James R. Meyers - Gilead Sciences, Inc.
Management
Yes, and, Kevin, just to add on that, and I agree with everything you said. I think HIV is a bit of a different market over the years. Of all the markets, of all the chronic therapy markets Gilead's ever been in, it's been driven more by increases in patient volume than by changes in price. And there's always some element of both in every therapeutic area that you're in, but disproportionately in HIV. There's always been a healthy steady flow of number of treated patients each year. As I think you're probably aware, and as Kevin just said, we're already in heavily, deeply-discounted payer segments in the U.S. market. What that means is that's already part of the run rate. So the normal impact of a generic is a big change from where you are. We're already, especially for the older products that are going to be coming off patent, the difference between generic pricing and where those prices are right now is much more incremental than you'd see in most markets, and anyways, that's something that's just very unique with that. We continue to see obviously a strong support for single-tablet regimens and fixed-dose combinations, and of course, there will be some level of impact whenever there is generic entry, particularly outside of the U.S. But we still very firmly believe that when we want to ultimately have the full launch of our entire TAF portfolio, particularly BIC/TAF, B-F/TAF, that this remains very much a sustainable franchise going forward. Again, I would say we hear sometimes how sustainable is price levels in HIV. That really hasn't been the story of HIV. It's really, I mean particularly in the U.S. market, because of the deeply-discounted segments and the CPI-U penalties you have over time, this has been a market that has overwhelmingly been driven by patient volume. So we're not as reliant on that. We have not been historically as reliant on, if you look at list pricing for sure, it's there. But net pricing has deteriorated over time, and that's already in the run rate. But I'll stop there, and we feel very confident in this being a sustainable franchise.