negate any comparative advantage of prescribing it over a generic Truvada alternative. In July 2021, Gilead announced it would decrease 340B Drug Pricing Program reimbursements to clinics serving primarily low-income communities; clinics argued this severely hinders their ability to provide HIV/AIDS prevention and treatment services among vulnerable populations. Anticompetitive behavior Gilead has also been accused of stifling competition. A lawsuit filed in the United States in 2019 alleged that the company entered "pay for delay" agreements with other manufacturers, wherein the manufacturers agreed to delay releasing generic versions of Truvada. In 2021, CVS Pharmacy and RiteAid filed a lawsuit on similar grounds against Gilead, Bristol-Myers Squibb, and Teva Pharmaceuticals in 2021. In response to criticisms over the price of Sovaldi, Gilead began licensing the rights to produce generic versions of the drug to select producers in India in 2015. Included in the licensing agreements were 'anti-diversion' provisions, designed to prevent the drug from being exported back to developed countries where the cheaper, generic alternatives were still unavailable. (In India, a one-month treatment cost approximately US$300, versus $1,000 per pill in the United States.) Gilead required the Indian producers to screen patients to determine who could buy Sovaldi, which was criticized by Médecins Sans Frontières since it could lead to the exclusion of vulnerable groups like refugees and migrants from accessing the medicines. In response to the criticism, Gilead eventually relaxed these requirements. Tax structures and tax avoidance Gilead has been criticized for tax avoidance. Tax avoidance, as opposed to tax evasion, is the use of legal means to shift tax burdens from the one jurisdiction to overseas affiliates that pay a lower tax rate, even if revenue is primarily generated outside the overseas jurisdiction. A 2016 report by the liberal think tank Americans for Tax Fairness argued that Gilead was able to avoid up to $10 billion in taxes on U.S. sales through mechanisms such as transfer pricing, the sale of assets between affiliated entities. In particular, Gilead sells intellectual property to an Irish subsidiary, which then sells the finished products, such as Sovaldi, in the United States and elsewhere, paying the low Irish tax rate on profits. The practice is common among multinational pharmaceutical companies like Gilead. On December 26, 2018, The Times reported that Gilead had used the Double Irish arrangement to avoid U.S. corporate taxes on global profits, stating that the firm "used a controversial tax loophole