Generic HIV drugs and HIV care in the UK

In the UK, the NHS provides world-class HIV care. Access to testing, monitoring and treatment is free and this will continue in the future. 

However, NHS funding restrictions mean that many services are running under tight budgets. Some services are changing and some have already been cut.

This is helped by community and healthcare organisations producing guidelines on best standards of care. For example the British HIV Association Standards of Care for People Living with HIV (2018).

Drug costs and treatment choice

UK treatment guidelines are clear that the choice of HIV drugs should be based on medical need.

  • HIV drugs are not based on the price but on being most effective.
  • But if two similar drugs are just as good, the least expensive should be used first.
  • If there are clinical reasons to use more expensive drugs, these will continue to be available.

Generic ARVs

When a drug is first approved, the manutacturer is given a license – called a patent. This usually allows 10 or more years for a company to profit from its investment.

After the patent ends, other companies can then make the same drug. These generic drugs are the same quality but they are usually much cheaper.

  • In the UK, 60-85% of all NHS prescriptions are for generic medicines.
  • The cost savings enable the NHS to continue to provide free health care.
  • Some of the HIV drugs that are still widely used are now off-patent and more will follow.

Just like in other health areas, the NHS is likely to move to generic HIV drugs unless the original manufacturers lower their prices.

  • Generic drugs are just as carefully made as the originals. They are the same high quality with the same active ingredients.
  • Generic drugs are just as effective as the original versions.
  • Generic drugs might be a different shape and/or colour to the original drug. The packaging, manufacturer and brand name are different but the active ingredients are the same.

Your doctor and pharmacist should always explain when you are changing to a generic drug. 

Generic drugs and single pill combinations

Generic drugs might mean that individual drugs are used rather than a combined pill.

Depending on their cost, combination pills like Atripla, Eviplera, Kivexa, Odefsey, Triumeq and Truvada might be used less often.

This would only increase the daily pill count by one or two pills, depending on the combination. Although this is less convenient, the savings will enable other important HIV services to continue.

The structure of HIV services: the case of efavirenz

Over the last few years the structure of providing HIV care has been changing. One controversial change has been to separate HIV care  from sexual health services in some part of the country.

However, so long as HIV continues to be commissioned as a specialised service HIV care will be managed by seven different commissioning groups.

These are Scotland, Wales, Northern Ireland plus four regions for England (North, South, Midlands and London).

As each region commissions services independently, there might be differences between regions for how drugs are prescribed because each region negotiates its own drug prices.

Standards of care should remain high wherever you are treated. All drugs will still be available in every region, but different prices might affect prescribing policies. This means you might choose a clinic in a different region to access a specific drug.

The NHS is running under financial pressure from government budget restrictions. Each year, your HIV clinic has to look after more people but on the same basic budget.

Last updated: 1 October 2019.