too am hesitant to switch all patients due to the Truvada lawsuit. If we proactively switch people to Descovy it's as if we are validating the lawsuit. New PrEP starts that are born with a penis typically get Descovy. We don't offer Descovy to those born with a vagina that report only anal sex-I have heard some that do. 

    Kandis V. Backus



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    KANDIS BACKUS
    Jackson MS
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  • 7.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-18-2020 12:20
    We have also been discussing the costs of ARV medications in general lately in our ECHO network and although TDF/FTC is supposed to go generic this year, we know that doesn't immediately translate to cost saving. Especially with the complex nature of how insurances determine formularies and negotiate contracts that are not transparent on the 'true' cost of the drugs.  Here are couple articles from JID and JAMA speaking to the costs of ARVs.  Both quick and good reads. And Fierce Pharma also had a great opinion peice, click here for that.

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    David Hachey
    Pocatello ID
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    Attachment(s)

    pdf
    jiz066.pdf   208 KB 1 version


  • 8.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-19-2020 10:05
    Thank you for sharing ​this Agnes!
    I hope every provider who is prescribing PrEP gets a chance to read this article. We should be aware and held responsible for the cost of medications prescribed when there is an alternative cost effective and clinically effective regimen. I believe in NYC providers are aware of the value or TDF/FTC after the DOH sent a provider letter and updated the guidelines but more work is to be done and I think this research paper came out at a perfect time to support the previous two initiative.  ​

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    Mary Malek, PharmD
    New York, NY
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  • 9.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-20-2020 10:10
    Here here, Mary!!

    Totally agree.

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    Michelle Ogle
    Bronx NY
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  • 10.  RE: TAF/FTC vs TDF/FTC for PrEP?

    Posted 03-23-2020 15:26
    Mary thanks for sending out this article. We already have major obstacles to getting eligible persons on PrEP - now we have e "new" combination drug whose costs cannot, in my opinion, justify the "safety" benefits.

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    Jeffrey Kirchner
    Lancaster General Health Physicians (LGHP) - Comprehensive Care
    Lancaster PA
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