NC Medicare Drug Spending: Biktarvy
The HIV Drug Costing North Carolina Medicare $122 Million a Year
Ranked 249th in prescriptions. But Biktarvy is NC's tenth most expensive Medicare drug, and its presence here reflects a distinctive part of the state's health profile.
$121.7M
Total NC Medicare spend on Biktarvy, 2023
$4,082
Average cost per prescription
#249 / #10
Rank by prescriptions / rank by total cost
What is Biktarvy and who takes it?
Biktarvy is a single-tablet antiretroviral regimen for HIV-1 combining three drugs in one once-daily pill. It's among the most commonly prescribed HIV treatments due to its effectiveness, tolerability, and simple dosing. Gilead Sciences manufactures it.
North Carolina has one of the higher HIV burdens in the South, with an estimated 35,000 people living with HIV. Rates are particularly high in urban counties like Mecklenburg, Wake, Durham, and Guilford, and in rural eastern NC. As people living with HIV age into Medicare, HIV drug costs are becoming a significant Part D expense in high-prevalence states.
Why does it cost $4,082 per prescription?
Biktarvy is a branded combination drug under patent. No generic exists for this specific three-drug combination. At $4,082 per monthly fill, patients on continuous HIV therapy generate roughly $49,000 per year from this one prescription.
What Part D enrollees with HIV should know
HIV medications require specialist oversight. Switching regimens for cost alone needs clinical supervision. But reviewing whether your plan covers your current regimen at the most favorable tier is worthwhile every enrollment period. The 2025 out-of-pocket cap of $2,000 significantly limits annual exposure regardless of tier. NC's ADAP program and Ryan White services may provide additional support for lower-income patients.
Why this drug appears in NC but not Ohio
Biktarvy ranks in NC's top-10 cost drugs but not in Ohio's. That reflects North Carolina's regional HIV burden. The Southeast carries a disproportionate share of the country's HIV cases, and as people aging with HIV move into Medicare, that pattern will shape Part D spending here for years to come.
NC Medicare filled 29,825 Biktarvy prescriptions in 2023 at $4,082 each. Lisinopril, taken by nearly 39 times as many NC Medicare patients, costs $8 per prescription. Biktarvy costs 510 times more per fill.
Top 10 North Carolina Drugs by Total Medicare Part D Spending, 2023
Source: CMS Medicare Part D Prescribers by Geography and Drug, 2023. North Carolina state-level data.
A note on this data: All figures come from the Centers for Medicare & Medicaid Services
(CMS) Medicare Part D Prescribers by Geography & Drug dataset, 2023. This data covers Medicare Part D
(prescription drug coverage) only and does not represent commercial insurance, Medicaid, or cash-pay prescriptions.
Suppressed values (fewer than 11 beneficiaries) are excluded from totals.
This article is for educational purposes only. Nothing here is medical advice. Talk to your doctor before
making any decisions about your medications or treatment. This content is not connected with or endorsed
by the U.S. Government or the federal Medicare program.
