The medication used as PrEP is patented, which means that only one company, Gilead, is legally allowed to produce and sell emtricitabine/tenofovir in USA, Canada, the UK, Australia, EU, and other developed countries. As Gilead has no competition, they can charge whatever price they feel the market will bear.
Developing countries, such as those in sub-Saharan Africa, India or Thailand clearly cannot afford to pay $1600/month for essential anti-HIV medications. Companies like Gilead have, fortunately, agreed to not enforce their patents in these countries. This allows the production and distribution of generic versions of their drugs in resource-poor settings.
As a result, over two-thirds of the world’s anti-HIV medications are now produced in India by Cipla, Mylan, Hetero Drugs & Emcure Pharmaceuticals. We receive our medications directly from these Indian manufacturers.
Other major producers of generics include South Africa, Thailand and Brazil.