Will Gilead's HIV Franchise Plan Be Broken On TrumpCare?

On Thursday, Leerink analyst Geoffrey Porges outlined how Gilead's HIV drugs, including a combination of emtricitabine, bictegravir, and tenofovir alafenamide, could be at risk should The Republican Party, revive the American Health Care Act, or offer a similar alternative.

Gilead Sciences almost escaped a potential game changer with the TrumpCare collapse, but its hopes for an HIV franchise still could be dashed on payer pushback as generics and "hybrid" combinations cut into its share.

The expansion of Medicaid under ObamaCare helped expand access to HIV drugs. Any changes to Medicaid funding under President Trump's administration or access could have hurt Gilead's chances of pushing its HIV drugs as it struggles to deal with 2016's sharp fall in hepatitis C sales.

"Gilead appears to have dodged a bullet with the failure of the American Health Care Act," Porges wrote in a note to clients. But "any change to Medicaid funding could increase pressure on the funding for up to half of the drug coverage in some states."

"If the current funding for Medicaid is unchanged, those options may not see much adoption, and Gilead's HIV franchise should not face disruption based on price," he wrote. If funding does change, semi-generic products could have a shot at undercutting Gilead on pricing, and take share, giving benefits to patients. But currently, Gilead looks safe in that environment where physicians and patients have freedom of choice for HIV drugs.

"Gilead may have to match the large discounts now offered to such plans for their legacy combinations when they launch bictegravir (plus emtricitabine and tenofovir alafenamide), but should still be able to secure preferred availability for their products in this channel," Porges said.