“I’m on the pill,” declares a transgender woman in an up-close shot featured in Gilead Science’s latest drug commercial. “But it’s not birth control,” says a young guy, with a smile, in another scene. The actors are touting Truvada, the only drug approved to prevent the transmission of HIV.
The commercial, aptly titled “I’m on the Pill,” is part of a marketing push that has helped turned the use of Truvada for preventing HIV into a $1.3 billion blockbuster, almost 5% of Gilead’s annual sales. It’s a big reversal for Gilead, just three years ago the company said using Truvada to prevent infection with the virus that causes AIDS did not represent a commercial opportunity. Now, Raymond James analyst Steve Seedhouse estimates this use could generate $2.9 billion in 2020 sales for Gilead, which is in investor disfavor as annual sales of its top-selling hepatitis C drugs have fallen 69% since 2015 to $4.4 billion.
“I’m on the Pill” has shown up on over 385 million screens (ad-jargon: “impressions”) since it first aired in June, according to ad-tracking firm iSpot.TV, which also estimates Gilead spent $13 million during that period placing the spot often in primetime TV slots during shows like The Late Show with Stephen Colbert, Family Guy, and Pose, a new FX show with a large transgender cast.
Truvada was first approved in 2004 as a treatment for HIV, not a preventative. It was the first once-a-day combination of HIV drugs, and its success made Gilead a biotech giant. Truvada’s total, global annual sales peaked at $3.57 billion in 2016. Another $2.6 billion was generated by Atripla, a combination of Truvada and Bristol-Myers Squibb BMY -1.06%’s Sustiva. Recently, Truvada’s sales have fallen (they dropped 12% last year) as HIV patients switched to newer medicines and Truvada’s patent in Europe expired.
In 2010, researchers funded by the Bill & Melinda Gates Foundation (Gilead donated the placebo and Truvada pills) presented data showing that giving Truvada to patients who did not have HIV, but who were at risk of contracting it, could reduce the risk of infection by 92%. The use, called PrEP–short for “pre-exposure prophylaxis”–caused a stir in public health circles. The Food & Drug Administration approved Truvada for PrEP in 2012.
Gilead was proud–Gilead’s chief scientific officer, Norbert Bischofberger, called it “the culmination of almost 20 years of research”–but the company saw using Truvada to prevent HIV infection as a commercial nonstarter. In 2013, Gilead’s vice president of medical affairs Jim Rooney told The New Yorker that the company did “not view PrEP as a commercial opportunity.” In 2015, Gilead spokesperson Cara Miller told Bloomberg the company “does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP.”
In 2014 there were just 22,000 PrEP users. But public health officials saw a population of more than one million Americans who might benefit from taking Truvada to prevent HIV infection.
New York City launched its first PrEP ad campaign in 2015, a year after the CDC put out its own clinical guidance recommending Truvada for PrEP. Other cities, like Washington, D.C., and San Francisco, also launched public information campaigns in recent years. (All three say they have not received funding from Gilead for their campaigns.)
Last year, Gilead started marketing Truvada on social media and dating apps like Snapchat, Tumblr and Grindr. Now the number of Truvada for PrEP users has since eclipsed the number of Truvada for HIV treatment patients. Gilead revealed in July that 180,000 people were taking Truvada for PrEP during their second quarter, which analyst Seedhouse estimates translates to some $500 million in sales.
“They really started experiencing pressure across many lines of their business, so it makes sense as to why they would be more aggressive in trying to build out into indications of other segments for Truvada,” says Piper Jaffray analyst Tyler Van Buren.
Truvada loses its U.S. patent in 2021, Gilead is developing another drug to replace it called Descovy and is running a Phase 3 clinical trial comparing the two drugs, which is expected to be complete in 2019. However, even Descovy’s patent would only last until 2022.
Gilead declined to be interviewed for this article. In a statement, the company noted that it has spent $100 million on grants to community-based organizations to support HIV prevention awareness since 2012 and noted that many people don’t realize they are at risk of HIV infection. “TV advertising is a natural evolution of efforts to educate people about risk factors and what they can do to protect themselves,” the company says.
Mitchell Warren, executive director of AVAC, a New York City-based nonprofit that promotes HIV prevention, agrees wholeheartedly. He has only one complaint about Gilead’s PrEP ads. “In my mind,” he says, “it’s six years too late.”