A recent study reveals significant changes in the utilization and costs of oral pre-exposure prophylaxis (PrEP) for HIV prevention between 2018 and 2022, highlighting both expanded access and evolving prescribing trends.

Researchers conducted a retrospective analysis of commercial and Medicaid insurance claims to evaluate the use of branded and generic PrEP medications, including Truvada (tenofovir/emtricitabine [TDF]), Descovy (emtricitabine/ tenofovir [TAF)], and their generic equivalents. The study population included patients without HIV aged 13 to 64 who were prescribed PrEP.

PrEP use rose steadily over the 5-year period (P < .001), with a marked 129.8% increase in prescriptions for TAF-based regimens. By 2022, generic TDF had become the most commonly used formulation, accounting for 55.4% of prescriptions, followed by TAF (39.7%) and branded TDF (5.0%).

The shift to generics was accompanied by a 56.7% drop in average total cost of care (TCC), declining from $127 529 in 2018 to $55 179 in 2022 (P < 0.001). Despite this overall reduction, PrEP medications made up a growing share of pharmacy costs, rising from 66% in 2018 to 70% in 2022.

The study also found cost disparities between insurance types, with commercial plans incurring TCC over 20% higher than Medicaid. Differences in patient demographics by insurance type—including gender, race, region, and social determinants of health—were statistically significant each year.

As long-acting injectable PrEP enters the market, the authors call for continued monitoring to ensure PrEP remains accessible and affordable for those at highest risk of HIV.

Reference

Lee T, Swart E, Do D, et al. Trends in utilization and costs of oral preexposure prophylaxis (PrEP) for HIV prevention. Presented at: AMCP 2025; March 31-April 3; Houston, TX; Abstract B5.