Telemedicine Preexposure Prophylaxis Prescribing From a Large Online US Company

HIV preexposure prophylaxis (PrEP) is highly effective in HIV prevention; telemedicine is a promising avenue for delivering PrEP care.

To explore telemedicine delivery of PrEP care (telePrEP) by the largest telePrEP company in the US.

This retrospective, single-arm cohort study used health record data of patients receiving telePrEP from MISTR LLC, a for-profit telehealth company, from November 27, 2018, to March 5, 2025. Patient characteristics and AIDSVu data were assessed to determine levels of PrEP use nationally. Retention in care was assessed for persons initiating PrEP in 2020, 2021, and 2022. Data were analyzed from March 5 to May 29, 2025.

Use of telePrEP.

The primary outcome was the proportion of patients receiving telePrEP among all patients receiving PrEP in the US. Persons were classified as PrEP users if they received at least 1 day of prescribed PrEP in a calendar year.

From 2018 through 2025, 162 422 unique patients received telePrEP prescriptions from the telehealth company. Patients were predominantly young (mean [SD] age, 33.3 [10.3] years) and male (156 255 of 162 417 [96%]). Of 162 406 patients with data available, 19 610 (12%) were African American or Black, 12 075 (7%) were Asian, 39 744 (25%) were Hispanic or Latino, 82 222 (51%) were White, and 8755 (5%) were of other race or ethnicity. Most had not previously used PrEP (57 597 of 74 860 [77%]), and more than one-third (58 761 of 162 403 [36%]) were uninsured. Most users (131 875 [81%]) opted for home laboratory specimen collection as part of their care. TelePrEP use increased substantially from 6443 patients in 2020 to 110 068 in 2024. TelePrEP as a proportion of all national PrEP use was 2% in 2020, 9% in 2022, and 19% in 2024. Retention in care was similar for cohorts starting in 2020, 2021, and 2022; 67% (16 716 of 24 976) to 73% (4571 of 6287) were retained in the calendar year after initiation, 42% (8408 of 19 916) to 43% (2732 of 6287) in the second year, and 32% (2043 of 6287) to 33% (6546 of 19 916) in the third year. Annual care reinitiation ranged from 2% to 5%.

This cohort study found that nearly 1 in 5 PrEP users in the US received their PrEP prescriptions from a single national telemedicine company in 2024. Most were new to PrEP and more than one-third were uninsured. TelePrEP provision benefits from facilitating policies such as Affordable Care Act coverage and the 340B Drug Pricing Program. The rapid growth and overall magnitude of telePrEP provision suggests that it is a critical part of HIV prevention infrastructure in the US that merits continued regulatory support.