HIV pre-exposure prophylaxis (PrEP) should be free across Canada to those meeting evidence-based guidelines

Abstract

HIV pre-exposure prophylaxis (PrEP) should be free across Canada for all those who meet evidence-based guidelines. PrEP is a highly effective tool for preventing HIV acquisition that has been approved for use in Canada since 2016. However, without public drug plans or private insurance, generic PrEP costs approximately $200 to $250 CAD monthly. Current PrEP programs across Canada are a confusing patchwork system with variability in coverage and prohibitive co-payments, making PrEP too expensive for many equity-deserving groups. However, publicly funded PrEP programs are demonstrated to be cost-effective and even cost-saving by reducing the long-term healthcare expenditures associated with managing HIV. PrEP is not just an individual-level clinical tool. It is a public health intervention. Alongside “treatment as prevention,” PrEP is an important population-level strategy for eliminating new HIV infections in Canada and can play a role in helping to address complex health inequities affecting communities highly affected by HIV. Navigating drug coverage for patients consumes time and resources among healthcare providers that could be spent helping to improve other social determinants of health. Affordability will remain the foremost barrier to PrEP access until PrEP is made free to all those who meet evidence-based guidelines.

Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data

“…Our model indicated that many eligible MSM were not engaged in PrEP care yet could have benefited from its use, as evidenced by their higher HIV incidence. The financial burden of PrEP in Montréal remains an important barrier, potentially leaving behind those most at risk of HIV acquisition [41].…”

Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey

“…Furthermore, understanding and navigating the medication coverage system in Canada can be confusing and discourage eligible GBM from using PrEP. 27 Costs of deductibles and pharmacy dispensing fees may have a further impact on the ability to access PrEP. Even in the setting of universally funded PrEP such as in BC, perceived cost may be a barrier if individuals are unaware of its availability.…”

“…24 , 25 Across Canada, approximately 60% of individuals have private medication coverage through employment. 26 Among insurers, there is considerable variation in the requirements and the extent to which drugs are subsidized, which has led some scholars to describe the current system as inefficient and as a “confusing patchwork.” 27 , 28 Furthermore, other groups, such as international students or visitors, do not have comprehensive medication coverage.…”

Gay, bisexual, and queer men’s confidence in the Undetectable equals Untransmittable HIV prevention message: longitudinal qualitative analysis of the sexual decision-making of pre-exposure prophylaxis users over time

“…Data were collected as part of the PrEP Implemention Project (PRIMP), an ongoing mixed methods implementation science study with the overarching objective of understanding how to better deliver PrEP to GBQM in Ontario and British Columbia, Canada. [33][34][35]…”