National Trends in Drug Payments for HIV Preexposure Prophylaxis in the United States, 2014 to 2018

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  Furukawa, Nathan W. ; Zhu, Weiming ; Huang, Ya-Lin A. ; Shrestha, Ram K. ; Hoover, Karen W.
• Description:
  Background:
  
  Use of HIV preexposure prophylaxis (PrEP) has increased nationwide, but the magnitude and distribution of PrEP medication costs across the health care system are unknown.
  
  Objective:
  
  To estimate out-of-pocket (OOP) and third-party payments using a large pharmacy database.
  
  Design:
  
  Retrospective cohort study.
  
  Setting:
  
  Prescriptions for tenofovir disoproxil fumarate with emtricitabine (TDF-FTC) for PrEP in the United States in the IQVIA Longitudinal Prescriptions database, which covers more than 90% of retail pharmacy prescriptions.
  
  Measurements:
  
  Third-party, OOP, and total payments were compared by third-party payer, classified as commercial, Medicaid, Medicare, manufacturer assistance program, or other. Missing payment data were imputed using a generalized linear model to estimate overall PrEP medication payments.
  
  Results:
  
  Annual PrEP prescriptions increased from 73 739 to 1 100 684 during 2014 to 2018. Over that period, the average total payment for 30 TDF-FTC tablets increased from $1350 to $1638 (5.0% compound annual growth rate) and the average OOP payment increased from $54 to $94 (14.9% compound annual growth rate). Of the $1638 in total payments per 30 TDF- FTC tablets in 2018, OOP payments accounted for $94 (5.7%) and third-party payments for $1544 (94.3%). Out-of-pocket payments per 30 tablets were lower among Medicaid recipients ($3) than among those with Medicare ($80) or commercial insurance ($107). Payments for PrEP medication in the IQVIA database in 2018 totaled $2.08 billion; $1.68 billion (80.7%) originated from prescriptions for persons with commercial insurance, $200 million (9.6%) for those with Medicaid, $48 million (2.3%) for those with Medicare, and $127 million (6.1%) for those with manufacturer assistance.
  
  Limitation:
  
  The IQVIA database does not capture every prescription nationwide.
  
  Conclusion:
  
  Third-party and OOP payments per 30 TDF-FTC tablets increased annually. The $2.08 billion in PrEP medication payments in 2018 is an underestimation of national costs. High costs to the health care system may hinder PrEP expansion.
  
  Primary Funding Source:
  
  Centers for Disease Control and Prevention.
  
  
• Subjects:
  Algorithms Anti-HIV Agents Drug Costs Drug Prescriptions Health Expenditures HIV Infections Humans Medicaid Medicare Pre-Exposure Prophylaxis Retrospective Studies

  More +
• Source:
  Ann Intern Med. 173(10):799-805
• Pubmed ID:
  32894696
• Pubmed Central ID:
  PMC7674258
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  173
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2de7dd0d7bb5efb29758f8e6540ce19af52f56e1b5e98789aac1bbda3800162e
• Download URL:
  https://stacks.cdc.gov/view/cdc/97479/cdc_97479_DS1.pdf
• File Type:
  [PDF - 108.96 KB ]