Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic

Killelea, Amy; Johnson, Jeremiah; Dangerfield, Derek T.; Beyrer, Chris; McGough, Matthew; McIntyre, John A.; Gee, Rebekah E.; Ballreich, Jeromie; Conti, Rena M.; Horn, Tim; Pickett, Jim; Sharfstein, Joshua M.

doi:10.1017/jme.2022.30

Cited by 22 publications

(18 citation statements)

References 30 publications

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“…The proposal from Killelea and colleagues for expanding access to PrEP prioritizes population health approaches to increase access to PrEP. 10 Universal purchasing and distribution strategies offer opportunities to stock and deliver PrEP medications in key settings outside of traditional health care delivery system walls. State and local public health department HIV programs could adopt the VFC framework and financing model could guide universal coverage and purchasing agreements between state and local public health departments, Medicaid programs, and insurers to assure that PrEP is available to anyone that wants it.…”

Section: What Should the Federal Government And State And Local Publi...mentioning

confidence: 99%

Health Departments and PrEP:A Missed Opportunity for Public Health

Comer¹,

Fernández²

2022

J. Law. Med. Ethics

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The paper identifies common barriers and challenges to Pre-Exposure Prophylaxis (PrEP) uptake and offers considerations for state and local public health departments to address barriers and retool infrastructure to increase access to PrEP to new users. Authors identify synergistic opportunities with federal agencies and funders to advance PrEP-related HIV prevention efforts, that prioritize strategies and investments to provide PrEP to people who could benefit from the intervention but are unaware of PrEP or struggle to access it. Barriers discussed and examined include financing strategies to reduce financial burden of PrEP medication, expanding PrEP access and outreach beyond clinical settings, and increasing the network and reach of the provider community to serve people we oppress through policy choices and discourses of racial and socioeconomic inferiority.

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Section: What Should the Federal Government And State And Local Publi...mentioning

confidence: 99%

Health Departments and PrEP:A Missed Opportunity for Public Health

Comer¹,

Fernández²

2022

J. Law. Med. Ethics

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“…The new approval, however, may provide an opportunity to consider a different approach to paying for and distributing PrEP medications, with equity at its center. A recent report—developed with input from patients, clinicians, health economists, and leaders of community health agencies—proposed establishment of a new federal program for PrEP access . Specifically, the proposed program suggests purchasing PrEP medications and laboratory services for people with Medicaid or without health insurance coverage and making the medication available through existing networks of pharmacies, laboratories, and clinics.…”

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confidence: 99%

Long-Acting Cabotegravir for HIV Prevention

Sharfstein

Killelea

Dangerfield

2022

JAMA

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On December 20, 2021, the US Food and Drug Administration (FDA) approved long-acting cabotegravir, the first injectable medication to prevent HIV. Two randomized clinical trials that together included 7790 study participants demonstrated that long-acting cabotegravir was more likely to prevent HIV acquisition than daily oral medication for people at risk of sexually acquiring HIV, including men who have sex with men, heterosexual women, and transwomen. 1 The advantage of the medication was attributed partly to the high efficacy of this and other integrase inhibitors and, in part, to better adherence for an injection compared with a once-daily pill regimen; whether this advantage remains outside of clinical trials remains unknown. It is hoped that this new tool for HIV prevention will accelerate progress toward the US goal of reducing new infections by 90% by 2030. However, the potential for public health benefit is jeopardized by the cost and complexity of the US health care system.The manufacturer of cabotegravir (ViiV Healthcare) set the initial list price for the long-acting drug at $3700 per dose. 2 Therefore, the required 2 doses in the first month and subsequent dosing every other month will cost $22 200 per year. At this price, public and private Policy innovation is necessary for the US to realize the promise of long-acting cabotegravir and future medical advances for HIV prevention.

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“…A new approach could overcome the challenges facing existing programs with similar goals, which is the animating concept behind the proposal from Killelea and colleagues in this issue of JLME. 9 What are key considerations for effective implementation of a national PrEP program? On a policy level, the fact that PrEP has an "A" rating as a health prevention tool from the United States Preventive Services Task Force (USPSTF) has already increased access to insured individuals.…”

mentioning

confidence: 99%