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

Increasing patient out-of-pocket costs for HIV pre-exposure prophylaxis (PrEP), which has been shown to dramatically reduce the risk of HIV infection, could significantly reduce PrEP use and increase HIV infection rates The report states that there is. It highlighted a new study co-led by researchers at the University of Pennsylvania Perelman School of Medicine and the Johns Hopkins Bloomberg School of Public Health.

the study, published Today is health problemswill examine the potential impact of increased out-of-pocket costs, depending, in part, on the outcome of ongoing litigation over certain provisions of the Affordable Care Act (ACA) of 2010. It was designed for a purpose.

Researchers used a large, unique database of medical and pharmacy claims to determine the rate at which patients did not fill (i.e., abandoned) their insurer-approved PrEP prescriptions at various out-of-pocket expense levels. I looked into it. Their findings suggest that even a small increase in her monthly PrEP copay from $0 to $10 doubles her PrEP prescription abandonment rate. Additionally, an increase in copays from $100 to $500 per month would result in nearly one-third of her patients abandoning their PrEP prescriptions.

This analysis also highlighted the negative effects of abandoning PrEP. One year after their first PrEP prescription, the rate of new HIV infections was two to three times higher than among those who never filled that prescription.

“Our findings suggest that increasing out-of-pocket costs for PrEP could reverse the progress made toward ending the HIV/AIDS epidemic in the United States,” said the study's lead author. said Dr. Jalpa Doshi. He is an M.D. and director of the Value-Based Insurance Design Initiative in Penn Medicine's Center for Health Incentives and Behavioral Economics.

To date, the FDA has approved two HIV PrEP products. Each product combines two standard antiretroviral drugs into one pill. For the past decade, the U.S. Centers for Disease Control and Prevention (CDC) has recommended PrEP as a way to prevent HIV infection in high-risk individuals.

Expanding access to PrEP can also central pillar This is part of CDC's Ending the HIV Epidemic in the United States (EHE) initiative, which aims 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 expert group on disease prevention, gave PrEP an “A” rating. Under the provisions of the ACA, this rating would require most private insurance plans to offer PrEP to their policyholders at no cost starting in 2021.

however, Ongoing legal challenges (Braidwood Management, Inc. v. Becerra) could invalidate that portion of the ACA and allow insurance companies to require copayments for PrEP and other preventive treatments. Against this background, Doshi and colleagues sought to measure how changes in out-of-pocket costs would affect his use of PrEP.

The team examined a U.S.-wide database covering medical care provided by insurance companies, including prescription records from 2016 to 2018. They analyzed this data set to determine his PrEP prescription abandonment rate (as a patient who does not receive his newly prescribed and insurance company-approved PrEP prescription from the pharmacy within 365 days) at various copay levels. (definition) has been determined. Their analysis included 58,529 patients who received a new insurer-approved PrEP prescription and adjusted for differences between patients. Refills were not included in the analysis.

The researchers found that as out-of-pocket costs increased, both the abandonment rate of PrEP prescriptions and the rate of late prescription filling increased. Additionally, patients who abandoned their PrEP prescriptions were two to three times more likely to become infected with HIV in the following year than those who filled their PrEP prescriptions.

Based on their analysis, the researchers found that increasing the monthly patient copay for PrEP from $0 to the $1-$10 category nearly doubled prescription abandonment rates (from 5.6% to 11.1%), while It is estimated that it will move to the category of $1. The abandonment rate for the $500 category is 34.7%. They estimated that the abandonment rate in the $500+ category would be approximately 42.6%, almost eight times higher than the abandonment rate at the $0 level.

Overall, the results suggest that even small increases in patient out-of-pocket costs for PrEP can lead to sharp increases in prescription abandonment and subsequent substantial increases in the rate of new HIV infections. Masu.