HIV Drug Costs With Medicare
Compare 18 hiv drug prices under Medicare Part D, averaging $4,875.61 per claim. Prices range from $1,854.00 (Sustiva) to $22,250.00 (Trogarzo) per prescription. 17 of 18 drugs have FDA-approved generics that cost 30-80% less.
Key Facts: HIV Drug Costs
- Cheapest drug
- Sustiva ($1,854.00)
- Most expensive
- Trogarzo ($22,250.00)
- Medicare Part D avg
- $4,875.61/claim
- Generics available
- 17 of 18
- Total Medicare spend
- $16.7B/yr
- Brand-only drugs
- 1
Source: CMS Medicare Part D Spending, latest reporting year. Costs reflect plan-paid amounts, not patient out-of-pocket.
HIV Drug Price Comparison
All 18 hiv drugs tracked in Medicare Part D, sorted from cheapest to most expensive. Click any drug for Medicare coverage details, generic timelines, and savings options.
| Drug | Generic Name | Medicare Avg/Claim | Generic Available? |
|---|---|---|---|
| Sustiva | Efavirenz | $1,854.00 | Yes |
| Truvada | Emtricitabine/Tenofovir DF | $2,066.00 | Yes |
| Prezista | Darunavir | $2,331.00 | Yes |
| Descovy | Emtricitabine/TAF | $2,418.00 | Yes |
| Tivicay | Dolutegravir | $2,452.00 | Yes |
| Isentress | Raltegravir | $2,452.00 | Yes |
| Dovato | Dolutegravir/Lamivudine | $2,910.00 | Yes |
| Symtuza | Darunavir/Cobicistat/Emtricitabine/TAF | $3,532.00 | Yes |
| Odefsey | Emtricitabine/Rilpivirine/TAF | $3,532.00 | Yes |
| Triumeq | Dolutegravir/Abacavir/Lamivudine | $3,580.00 | Yes |
| Genvoya | Elvitegravir/Cobicistat/Emtricitabine/TAF | $3,619.00 | Yes |
| Biktarvy | Bictegravir/Emtricitabine/TAF | $3,746.00 | No |
| Juluca | Dolutegravir/Rilpivirine | $3,831.00 | Yes |
| Complera | Emtricitabine/Rilpivirine/TDF | $4,012.00 | Yes |
| Cabenuva | Cabotegravir/Rilpivirine | $6,593.00 | Yes |
| Rukobia | Fostemsavir | $6,833.00 | Yes |
| Sunlenca | Lenacapavir | $9,750.00 | Yes |
| Trogarzo | Ibalizumab | $22,250.00 | Yes |
Medicare Part D Coverage for HIV Drugs
All 18 hiv drugs in this comparison are dispensed under Medicare Part D. Total Medicare spending reached $16.7B in the latest reporting year, averaging $4,875.61 per prescription fill.
Your out-of-pocket cost depends on three factors: (1) your plan's formulary tier — generics typically land on Tier 1 ($0-$10 copay), preferred brands on Tier 2 ($30-$50), and specialty drugs on Tier 4-5 (often 25-33% coinsurance); (2) your deductible status — most plans require you to meet up to a $590 deductible before copays apply; (3) the coverage phase — initial coverage, coverage gap, or catastrophic. As of 2025, Medicare Part D caps total annual out-of-pocket at $2,000 under the Inflation Reduction Act.
For the 1 brand-only drugs in this category, expect Tier 2-3 placement with higher copays. Manufacturers cannot offer copay cards to Medicare beneficiaries (anti-kickback rules), but charity foundations like the PAN Foundation, NeedyMeds, and the HealthWell Foundation provide grants for many hiv drugs. The 17 drugs with generic availability are usually the most cost-effective starting point — ask your prescriber whether a generic substitution is clinically appropriate.
Drug costs vary dramatically within this category. Trogarzo (Ibalizumab) at $22,250.00 per claim is 12x more expensive than Sustiva (Efavirenz) at $1,854.00 — yet both treat hiv. Therapeutic substitution within the same drug class is often the single biggest savings lever, and it requires only a prescriber conversation, not a plan change.
Frequently Asked Questions
Medicare Part D pays an average of $4,875.61 per claim for hiv medications across 18 tracked drugs. Patient out-of-pocket costs depend on your plan's formulary tier, deductible, and whether you've reached the catastrophic coverage phase. Most hiv drugs fall on Tier 2 (preferred brand) or Tier 3 (non-preferred brand) of standard Medicare Part D formularies.
The least expensive hiv medication is Sustiva (Efavirenz) at $1,854.00 per Medicare Part D claim. A generic version is FDA-approved and available — ask your pharmacist about substitution to lower copays further.
Yes. All 18 hiv drugs tracked here appear in Medicare Part D claims data, meaning they are dispensed under Part D plans. Coverage details — formulary tier, prior authorization requirements, step therapy — vary by plan. Check your plan's formulary or call 1-800-MEDICARE before filling.
Yes, 17 of 18 hiv drugs have FDA-approved generic alternatives. Generics contain the same active ingredient and meet bioequivalence standards, but typically cost 30-80% less. On Medicare Part D, generics usually fall on Tier 1 with the lowest copay.
Three primary strategies: (1) Switch to a generic if available — Tier 1 generics typically cost under $10 per fill on Medicare Part D; (2) Use manufacturer copay assistance for brand-name drugs (commercial insurance only — Medicare beneficiaries can apply for patient assistance foundations like NeedyMeds or the PAN Foundation); (3) Compare cash prices using GoodRx, SingleCare, or Mark Cuban's Cost Plus Drugs — sometimes cash pay beats your Part D copay. Talk to your doctor about therapeutic alternatives in the same drug class.
Drug Classes Used for HIV
Related Conditions
Cost per claim is the average plan-paid amount per prescription fill under Medicare Part D. Patient out-of-pocket varies by formulary tier and deductible status. Generic availability is based on FDA Orange Book data.
Source: CMS Medicare Part D Spending, 2026.