Estimated Coverage to Address Financial Barriers to HIV Preexposure Prophylaxis Among Persons With Indications for Its Use, United States, 2015

Abstract

Background An estimated 1.2 million American adults engage in sexual and drug use behaviors that place them at significant risk of acquiring HIV infection. Engagement in health care for the provision of daily oral antiretroviral medication as preexposure prophylaxis (PrEP), when clinically indicated, could substantially reduce the number of new HIV infections in these persons. However, resources to cover the financial cost of PrEP care is an anticipated barrier for many of the populations with high numbers of new HIV infections. Methods Using nationally representative data, we estimated the current national met and unmet need for financial assistance with covering the cost of PrEP medication, clinical visits, and laboratory costs among adults with indications for its use, overall and by transmission risk population. Results This study found that, of the 1.2 million adults estimated to have indications for PrEP use, <1% (∼7,300) are in need of financial assistance for both PrEP medication and clinical care, at an estimated annual cost of $89 million. An additional 7% (∼86,300) are in need of financial assistance only for PrEP clinical care at an estimated annual cost of $119 million. Conclusion This information on PrEP care costs, insurance coverage, and unmet financial need among persons in key HIV transmission risk subpopulations can inform policy makers at all levels as they consider how to address remaining financial barriers to the use of PrEP and accommodate any changes in eligibility for various insurance and financial assistance programs that may occur in coming years.

Lack of health insurance is associated with delays in PrEP initiation among young black men who have sex with men in Atlanta, US: a longitudinal cohort study

“…A study modelling the burden of financial barriers to PrEP estimated that only 7% of those with an indication for PrEP would need financial assistance outside of health insurance and that most of those would be able to obtain funding using the MAP . In contrast, in our study, 47% of YBMSM were uninsured and required use of the MAP to access PrEP.…”

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

“…While there is evidence to support cost as a perceived barrier to PrEP uptake for those who present for PrEP, the actual scale of this problem may be limited. A recent independent study of nationally representative data, including authors from the CDC, demonstrated that fewer than 1% of the individuals with indications for PrEP required financial assistance for both PrEP medication and clinical care [146]. An additional 7% required financial assistance only for PrEP clinical care (not PrEP medication).…”

“…An additional 7% required financial assistance only for PrEP clinical care (not PrEP medication). Thus, only a small number of patients were not financially covered for clinician visits or laboratory tests, and an even smaller number had no coverage for medication and clinical costs of PrEP care [146]. Regardless, there is a proportion of patients, albeit small, with an unmet need for financial assistance in PrEP care.…”

Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining

“…We engaged in monthly check-ins with these nurses to address questions or concerns and to review the referral processes. We obtained funding from the Ontario HIV Treatment Network (OHTN) to provide PrEP medication at subsidized rates (up to free) to patients with financial limitations to ensure cost did not impede PrEP uptake [21,29,30]. Patients who met our inclusion criteria could attend one of four clinics in Ottawa; two were community-based infectious disease clinics, one was a hospital-based infectious disease clinic, and one was our nurse-led PrEP clinic (PrEP-RN) [21].…”