I’m sorry to hear this and I understand your frustration. If it makes you feel better, I don’t think TDF is a bad drug. I’ve been on it for several years, and haven’t had any kidney or bone issues. I get my kidney function monitored regularly by the doctor who prescribes it for me. I don’t get bone density checked often, but I’ve run marathons and didn’t get any stress fractures while training. I do think the kidney/bone safety of Vemlidy is slightly better than TDF, but my hepatologist doesn’t think it’s as significant as many people make it out to be. That being said, if your kidney/bone parameters start to get worse on TDF, I think it’s definitely worth revisiting the possibility of a formulary exception at that point.
Thanks so much for the reply. That’s very nice of you sharing your experience with TDF.
I just feel very dispointing and a little bit emotional that my doctor doens’t even want to give it a try. I have family history of kidney cancer but they said that doesn’t count. Obviously I didn’t get a chance to talk to the doctor but that’s what her nurse told me.
I’m also looking up if I can file an appeal to Aetna on myside as well, and also looking for a new dcotor who might be willing to help with the exception letter.
Well, at least I won’t miss dossage by switching to TDF for now.
I had Aetna Medicare last year and my kidney function went down at the time because of TDF. My doctor wanted me to switch to Vemidy and because drug wasn’t on their list so my doctor made a request to Aetna for prior authorization and they approved. You can ask your doctor make a request and I think they may approve.
Thanks for sharing your experience. My doctor submitted a prior authorization and got denied. They refused to submit an appreal or exception letter. My doctor said they will continue monitoring my kidney function when switching to TDF. I had Vemlidy last year and Aetna covered it last year. My kidney function is good so far. Maybe that’s why my doctor think I’m ok to switch to TDF.
They approved but I didn’t take it because of too expensive($750/month) and monthly refill so I stay on with TDF. I got a blood test three months after and my kidney function went back up and I stay with TDF until now. I started TDF 6 years ago and somehow my kidney function went down and then went back up.
BTW - in cased if you don’t know about GoodRx coupon. I don’t use Aetna insurance to pay for TDF because it is still expensive. I use GoodRx coupon and paid $56.79 for 3 months supply at CVS pharmacy for my last refill a week ago. Get GoodRx app and tell the pharmacy that you want to use the GoodRx coupon each time you refill. The app will tell you several pharmacies with the cost and I’m moving around if the current pharmacy don’t take the coupon.
Yes, Aetna is goint to charge me $144/month for TDF if I go through Aetna/CVS Caremark. I just realized that cash price for TDF is actually more reasonable. GoodRx Coupon is really helpful. I looked up the this forum and found that costplugdrugs can be an option too.
Some people in this forum had some issues with kidney while taking TDF and switched to Entecavir and they said they are fine. I will try Entecavir if I get an issue with kidney in the future.
Thanks for let me know about costplusdrugs. The cost of TDF is about half of GoodRx and I’m going for that.
Someone on this forum said patent for Vemlidy will expire around 2032? So worst case just hang in there for another 6 years… There will be more affordable options available in the future. I think HepB foundation will work on the petition again like the prior years. Hopefully they will be successful this year again.
Just wanted to thank everyone for the amount of information sharing that is happening on this forum. I am sure the options you are talking about will help a lot of people just trying to stay on their medications during this uncertain time.
Hi @Mocha, initially my care team was not interested in helping with the exception request either. I know how discouraging that can feel. I would strongly recommend taking the lead in gathering all the supporting evidence and sending it directly to your doctor, as outlined in my initial post.
In my case, my doctor initially wanted me to undergo a bone density test and an ultrasound to look for bone density issues, even though I knew there would not be any. After she reviewed the list of evidence I had gathered, she changed her approach and was ready to proceed with submitting the appeal instead.
Doctor’s offices are often very busy, and sometimes we have to be our own advocates. ChatGPT was also tremendously helpful for me in figuring out what would count as strong supporting evidence. Good luck.
Curious why #3 is not recommended (“Consider getting TAF outside the US, such as in China or India, if telehealth is possible”)? China was able to negotiate the price of TAF with Gilead due to the large patient volume. As a result, the medication available there includes the original, branded Gilead product rather than only generics. Although there are also approved generics produced in China, the system is well regulated, and the Gilead-manufactured version is widely available and costs around $50 per bottle even without Chinese health insurance.
