HIV PrEP access and affordability: a multidisciplinary specialty pharmacy model.

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Pharmacoeconomics

Background:

• Expanding access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is crucial for ending the HIV epidemic.
• Healthcare providers often cite financial barriers as a significant impediment to prescribing PrEP.
• Understanding medication access and affordability is key to improving PrEP uptake.

Purpose of the Study:

• To describe the accessibility and affordability of PrEP medication for patients at a specialized PrEP clinic.
• To evaluate the time course of PrEP initiation and identify factors contributing to delays.
• To assess the out-of-pocket costs associated with PrEP medication.

Main Methods:

• A retrospective cohort study was conducted involving adults initiating tenofovir disoproxil fumarate/emtricitabine.
• Data were collected from electronic health records and pharmacy claims over a defined period.
• Time intervals for PrEP initiation, insurance approval, and reasons for delay were analyzed.

Main Results:

• The study included 63 patients, predominantly male, white, and commercially insured.
• Median time to PrEP initiation was 7 days, with delays in 25% of patients, often due to patient preference.
• Out-of-pocket medication costs were $0 for most patients, with 86% utilizing manufacturer copay cards.

Conclusions:

• The majority of patients, particularly those commercially insured, accessed PrEP with low out-of-pocket expenses, largely due to manufacturer assistance.
• These findings challenge the notion that financial barriers significantly limit PrEP access in this population.
• While generalizability is limited, the study highlights the effectiveness of support programs in mitigating PrEP costs.