Payments for Preexposure Prophylaxis in the United States: Too Much for Too Few
Authors: Kevin L. Ard, Rochelle P. Walensky
Journal: Annals of Internal Medicine (2020)

Editorials17 November 2020Payments for Preexposure Prophylaxis in the United States: Too Much for Too FewKevin L. Ard, MD, MPH and Rochelle P. Walensky, MD, MPHKevin L. Ard, MD, MPHMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.L.A., R.P.W.)Search for more papers by this author and Rochelle P. Walensky, MD, MPHMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.L.A., R.P.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-5643 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although HIV preexposure prophylaxis (PrEP) is highly effective, is recommended by the Centers for Disease Control and Prevention and U.S. Preventive Services Task Force (1, 2), and is a key component of the federal government's Ending the HIV Epidemic plan, only a fraction of persons who could benefit from PrEP receive it. In their article, Furukawa and colleagues (3) provide a detailed analysis of PrEP payments that highlights one fundamental reason why: drug cost.Using a database representing more than 90% of retail pharmacy prescriptions in the United States, Furukawa and colleagues found that payments for tenofovir disoproxil fumarate with ...References1. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States – 2017 update. 2018. Accessed at www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf on 30 July 2020. Google Scholar2. Owens DK, Davidson KW, Krist AH, et al; US Preventive Services Task Force. Preexposure prophylaxis for the prevention of HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019;321:2203-2213. [PMID: 31184747] doi:10.1001/jama.2019.6390 CrossrefMedlineGoogle Scholar3. Furukawa NW, Zhu W, Huang YA, et al. National trends in drug payments for HIV preexposure prophylaxis in the United States, 2014 to 2018. A retrospective cohort study. Ann Intern Med. 2020;173:799-805. doi:10.7326/M20-0786 LinkGoogle Scholar4. Smith DK, VanHandel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018;28:850-857. [PMID: 29941379] doi:10.1016/j.annepidem.2018.05.003 CrossrefMedlineGoogle Scholar5. Siegler AJ, Mouhanna F, Giler RM, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28:841-849. [PMID: 29983236] doi:10.1016/j.annepidem.2018.06.005 CrossrefMedlineGoogle Scholar6. Juusola JL, Brandeau ML, Owens DK, et al. The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men. Ann Intern Med. 2012;156:541-50. doi:10.7326/0003-4819-156-8-201204170-00001 LinkGoogle Scholar7. Gilead Sciences. Gilead Sciences to provide free Truvada for PrEP to support U.S. initiative to End the HIV Epidemic [news release]. 9 May 2019. Accessed at www.gilead.com/news-and-press/press-room/press-releases/2019/5/gilead-sciences-to-provide-free-truvada-for-prep-to-support-us-initiative-to-end-the-hiv-epidemic on 5 August 2020. Google Scholar8. Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020;396:239-254. [PMID: 32711800] doi:10.1016/S0140-6736(20)31065-5 CrossrefMedlineGoogle Scholar9. Walensky RP, Horn T, McCann NC, et al. Comparative pricing of branded tenofovir alafenamide–emtricitabine relative to generic tenofovir disoproxil fumarate–emtricitabine for HIV preexposure prophylaxis. A cost-effectiveness analysis. Ann Intern Med. 2020;172:583-590. doi:10.7326/M19-3478 LinkGoogle Scholar10. Landovitz RJ, Donnell D, Clement M, et al. HPTN 083 final results: pre-exposure prophylaxis containing long-acting injectable cabotegravir is safe and highly effective for cisgender men and transgender women who have sex with men [Abstract]. Presented at 23rd International AIDS Conference, 6–10 July 2020. Abstract OAXLB0101. Google Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.L.A., R.P.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-5643.Corresponding Author: Kevin L. Ard, MD, MPH, 55 Fruit Street, Cox 5, Boston, MA 02114; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Ard: 55 Fruit Street, Cox 5, Boston, MA 02114.Dr. Walensky: Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Bul 130, Boston, MA 02114.This article was published at Annals.org on 8 September 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNational Trends in Drug Payments for HIV Preexposure Prophylaxis in the United States, 2014 to 2018 Nathan W. Furukawa , Weiming Zhu , Ya-Lin A. Huang , Ram K. Shrestha , and Karen W. Hoover Metrics Cited byPaying for PrEP: A qualitative study of cost factors that impact pre-exposure prophylaxis uptake in the US.Academic Detailing to Increase Prescribing of HIV Pre-exposure ProphylaxisSwitching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide for Human Immunodeficiency Virus Preexposure Prophylaxis at a Boston Community Health CenterThe case for prescribing PrEP in community mental health settingsHIV preexposure prophylaxis costly in USA 17 November 2020Volume 173, Issue 10Page: 844-845KeywordsDrugsHIVHIV infectionsHIV preventionLipidsMedicarePreexposure prophylaxisPrevention, policy, and public healthSexual identityVeteran care ePublished: 8 September 2020 Issue Published: 17 November 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...