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Out-of-pocket cost increase could put
HIV prevention medications out of reach
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The study, co-led by Penn Medicine, found that even modest increases in out-of-pocket costs for HIV prevention drugs could double rate at which prescriptions go unfilled.
Also, patients who abandoned their PrEP prescription were two to three times more likely to get infected with HIV in the following year, compared to those who filled their PrEP prescription
January 08, 2024
PHILADELPHIA - 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, according to a new study co-led by researchers at the Perelman School of Medicine at the University of Pennsylvania and Johns Hopkins Bloomberg School of Public Health. The study, published today in the January issue of Health Affairs, was designed, in part, to explore the impact that out-of-pocket cost increases could have, depending on the outcome of an ongoing court case challenging certain provisions of the 2010 Affordable Care Act (ACA).
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.
"Our findings suggest that out-of-pocket cost increases for PrEP could upend the progress that has been made towards ending the HIV/AIDS epidemic in the United States," said study senior author Jalpa Doshi, PhD, a professor of Medicine and the 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 of which combines two standard antiretroviral drugs in a single pill. For the past decade, the U.S. Centers for Disease Control and Prevention (CDC) has recommended PrEP as a way of preventing HIV infection among higher-risk individuals. Expanding access to PrEP is also one of the central pillars of the CDC's Ending the HIV Epidemic in the U.S. (EHE) initiative, which seeks to reduce new HIV infections in the United States by 90% by 2030. In 2019, the U.S. Preventive Services Task Force (USPSTF), an independent group of experts on disease prevention, gave PrEP an "A" rating. Under a provision of the ACA, that rating has meant that, since 2021, most private insurance plans have been required to provide PrEP to policyholders without cost sharing.
However, an ongoing legal challenge (Braidwood Management, Inc. v. Becerra) may nullify that part of the ACA, allowing insurers to now require out-of-pocket costs for PrEP and other preventive therapies. Against this background, Doshi and her colleagues sought to gauge how out-of-pocket cost changes affect PrEP use.
They found that both the rate of PrEP prescription abandonment and the rate of delayed prescription fills increased as out-of-pocket costs rose. Also, patients who abandoned their PrEP prescription were two to three times more likely to get infected with HIV in the following year, compared to those who filled their PrEP prescription.
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.

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