What would happen to PrEP adherence if out-of-pocket costs rise?
What would happen if PrEP, a highly effective medicine that reduces one’s chances of contracting HIV, was no longer free of charge under almost all private health insurance plans? This was a question a research team delved into following the news that a federal district court judge struck down the ACA free preventive services provision. The research team sought to find out what might happen if out-of-pocket costs for PrEP were to rise and specifically, would people abandon the treatment?
CHIBE Associate Director Jalpa Doshi, PhD, published a Health Affairs paper with colleagues on estimating the impact of out-of-pocket cost changes on abandonment of HIV pre-exposure prophylaxis.
They looked at a sample of around 58,000 people with a new insurer-approved PrEP prescription and simulated the percentage of patients who would abandon PrEP under hypothetical changes to out-of-pocket costs, ranging from $0 to more than $500. They found that an increase from $0 to between $100-500 in monthly PreP out-of-pocket costs would increase PrEP abandonment rates by 6 times. Even going from $0 to $10 a month in out-of-pocket costs would double the percent of patients not filling their prescription.
“These results imply that recent legal challenges to the provision of PrEP with no cost sharing could substantially increase PrEP abandonment and HIV rates, upending progress on the HIV/AIDS epidemic,” the authors concluded.
In June 2024, the court ruled in the Braidwood Management v. Becerra case that the businesses and individuals involved were exempt from fully covering PrEP. Dr. Doshi and Lorraine T. Dean, ScD, wrote an op-ed in The Hill following the news, stating that the case could set a dangerous precedent and invalidate a range of free preventative services.
“By limiting access to PrEP, Braidwood and cases like it could upend the progress the U.S. has made in eliminating HIV. No patient should have to choose between their health and financial well-being, especially in a society as wealthy as the United States,” they wrote.
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