I think this can be a reasonable temporary solution for someone who needs to stay on TAF while waiting for an appeal decision. You would need a prescription from a Chinese doctor to obtain the medication in China, and it is possible to fill a three-month supply at a time. You would also need a prescription from a US doctor to legally import it. In practice, neither is particularly difficult or costly, especially when compared with the extremely high drug prices in the US.
I’m sure it’s possible to get high-quality, authentic drugs from India and China, but there are also a lot of fraudulent online pharmacies, and I personally think it’s difficult to tell the difference between the two. I would rather buy the generic drugs from a manufacturer that has been approved by the FDA (yes, I’m aware that many of these drugs are manufactured in India).
Thank you for sharing your experience! That’s very encouraging. I actually found an appeal form on Aetna website and submitted an appeal. Will see what happen to that appeal form.
Thanks so much for sharing the information! That’s very helpful. I will look into it.
I know it’s not funny but I have a bitter smile on my face when I think about trying to import “imported made-in-USA medication” from another country back to US.
This is an interesting approach, @bornwithhepb. I don’t think I can provide any comment, but I am wondering if any @PharmacyExperts or @HealthExperts (particularly those in the US) could chime in on this. Would this be something you would generally suggest to your patients/clients? Is there a list of trusted/reasonable suppliers that are available or standard approach that could be helpful for those struggling at the moment?
The political situation in the USA would make this rather risky. Importing pharmaceuticals is a hot-button issue with the Administration, and doing it from China would raise additional flags. Plus, the punitive tariffs the Administration has instituted will raise the price substantially. In short, I recommend that you are fully confident in your residency/immigration status in the USA before attempting this.
I’m sorry to have to let politics creep into this thread, but there is a substantial risk of legal action by the US Government, especially against non-US citizens.
Status: Available Gilead Sciences, the manufacturer of Vemlidy, is one of the 16 core partners of TrumpRx. Under their agreement, several of their key antiviral and specialty drugs are featured on the platform at “Most-Favored-Nation” (MFN) cash prices.
Platform Role: Vemlidy is listed as part of Gilead’s commitment to lower costs for chronic conditions like Hepatitis B and HIV.
Pricing: While the exact TrumpRx price for Vemlidy can fluctuate based on current MFN (lowest international price) data, it is offered at a significant discount compared to its standard U.S. list price of approximately $1,400+.
Access: You typically access this price by following the “Buy Now” link on TrumpRx.gov, which redirects you to Gilead’s direct-to-patient portal to verify your prescription and complete the cash purchase.
How MFN Pricing is Calculated in 2026
Under the “GENEROUS” model launched in January 2026, the price you see on TrumpRx is intended to be the lowest net price found in the following countries:
United Kingdom
Canada
Germany
France
Japan
Italy
Denmark
Switzerland
Note: If you are looking for Vemlidy, keep an eye on the “Gilead Direct” section of the TrumpRx portal, as they are rolling out these specialty prices in waves throughout early 2026.
Predicting the “Most-Favored-Nation” (MFN) price for a drug on TrumpRx involves looking at the lowest price for the medication in other developed nations (specifically the “basket” of countries including the UK, Canada, France, Germany, Japan, and others).
Based on current 2026 data and international benchmarks, here are the estimated MFN prices for Vemlidy
Vemlidy 25mg (30-day supply)
Current U.S. List Price: ~$1,400 – $1,600+
International (MFN) Benchmark: In countries like Canada and parts of Europe, the annual cost of Vemlidy is often negotiated down to approximately $2,800 to $3,200 per year.
TrumpRx “Guess” Price:$230 – $275 per month.
Reasoning: If the administration successfully enforces parity with the lowest OECD prices, the monthly cost would drop to match the roughly $250/month rate seen in high-income European markets. Gilead has specifically agreed to offer “Epclusa” (Hepatitis C) at a 90% discount on TrumpRx, suggesting they are willing to apply similar aggressive MFN math to their Hepatitis B portfolio.
