Rise in PrEP Costs Could Hinder Expansion

While the use of preexposure prophylaxis (PrEP) against HIV has increased across the United States in recent years, the rise of PrEP costs across the health care system is yet to be fully catalogued.

Now, a team of investigators publishing in Annals of Internal Medicine have provided an estimate of out-of-pocket and third-party payments for PrEP by drawing on a database which covers more than 90% of retail pharmacy prescriptions.

The team conducted a retrospective cohort study to estimate out-of-pocket (OOP) and third-party payments using a large pharmacy database.

Data on prescriptions for the tenofovir disoproxil fumarate formulation of PrEP were taken from the IQVIA Longitudinal Prescriptions database.

“Third-party, out-of-pocket, and total payments were compared by third-party payer, classified as commercial, Medicaid, Medicare, manufacturer assistance program, or other,” study authors explained. Missing payment information was accounted for using a linear model to approximate overall PrEP payments.

According to the study findings:

• Yearly PrEP prescriptions increased from 73,739 to 1,100,684 between 2014-2018.

• The average payment for 30 PrEP tablets rose from $1350 to $1638, a 5.0% compound annual growth rate.

• The average out-of-pocket payment increased from $54 to $94 (14.9% compound annual growth rate).

• Out of $1638 in total payments per 30 tablets in 2018, out-of-pocket payments accounted for $94 (5.7%) and third-party payments for $1544 (94.3%).

• Out-of-pocket payments per 30 tablets were lower among Medicaid recipients ($3) than among those with Medicare ($80) or commercial insurance ($107).

These costs could be a part of why the health care system has been unable to expand PrEP uptake as rapidly as infectious disease clinicians have advocated for. These findings also inform the contested debates around the future of PrEP.