Increasing patients’ out of pocket costs for HIV pre-exposure prophylaxis (PrEP), medications, which have been shown to dramatically reduce the risk of HIV infection, could lead to a significant reduction in PrEP use and a rise in HIV infection rates, according to a new study co-led by researchers at the Perelman School of Medicine and Johns Hopkins Bloomberg School of Public Health.
The study, published in the January issue of Health Affairs, is designed, in part, to explore the impact that out-of-pocket cost increases could have, depending on the outcome of an ongoing court case challenging certain provisions of the 2010 Affordable Care Act.
The researchers used a large, proprietary database of medical and pharmacy claims to determine the rates at which patients failed to fill (i.e., abandoned) insurer-approved PrEP prescriptions at different levels of out-of-pocket costs. Their findings suggest that even a small increase, from $0 to $10 in monthly PrEP out-of-pocket costs, would double the rate of PrEP prescription abandonment. Further, an increase in out-of-pocket costs to between $100 and $500 per month would result in nearly one-third of patients abandoning their PrEP prescriptions.
The analysis also highlighted the negative consequences of abandoning PrEP: The rate of new HIV infections in the year after the initial PrEP prescription was two to three times higher among those who never filled those prescriptions.
“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,” says study senior author Jalpa Doshi, a professor of medicine and the director of Value-Based Insurance Design Initiatives at the Center for Health Incentives and Behavioral Economics at Penn Medicine.
Read more at Penn Medicine News.
