HIV preexposure prophylaxis costly in USA
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HIV preexposure prophylaxis costly in USA Prescriptions and payments for HIV preexposure prophylaxis (PrEP) have increased in the US, resulting in high national costs, according to findings of a cost analysis conducted by the Centers for Disease Control and Prevention and published in Annals of Internal Medicine.1 Data from the IQVIA Real World Data Longitudinal Prescriptions database were used to estimate changes in the annual number of PrEP prescriptions for emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) in the US between 2014 and 2018, and changes in third-party payments and out-of-pocket (OOP) costs for PrEP. The annual number of PrEP prescriptions increased from 73 739 in 2014 to 1 100 684 in 2018, while total payments per 30 tablets of TDF–FTC increased from $1350 to $1638 and OOP payments increased from $54 to $94. Third-party payments accounted for 94.3% of total costs for TDF-FTC in 2018, while OOP payments accounted for 5.7%. OOP payments per 30 tablets ranged from $3 with Medicaid coverage to $80 with Medicare and $107 with commercial insurance. Nationally, payments for PrEP totalled $2.08 billion in 2018, including $1.68 billion in commercial insurance payments, $200 million in Medicaid payments, $48 million in Medicare payments, and $127 million covered by Gilead Sciences’ copayment assistance programs. "Although the cost per person may decrease with the debut of generic TDF–FTC, the overall health care cost of PrEP will likely increase as more persons gain access to and continue to use PrEP. The high cost of PrEP does not diminish its central role in the Ending the HIV Epidemic initiative. Rather, it should promote action around ways to lower PrEP costs to the health care system to prevent coverage denials, eliminate prior authorization requirements, and increase access," said the authors. "The work of Furukawa and colleagues reminds us of the untenable status quo: billions spent to provide PrEP to a minority of those who could benefit, rising out-of-pocket payments, and a mismatch between where PrEP is most needed and most used. The Ending the HIV Epidemic initiative aims to reduce HIV infections by 50% in 5 years and 90% in 10 years, but this public health effort must start by releasing the cost noose that is strangling its own success," commented Drs Kevin Ard and Rochelle Walensky from Harvard Medical School, Boston, Massachusetts, in an accompanying editorial published in Annals of Internal Medicine.2 1. Furukawa NW, et al. National Trends in Drug Payments for HIV Preexposure Prophylaxis in the United States, 2014 to 2018 Annals of Internal Medicine : 8 Sep 2020. Available from: URL: https://doi.org/10.7326/M20-0786. 2. Ard KL, et al. Payments for Preexposure Prophylaxis in the United States: Too Much for Too Few Annals of Internal Medicine : 8 Sep 2020. Available from: URL: https:// doi.org/10.7326/M20-5643. 803502322
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PharmacoEconomics & Outcomes News 19 Sep 2020 No. 862
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