Patent extensions of branded drugs impede patient access to next generation therapeutics while also making the pharmaceutical manufacturer overly reliant on a revenue model that privileges the short-term over long-term growth. When patent protection of a branded drug nears its end, a manufacturer that makes minor changes to the formulation can extend patent protections; if the drug maker has a much more effective successor therapeutic ready for FDA approval, it can delay the release of the successor treatment to maximize monopolistic profits of the older, less effective version. Reports suggest that Gilead delayed the release of Descovy (emtricitabine and tenofovir alafenamide) in favor of maximizing profits of Truvada (tenofovir disoproxil fumarate). The decision led to legal expenses, including settlements with plaintiffs alleging impropriety, which diverts time and resources away from research and development of innovative treatments. The FDA approved Truvada for treatment of HIV in 2004. Internal documents show that one year prior, Gilead proposed patent exclusivity strategy while already working on the more potent version of tenofovir, Descovy.( 1 ) Gilead?s delay strategy created foreseeable legal risks. The company was the subject of a New York Times exposé, which included leaked internal memos outlining the patent extension plan.( 2 ) The negative press coverage detailed that a small percentage of Truvada users suffered kidney damage and osteoporosis, avoidable consequences had Gilead expedited development of a successor compound with a safer risk profile. As a result of Holley v. Gilead Sciences, the company agreed to a $40 million settlement with 2,625 plaintiffs ?to avoid the cost and distraction of litigating these cases, and in no way is this settlement an admission of liability or wrongdoing.?( 3 ) While Gilead admits no fault, the settlement itself can create doubt with investors and other stakeholders. Gilead opted to maximize revenue of an older therapeutic when it had a more effective version ready to enter the market. Those living with HIV were held captive to a revenue model that preferred patent extensions over bringing the next generation of safer, more effective therapies to market. A report on how patent exclusivity extensions could stifle innovation functions as a guardrail to ensure Gilead prioritizes investments in the breakthrough therapeutics of the future. 1 https://int.nyt.com/data/documenttools/gilead-sept-2003/1561f0e7e503288f/full.pdf . 2 How Gilead Profited by Slow-Walking a Promising H.I.V. Therapy - The New York Times . 3 Gilead Statement on Agreement in Principle to Resolve Federal TDF Litigation