HIV PrEP access and affordability: a multidisciplinary specialty pharmacy model

Abstract

Background: Increasing the number of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) providers expands PrEP access to more eligible patients to help end the HIV epidemic. Previous studies have noted providers perceive financial barriers as a limitation to prescribing PrEP.

Objective: This study aimed to describe PrEP medication access and affordability in patients seen at a multidisciplinary PrEP clinic.

Method: We conducted a single-center, retrospective, cohort study of adults initiating tenofovir disoproxil fumarate/emtricitabine in the Vanderbilt PrEP Clinic between September 1, 2016, and March 31, 2019, with prescriptions filled by Vanderbilt Specialty Pharmacy. Data were gathered from the electronic health records and pharmacy claims. We evaluated 3 different time periods: initial evaluation to PrEP initiation, prescription of PrEP to insurance approval, and insurance approval to initiation. Treatment initiation was considered delayed when >7 days from initial evaluation, and reasons for delay were recorded. Continuous variables are presented as median (interquartile range [IQR]), and categorical variables are presented as percentages.

Results: We included 63 patients; most were male (97%), white (84%), and commercially insured (94%) with a median age of 38 years (IQR 29-47). Primary indication for PrEP was men who have sex with men at high risk of acquiring HIV (97%). Median time from initial appointment to treatment initiation was 7 days (IQR 4-8). Treatment delays occurred in 25% of patients and were mostly driven by patient preference (50%). Insurance prior authorization was required in 27% of patients; all were approved. Median total out-of-pocket medication costs for the entire study period were $0 (IQR $0-$0). Most patients (86%) used manufacturer copay cards.

Conclusion: In this cohort of mostly commercially insured men, the majority were able to access PrEP with low out-of-pocket costs facilitated by manufacturer assistance. Although generalizability beyond this population is limited, these results contradict perceived financial barriers to PrEP access.