A new study, jointly led by researchers from the Perelman School of Medicine at the University of Pennsylvania and the Johns Hopkins Bloomberg School of Public Health, suggests that an increase in out-of-pocket costs for HIV pre-exposure prophylaxis (PrEP) and medications that have been shown to drastically reduce the risk of HIV infection could lead to a significant reduction in PrEP usage and an increase in HIV infection rates.
The study, which was published today in Health Affairs, was partially designed to examine the potential impact of cost increases, depending on the outcome of a pending lawsuit challenging certain provisions of the 2010 Affordable Care Act (ACA).
The researchers used a large proprietary database of medical and pharmacy insurance claims to determine the frequency at which patients abandoned their insurer-approved PrEP prescriptions at different levels of out-of-pocket costs. Their results indicate that even a slight increase in monthly out-of-pocket costs from $0 to $10 would double the rate of PrEP prescription abandonment. Furthermore, an increase in out-of-pocket costs to $100 to $500 per month would result in nearly a third of patients abandoning their PrEP prescriptions.
The analysis also highlighted the negative consequences of discontinuing PrEP: the rate of new HIV infections in the year following the first PrEP prescription was two to three times higher among those who had not fulfilled their prescriptions.
“Our findings suggest that increases in out-of-pocket costs for PrEP could potentially undo the progress made in ending the HIV/AIDS epidemic in the United States,” said Jalpa Doshi, PhD, lead author of the study, Professor of Medicine, and Director of Value-based Insurance Design Initiatives at the Center for Health Incentives and Behavioral Economics at Penn Medicine.
To date, the FDA has approved two HIV PrEP products, each combining two antiretroviral standard medications in a single pill. For a decade, the US Centers for Disease Control and Prevention (CDC) have recommended PrEP as a means of preventing HIV infection in individuals at higher risk. Expanding access to PrEP is also one of the key pillars of the CDC’s “Ending the HIV Epidemic in the US” (EHE) initiative, which aims to reduce new HIV infections in the United States by 90% by 2030. In 2019, the US Preventive Services Task Force (USPSTF), an independent expert panel on disease prevention, rated PrEP as “A”. This classification, under a provision of the ACA, means that since 2021, most private insurance plans are required to offer PrEP to their enrollees at no cost.
The study, led by co-author Lorraine Dean, ScD, Associate Professor at the Johns Hopkins Bloomberg School of Public Health, was supported by the National Institutes of Health (R21NR018387, R01NR017573, R25MH083620, and T32AI102623).
University of Pennsylvania School of Medicine