Cost Is One of the Biggest Barriers to HIV Treatment Adherence

You already know that Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) is one of the most effective and widely prescribed HIV treatments available. But you also know that a $3,500–$4,000 monthly cash price can stop patients from filling their prescriptions — or worse, cause them to ration doses or abandon treatment entirely.

Medication non-adherence due to cost is a real, measurable problem in HIV care. And while most of your patients won't actually pay that sticker price, navigating the savings landscape is confusing enough that many patients fall through the cracks. This guide is designed to help you and your staff connect patients with the right programs quickly.

What Patients Are Actually Paying

The financial picture for Biktarvy varies widely depending on coverage:

• Commercially insured patients — copays typically range from $0–$75/month after manufacturer copay assistance. Without copay cards, specialty tier copays can run $100–$300+/month.
• Medicare Part D patients — copays vary by plan and phase (deductible, coverage gap, catastrophic). Patients in the coverage gap can face significant out-of-pocket costs.
• Medicaid patients — typically $0–$3/month, depending on state.
• Uninsured patients — face the full $3,500–$4,000/month cash price unless enrolled in patient assistance programs.
• Ryan White/ADAP patients — $0 in most states through AIDS Drug Assistance Programs.

The patients most likely to struggle are those with high-deductible commercial plans, Medicare beneficiaries in the coverage gap, and uninsured patients who don't know about assistance programs.

Manufacturer Savings Programs

Gilead Advancing Access Copay Coupon Card

This is the most impactful tool for commercially insured patients. Key details:

• Eligible patients may pay as little as $0 per month
• Available to patients with commercial insurance (not government insurance)
• Enrollment at gileadadvancingaccess.com or by calling 1-800-226-2056
• Can be applied at the pharmacy with a copay card
• Your staff can help patients enroll during office visits

Clinical tip: Train your front desk and nursing staff to screen every commercially insured patient for copay card eligibility. Many patients don't know these programs exist, and enrollment takes only a few minutes.

Gilead Advancing Access Patient Assistance Program (PAP)

For uninsured or underinsured patients who meet income criteria:

• May provide Biktarvy at no cost
• Income-based eligibility criteria
• Requires provider involvement — you'll need to complete an enrollment form and provide prescription information
• Enrollment at gileadadvancingaccess.com

Keep PAP enrollment forms in your office and build this into your intake workflow for uninsured patients.

Coupon and Discount Card Programs

Beyond the manufacturer program, several independent coupon card programs can help reduce costs, particularly for patients who don't qualify for manufacturer assistance:

• GoodRx — shows cash price comparisons across pharmacies; can sometimes reduce the cash price, though discounts on brand-name specialty medications are limited
• RxAssist — comprehensive database of patient assistance programs at rxassist.org
• NeedyMeds — similar directory at needymeds.org
• SingleCare — another coupon aggregator worth checking

For commercially insured patients, the Gilead copay card is almost always the best first option. Coupon cards are more useful for uninsured patients or those trying to bridge a gap.

Foundation and Nonprofit Assistance

Several foundations offer copay assistance specifically for HIV medications:

• Patient Advocate Foundation (PAF) — copay assistance and case management
• PAN Foundation — provides grants to cover out-of-pocket costs for insured patients
• HealthWell Foundation — similar copay assistance grants for HIV treatment
• Ryan White HIV/AIDS Program and ADAP — federally funded programs that cover HIV treatment costs for eligible patients in most states. ADAP eligibility varies by state but generally covers patients up to 300-500% of the federal poverty level.

Clinical tip: Foundation funds can run out during the year. Encourage patients to apply early (January) and have backup options identified. Your social worker or patient navigator, if you have one, should monitor fund availability throughout the year.

Generic Alternatives and Therapeutic Substitution

As of 2026, there is no generic version of Biktarvy. However, if cost is a barrier and patient assistance isn't available, consider therapeutic alternatives:

• Dovato (Dolutegravir/Lamivudine) — a two-drug INSTI-based regimen by ViiV Healthcare. May have different copay assistance programs available. Note: not appropriate for patients with hepatitis B co-infection or HIV-1 RNA above 500,000 copies/mL.
• Triumeq (Dolutegravir/Abacavir/Lamivudine) — another INSTI-based option. Requires HLA-B*5701 testing. ViiV also offers savings programs.
• Cabenuva (Cabotegravir/Rilpivirine) — long-acting injectable option. Different cost structure since it's administered in-clinic. May be covered differently by insurance.

Any switch should be clinically appropriate — don't compromise virologic control for cost. But knowing the alternatives helps you have informed conversations with patients when affordability is a barrier. For more on alternatives, see alternatives to Biktarvy.

Building Cost Conversations Into Your Workflow

The most effective way to prevent cost-related non-adherence is to address it proactively. Here are practical steps:

At Intake / New Patient Visits

• Screen insurance status and coverage tier for Biktarvy
• Enroll eligible patients in Gilead copay card immediately
• Refer uninsured patients to PAP enrollment
• Connect underinsured patients with ADAP or foundation assistance

At Every Follow-Up

• Ask: "Are you having any trouble affording or filling your medication?"
• Check refill history — gaps may indicate cost barriers
• Re-screen annually as insurance changes

Staff Training

• Ensure clinical staff know how to enroll patients in the Gilead copay card
• Keep current PAP enrollment forms accessible
• Designate a staff member (social worker, patient navigator, or MA) as the point person for benefits navigation

Pharmacy Coordination

• Build relationships with specialty pharmacies — they often have dedicated teams for benefits investigation and prior authorization
• If patients report stock issues, direct them to Medfinder for Providers to help locate pharmacies with Biktarvy in stock

Quick Reference: Which Program for Which Patient?

• Commercially insured → Gilead Advancing Access copay card (first choice)
• Commercially insured, copay card maxed → PAN Foundation or HealthWell Foundation
• Medicare Part D → Foundation copay assistance (PAF, PAN, HealthWell)
• Medicaid → Usually low or no copay; no additional programs needed
• Uninsured → Gilead PAP (no cost) or ADAP enrollment
• Underinsured / high deductible → ADAP + copay card combination

Final Thoughts

Your patients shouldn't have to choose between paying rent and staying on their HIV medication. The savings programs available for Biktarvy are robust — the challenge is awareness and access. By building cost screening into your standard workflow and keeping your team trained on available programs, you can prevent the kind of cost-driven non-adherence that leads to virologic failure, resistance, and worse outcomes. For provider tools including pharmacy stock lookup, visit Medfinder for Providers.