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Investing in National HIV PrEP
Preparedness (Over-the-Counter free PrEP)
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Download the PDF
Download the PDF
march 2023
Free the PrEP - Over-the-Counter Access to HIV Preexposure Prophylaxis
aug 2023
List of authors.
• Douglas Krakower, M.D.,
• and Julia L. Marcus, Ph.D.
excerpts
On July 13, 2023 - after a years-long campaign to "free the Pill" - the Food and Drug Administration (FDA) approved the first over-the-counter (OTC) oral contraceptive pill. There is another medication whose availability on pharmacy shelves we believe could promote access and autonomy in the domain of sexual health: preexposure prophylaxis (PrEP) for HIV.
OTC availability of PrEP wouldn't be a panacea. Even without the costs of provider visits and laboratory monitoring, generic TDF-FTC may remain unaffordable for some people, particularly with the additional cost of an HIV self-test. Legislation was recently introduced to require insurers to fully cover the cost of OTC oral contraceptive pills when they become available. Similarly, policies requiring insurance coverage for OTC PrEP and HIV self-tests would be critical to keeping PrEP affordable. A national PrEP program has been proposed to support PrEP care for people who are uninsured,5 and inclusion of OTC medications in such a program could help ensure broad and equitable access.
It has taken 63 years since initial approval to free the Pill from prescription-only status. We can't wait that long for PrEP: the federal Ending the HIV Epidemic in the U.S. initiative aims to reduce national HIV incidence by 90% by 2030. Building on lessons learned from contraception, we believe it's incumbent on the HIV-prevention community - including health professionals, advocates, and manufacturers - to lay the groundwork for a collaborative movement to "free the PrEP."
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