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Trends in Oral and Injectable HIV Preexposure Prophylaxis Prescriptions in the US, 2013-2023
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Download the PDF here
Oct 12 2024 JAMA.
National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Preexposure prophylaxis (PrEP) with antiretroviral medications is effective in preventing HIV acquisition.1 Multiple PrEP medications have recently become available in the US, including 3 oral options with comparable safety and efficacy: branded tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) (July 2012), branded tenofovir alafenamide fumarate/emtricitabine (TAF/FTC) (October 2019), and generic TDF/FTC (October 2020).1 A long-acting injectable option (cabotegravir) became available in December 2021.1 TDF/FTC and cabotegravir have been approved for use by men and women; TAF/FTC has not been approved for females.1 The costs of branded medications are substantially higher than those of generic PrEP.2 Information on PrEP prescriptions by medication type is limited. This study examined trends in PrEP medication prescriptions in the US from 2013 to 2023.
Results
From January 2013 to December 2023, a cumulative 1 126 878 persons were prescribed oral or injectable PrEP, 88.6% of whom were male. The annual number of PrEP users increased from 10 281 in 2013 to 505 730 in 2023.
The monthly use of branded TDF/FTC increased from January 2013 to September 2019, but decreased after branded TAF/FTC and generic TDF/FTC became available (Figure). From December 2021 to December 2023, generic TDF/FTC had the highest monthly share of users among all medications (74 319 vs 74 106 for TAF/FTC; 11 002 for branded TDF/FTC).
A cumulative 99% of persons prescribed PrEP from 2013 to 2023 were prescribed oral PrEP. Since injectable cabotegravir became available in early 2022, it has been prescribed for a cumulative 15 428 persons. From 2022 to 2023, the percentage of PrEP users prescribed cabotegravir increased from 1.1% to 2.5%.
Injectable PrEP use was low likely because of barriers such as the high cost of stocking this expensive medication in clinics.
New PrEP medications are heavily marketed, yet, generic PrEP dominated the market despite the availability of 3 branded medications. This could be attributed to a 2021 federal guidance directing insurers to cover the cost of generic PrEP medication without patient cost-sharing,5 suggesting that effective health policy can result in lower health care expenditures.
Study limitations include that IQVIA did not capture prescriptions in organizations, such as Kaiser Permanente and the Veterans Administration, and did not include information about the current gender of PrEP users, so transgender users could not be identified. Also, PrEP use by race and ethnicity was not assessed because this information was missing for most users, and payer information was missing for about 20%.
Injectable PrEP use was low likely because of barriers such as the high cost of stocking this expensive medication in clinics. The lower proportion of persons prescribed generic TDF/FTC with public insurance vs private insurance may be attributed to use of 340B programs with prescribing of branded medications required for manufacturer rebates.
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