1. Is Insurance a Barrier to HIV Preexposure Prophylaxis? Clarifying the Issue
- Author
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Rogério M. Pinto and Emma Sophia Kay
- Subjects
medicine.medical_specialty ,AJPH Ending the HIV Epidemic ,Anti-HIV Agents ,Cost-Benefit Analysis ,MEDLINE ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Health Services Accessibility ,Insurance Coverage ,Food and drug administration ,Deductibles and Coinsurance ,Humans ,Medicine ,health care economics and organizations ,List price ,Medical Assistance ,Cost–benefit analysis ,business.industry ,Public Health, Environmental and Occupational Health ,Insurance, Pharmaceutical Services ,United States ,Underinsured ,Clinical trial ,Family medicine ,Cost sharing ,Pre-Exposure Prophylaxis ,business - Abstract
Clinical trials have demonstrated that preexposure prophylaxis (PrEP) protects against HIV infection; yet, even with its approval by the Food and Drug Administration (FDA) in 2012, less than 10% of eligible users in the United States are currently taking PrEP. While there are multiple factors that influence PrEP uptake and pose barriers to PrEP implementation, here we focus on PrEP’s cost in the United States, which, at the current list price of $2000 per month and with high levels of cost sharing, can leave insured users with more than $1000 in out-of-pocket costs every year. We discuss how patient deductibles, monthly premiums, copayments, and coinsurance vary widely and may increase the financial burden. Although drug payment-assistance programs have made PrEP more affordable to uninsured and underinsured users, lack of insurance is a barrier to PrEP accessibility. The FDA approved a generic version in 2017; however, that version has not been distributed to US consumers and may not be more affordable. As other countries begin implementing PrEP programs, the extent of PrEP’s availability as a tool in the global fight against HIV remains to be seen.
- Published
- 2020