Do Prescriptions for Expedited Partner Therapy for Chlamydia Get Filled? Findings From a Multi-Jurisdictional Evaluation, United States, 2017–2019

Abstract

Background Expedited partner therapy (EPT) is commonly provided by prescription; however, the efficacy of this modality is unknown. We examined whether EPT prescriptions are filled when the cost barrier is removed. Methods To track EPT prescription fill rates, we used single-use pharmacy vouchers that covered the cost of azithromycin, 1 g (chlamydia treatment). We recruited clinical sites to distribute vouchers to patients with chlamydia who would receive an EPT prescription under clinic policies. When distributing vouchers, sites recorded and retained: voucher unique identifier, sex and age of index patient, distribution date, and whether partner name was written on the EPT prescription. Pharmacists receiving vouchers entered the identifier, sex and age of presenting person, and redemption date into a standard pharmacy claim transmission system. Data for redeemed vouchers were retrieved from an industry portal and linked with data retained at clinical sites. Results Thirty-two clinical sites distributed 931 vouchers during September 2017 to January 2019; 382 (41%) were redeemed. Vouchers distributed to patients 18 years or younger (49 [30%] of 163) were less likely to be redeemed compared with those distributed to patients older than 18 years (322 [44%] of 736; P = 0.001). Just over half of vouchers were redeemed the same day (196 [56%] of 352) and 1 mile or less from the clinical site (188 [54%] of 349). After excluding an outlier site, vouchers accompanied by EPT prescriptions including a partner name (15 [56%] of 27) were more likely to be redeemed than those lacking a name (83 [34%] of 244; P = 0.03). Conclusions Less than half of EPT prescriptions were filled, even when medication was free. Whenever possible, EPT should be provided as drug-in-hand.

Sexually Transmitted Infections Treatment Guidelines, 2021

“…Providers should visit https://www.cdc.gov/std/ept to obtain updated information for their state. Providing patients with packaged oral medication is the preferred approach because the efficacy of EPT using prescriptions has not been evaluated, obstacles to EPT can exist at the pharmacy level ( 121 , 122 ), and many persons (especially adolescents) do not fill the prescriptions provided to them by a sex partner ( 123 , 124 ). Medication or prescriptions provided for EPT should be accompanied by educational materials for the partner, including treatment instructions, warnings about taking medications (e.g., if the partner is pregnant or has an allergy to the medication), general health counseling, and a statement advising that partners seek medical evaluation as soon as possible for HIV infection and any symptoms of STIs, particularly PID.…”

Sexual and reproductive health services provided by community pharmacists: a scoping review

“…Four of the nine studies evaluated pharmacists' involvement in chlamydia screening, [42][43][44][45] two evaluated Open access screening along with treatment services, 46 47 and three evaluated treatment services only. [48][49][50] Screening for chlamydia was offered through distribution of chlamydia test kits, 42 44 46 or by collection of urine samples that were stored at the pharmacy and shipped to a pathology provider for analysis. 43 45 In one study, it was not clear how screening was performed.…”

“…48 Slutsker et al reported similar results; 41% of vouchers were redeemed even when the medication was free of charge. 50 Another study used the same methodology but for index cases with uncomplicated chlamydia and found that 87% of vouchers were redeemed. 49 Overall, users reported a high level of satisfaction with the services provided.…”

Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection

“…Potential embarrassment [ 26 ], pharmacists’ refusal to fill prescriptions without patient identifiers [ 27 ], and out-of-pocket expenses when a partner does not have insurance or when an index patient’s insurance does not cover multiple doses of treatment [ 28 ] may preclude the prescription from being filled. Even when cost barriers are removed, less than half of EPT prescriptions are filled [ 29 ].…”