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A new analysis shows alimatravir, a once-monthly oral PrEP drug in phase 3 trials, could be manufactured for as little as $3 per person per year — potentially the cheapest HIV prevention drug ever. But Merck's current licensing plan excludes countries with over 230,000 new HIV infections annually, including Brazil, Colombia, Peru, and Argentina. Experts warn that without broader access, the drug's promise won't translate into epidemic impact.
A once-monthly oral HIV prevention pill could be manufactured for just $3 per person per year, according to a cost-modeling analysis presented at AIDS 2025 in Rio de Janeiro. Alimatravir, developed by Merck and currently in phase 3 trials, would be far cheaper than existing PrEP options — but only if it's made widely available. Researchers calculated the full production cost, including formulation, packaging, transport, profit, and taxes, and arrived at $2.49/person/year, rounding up to ~$3.
The catch? Merck's voluntary licensing agreements cover 129 low- and middle-income countries but leave out nations accounting for an estimated 230,000 new HIV acquisitions per year. Notably excluded are four countries — Brazil, Colombia, Peru, and Argentina — that are actively participating in the phase 3 trials funded by the Gates Foundation. Latin American countries excluded from the plan have seen a 12% increase in HIV acquisitions since 2010, compared to a 55% drop in included African countries.
By the Numbers:
Why it matters: With only 2.3 million people on PrEP globally and HIV incidence rising in key regions, alimatravir's ultra-low manufacturing cost could be a game-changer — but only if licensing gaps are closed and generic production scales up. As one researcher put it: "It needs to be $3 everywhere, not just some places."
