• Posted January 9, 2024

Court Ruling Could Bring Higher Patient Costs for PrEP, and More HIV Infections

HIV pre-exposure prophylaxis (PrEP) is a lifeline for Americans, many of them gay men, who are at high risk of contracting the virus that causes AIDS.

But a case that is winding its way through the court system might push the cost of PrEP to levels that are unaffordable for many -- and that could cost lives, the authors of a new study warn.

“Our findings suggest that out-of-pocket cost increases for PrEP could upend the progress that has been made towards ending the HIV/AIDS epidemic in the United States,” said senior study author Jalpa Doshi, a professor of medicine at the University of Pennsylvania.

The context: People who take either of the two FDA-approved antiretroviral medications (each are actually two-pill combos) get a highly effective means of preventing HIV infection, even when exposed through sex. The U.S. Centers for Disease Control and Prevention has long contended that access to PrEP is key to ridding the nation of HIV/AIDS.

But maintaining that access is crucial: Under an Affordable Care Act rule that went into effect in 2021, insurance companies are barred from charging co-pays whenever members obtain PrEP.

However, a court case (Braidwood Management, Inc. v. Becerra) now under consideration could overturn that ACA rule, allowing insurers to demand that PrEP use be subject to co-pays.

How might that affect uptake of the drugs? In their study, Doshi's team looked at 2016-2018 information from an insurer-provided health care database.

They tracked the records of over 58,500 patients with new, insurer-approved PrEP prescriptions, and tracked how many of those patients started dropping the meds when co-pays began to rise.

As expected, folks began quitting PrEP if their out-of-pocket expenses rose.

Even raising co-pays from $0 to $10 doubled patients' "prescription abandonment" rate, from 5.6% of patients to 11.1%, the researchers found.

If co-pays went even higher -- between $101 to $500 -- more than a third of patients would bail from the regimen.

What might that mean for their health? According to the UPenn news release, people who quit PrEP were "two to three times more likely to get infected with HIV in the following year, compared to those who filled their PrEP prescription."

Doshi and her team believe numbers like that could foretell a rise in HIV/AIDS across the United States, and present a real setback to efforts to put an end to the epidemic in this country.

The study was published Jan. 8 in the journal Health Affairs.

More information

For more on PrEP, head to the CDC.

SOURCE: University of Pennsylvania, news release, Jan. 8, 2024

What This Means for You

Depending on the outcome of current litigation, Americans using PrEP might have to pay hefty co-pays, and that could mean rising numbers of HIV infections.