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Seeking to widen access to a pricey HIV prevention pill, a group of prominent AIDS activists is urging the federal government to create a national public health program that could lower costs by sidestepping patents held by Gilead Sciences (GILD), the manufacturer.

At issue is the cost of Truvada, which is also known as PrEP and was approved six years ago as the first pill to prevent HIV. Despite clinical trials demonstrating a high degree of safety and efficacy, however, the uptake in the U.S. has been slow, falling far short of the potential to have a significant impact.

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In 2017, about 109,000 people received the drug, or about 8 percent of those who were eligible for a prescription. Prescriptions, in fact, have leveled off to about 4,000 per year, which means it would take more than 22 years for the pill to reach the estimated 1.1 million Americans who would benefit from the medicine, according to a new 40-page report by the activists, the PrEP4All Collaboration.

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