Costs of HIV PrEP Could Curb Expansion, Researchers Warn

Payments for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) medication in the United States totaled more than $2.08 billion in 2018, according to a Centers for Disease Control and Prevention study recently published in Annals of Internal Medicine. 

To gain insight into PrEP payments nationwide, researchers looked at prescriptions for tenofovir disoproxil fumarate with emtricitabine (TDF-FTC) in the United States between 2014 and 2018 using the IQVIA database. The database includes more than 90% of retail pharmacy prescriptions nationwide.

During 5-year period, annual PrEP prescriptions grew from 73,739 to 1.1 million, according to the study. For 30 tablets, the average total payment rose from $1350 to $1638, while the average out-of-pocket payment rose from $54 to $94—increases that represented compound annual growth rates of 5% and 14.9%, respectively. 

“Of the $1638 in total payments per 30 TDF-FTC tablets in 2018, out-of-pocket payments accounted for $94 (5.7%) and third-party payments for $1544 (94.3%),” researchers reported. “Out-of-pocket payments per 30 tablets were lower among Medicaid recipients ($3) than among those with Medicare ($80) or commercial insurance ($107).” 

Of the $2.08 billion in PrEP medication payments in the IQVIA database in 2018, 80.7% involved commercial insurance, 9.6% Medicaid, 2.3% Medicare, and 6.1% manufacturer assistance. 

“The $2.08 billion in PrEP medication payments in 2018 is an underestimation of national costs,” researchers pointed out. “High costs to the health care system may hinder PrEP expansion.”

—Jolynn Tumolo 

Reference: 

Furukawa NW, Zhu W, Huang YA, Shrestha RK, Hoover KW. National Trends in Drug Payments for HIV Preexposure Prophylaxis in the United States, 2014 to 2018 : A Retrospective Cohort Study. Ann Intern Med. 2020;173(10):799-805. doi:10.7326/M20-0786