Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015–2016

Abstract

BackgroundIn 2015, there were approximately 40,000 new HIV diagnoses in the United States. Preexposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP. Methods and findingsWe analyzed prescription drug claims for individuals prescribed PrEP in the Integrated Dataverse (IDV) from Symphony Health for the period of September 2015 to August 2016 to describe PrEP patients, prescribers, relative uptake, and payment methods in the US. Data were available for 75,839 individuals prescribed PrEP, and findings were extrapolated to approximately 101,000 individuals, which is less than 10% of the 1.1 million adults for whom PrEP was indicated. Compared to individuals with newly diagnosed HIV infection, PrEP patients were more likely to be non-Hispanic white (45% versus 26.2%), older (25% versus 19% at ages 35-44), male (94% versus 81%), and not reside in the South (30% versus 52% reside in the South).Using a ratio of the number of PrEP patients within an MSA to the number of newly diagnosed individuals with HIV infection, we found MSAs with relatively low uptake of PrEP were concentrated in the South. Of the approximately 24,000 providers who

Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

“…In doing so, we use a “28-day month” to allow for patients who receive fills in 7-day increments (e.g. 7 , 14 , 28) and to allow for occasional non-adherence (e.g. missed days).…”

“…For patients unable to physically visit their doctor, telehealth visits have emerged as a viable alternative to support patients who may need a prior authorization, a refill or a new prescription. While many insurance providers and pharmaceutical benefit managers (PBMs) place limits on how early patients may refill their medications (e.g., 2 – 7 days before the expected runout date), many payers relaxed these restrictions in response to Covid-19, and the US Drug Enforcement Administration provided updated guidance on early refills [ 4 ]. Our objective is therefore to determine the extent and degree to which filling and denial patterns changed across cornerstone drugs unimpacted by shortage during Covid-19 in six therapeutic classes with significant population health impacts (viz.…”

Patient Access to Chronic Medications During the COVID-19 Pandemic: Evidence from a Comprehensive Dataset of US Insurance Claims

“…This allows us to track patients longitudinally even if they switch insurers or pharmacies. This dataset is regularly used in medical, regulatory, and policy research, as well as by commercial firms like pharmaceutical and insurance companies [e.g., [6][7][8][9]. The extract from this dataset that we received contains de-identified data on 9.4 billion prescription claims from more than 252 million patients between May, 2019 and August, 2020.…”

Community Legal Systems: Targeting PrEP and HIV Education to Decrease Risk of HIV Transmission

“…While the proportion of new HIV diagnoses in the south is larger than all other areas of the country combined, the use of PrEP is low [29,30]. To put this into perspective, in 2015, a comparison of the rate of HIV diagnoses to prescribed PrEP in the western U.S. was 19% to 27% (HIV/PrEP) and in the southern U.S. is 51% compared to 29.7% [31].…”

“…Another group with a high risk of HIV and low use of PrEP are men who have sex with men (MSM), particularly among men from minority racial groups. One barrier seems to have been a lack of awareness given the documented increase in awareness and the concurrent increase in reported use of PrEP from 2014 to 2017 [30,34]. Still, the combination of minority status and living in the south are linked to low use of PrEP [35].…”