HIV PrEP Medication Costs US More Than $2 Billion Annually

Payments for HIV preexposure prophylaxis (PrEP) drugs in the United States totaled more than $2.08 billion in 2018, according to a study published online in the Annals of Internal Medicine.

Researchers investigated prescriptions for tenofovir disoproxil fumarate with emtricitabine (TDF-FTC) for PrEP between 2014 and 2018 using the IQVIA Longitudinal Prescriptions database, which covers more than 90% of retail pharmacy prescriptions. 

Between 2014 and 2018, they found, annual PrEP prescriptions increased from 73,739 to 1.1 million. For 30 tablets, the average total payment increased from $1350 in 2014 to $1638 in 2018; the average out-of-pocket payment grew from $54 to $94. 

Out-of-pocket payments accounted for 5.7% of the $1638 cost in 2018, while third-party payments accounted for 94.3%. For 30 tablets, people with Medicaid paid an average $3. People with Medicare paid an average $80 for 30 tablets, and people with commercial insurance paid an average $107.  

Of the $2.08 billion in total payments for PrEP medication in 2018, $1.68 billion, or 80.7%, stemmed from prescriptions for people with commercial insurance, $200 million for people with Medicaid, $48 million for people with Medicare, and $127 million for people with manufacturer assistance. 

Researchers noted the IQVIA database does not include every prescription, which they considered a limitation of the study. 

“The $2.08 billion in PrEP medication payments in 2018 is an underestimation of national costs,” they wrote. “High costs to the health care system may hinder PrEP expansion.”  —Jolynn Tumolo