Connect with us

Hi, what are you looking for?

POZ

Out-of-pocket cost increase could put HIV prevention medications out of reach – study

Even a modest increase in patient out-of-pocket costs for PrEP could result in a sharp increase in prescription abandonment—and a subsequent large increase in the rate of new HIV infections.

Increasing patients’ out of pocket costs for HIV pre-exposure prophylaxis (PrEP), medications, which have been shown to dramatically reduce the risk of HIV infection, could lead to a significant reduction in PrEP use and a rise in HIV infection rates.

This is according to a study that appeared in Health Affairs, where the researchers used a large, proprietary database of medical and pharmacy claims to determine the rates at which patients failed to fill (i.e. abandoned) insurer-approved PrEP prescriptions at different levels of out-of-pocket costs.

Their findings suggest that even a small increase, from $0 to $10 in monthly PrEP out-of-pocket costs, would double the rate of PrEP prescription abandonment. Further, an increase in out-of-pocket costs to between $100 and $500 per month would result in nearly one-third of patients abandoning their PrEP prescriptions.

The analysis also highlighted the negative consequences of abandoning PrEP: The rate of new HIV infections in the year after the initial PrEP prescription was two to three times higher among those who never filled those prescriptions.

To date, the FDA has approved two HIV PrEP products, each of which combines two standard antiretroviral drugs in a single pill. For the past decade, the US Centers for Disease Control and Prevention (CDC) has recommended PrEP as a way of preventing HIV infection among higher-risk individuals.

The team reviewed a US-wide database covering insurer-provided health care, including prescription records, dating from 2016-2018. They analyzed this dataset to determine the rate of PrEP prescription abandonment — defined as a patient not picking up their newly-prescribed and insurer-approved PrEP prescription from the pharmacy within 365 days — at different out-of-pocket cost levels. Their analysis covered 58,529 patients with new, insurer-approved PrEP prescriptions, and adjusted for differences among the patients. Refills did not feature in the analysis. 

Based on their analyses, the researchers estimated that raising monthly patient out-of-pocket costs for PrEP from $0 to the $1-$10 category would nearly double the prescription abandonment rate (from 5.6 percent to 11.1 percent), while moving to the $101-$500 category the abandonment rate would be 34.7%. At the $500+ category, they estimated, the abandonment rate would be about 42.6%, nearly eight times the rate at the $0 level.

Overall, the results suggest that even a modest increase in patient out-of-pocket costs for PrEP could result in a sharp increase in prescription abandonment—and a subsequent large increase in the rate of new HIV infections.

Advertisement. Scroll to continue reading.

The study was co-led by Lorraine Dean, ScD, Associate Professor at the Johns Hopkins Bloomberg School of Public Health.

Advertisement
Advertisement

Like Us On Facebook

YOU MAY ALSO LIKE

POZ

The amount allocated for every Filipino living with HIV under the Outpatient HIV/AIDS Treatment (OHAT) Package of the Philippine Health Insurance Corporation (PhilHealth) has...

POZ

Women with HIV experience accelerated DNA aging, a phenomenon that can lead to poor physical function.

From the Editor

May mga yumayaman sa HIV “advocacy”. And this is maddening because this often comes at the expense of PLHIVs themselves. So we say, enough....

From the Editor

Yes, seminars are essential in LGBTQIA and HIV advocacy. But for some, it's the be-all/end-all of all efforts, giving rise to 'seminar activists' who...

Advertisement