合格医疗计划覆盖范围的地理差异和艾滋病毒暴露前预防的先前授权要求
Kathleen A McManus1, Benjamin Fuller2, Amy Killelea3
1Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
JAMA network open
|November 10, 2023
概括
合格的健康计划覆盖艾滋病毒暴露前预防 (PrEP) 的emtricitabine/tenofovir disoproxil fumarate比emtricitabine/tenofovir alafenamide更常见. 预先授权和专业级别各不相同,特别是在南方,影响了PrEP的获取.
科学领域:
- 公共卫生 公共卫生
- 卫生政策 卫生政策
- 药物经济学 药物经济学
背景情况:
- 艾滋病毒暴露前预防 (PrEP) 对于结束艾滋病毒流行 (EHE) 倡议至关重要.
- 现有两种PrEP配方:emtricitabine/tenofovir二氧化 fumarate (TDF) 和emtricitabine/tenofovir alafenamide (TAF) 这两种配方均可使用.
- 医疗计划覆盖范围的变化可能会造成对PrEP的访问障碍.
研究的目的:
- 评估合格健康计划 (QHP) 覆盖范围,事先授权 (PA) 要求和TDF和TAF的专业分级.
- 在2019年批准TAF用于PrEP后,评估这些因素.
主要方法:
- 对符合2018-2020年患者保护和负担得起的医疗保健法案的美国质量健康保险的横截面分析.
- 根据地区和EHE优先管辖区分类QHP.
- 数据分析从2022年3月到2023年3月进行.
主要成果:
- 在所有年份中,TDF覆盖率都高于TAF (94.8%-99.8% vs 87.4%-92.7%).
- 在南方的QHP中,对于这两种配方来说,单独使用PA的比例最高.
- 对于TDF的PA在南方显著增加 (2018年的10.0%到2020年的46.8%),并且在EHE司法管辖区更高.
- 与TAF相比,TDF更有可能被置于专业级别.
结论:
- 尽管有类似的迹象,但QHP显示TDF的优惠覆盖范围和使用管理比TAF更为严格.
- 在南方和EHE司法管辖区等关键地区,TDF的高PA率引发了对PrEP健康公平性的担忧.
- 政策干预,包括监管行动和国家PrEP计划,可能需要解决PrEP获取差异.
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