Special issue supports national program to increase access to PrEP to prevent the spread of HIV
Researchers from the Johns Hopkins Bloomberg School of Public Health contributed to a special issue of the Journal of Law, Medicine and Ethics, including studies and commentary that support a national program to improve access to PrEP, a drug that prevents the spread of HIV.
The policy proposal for a national PrEP program was released in December 2021 by researchers at Johns Hopkins University, including the Bloomberg School, and national HIV policy experts. The proposal, “Funding and Providing Pre-Exposure Prophylaxis PrEP to End the HIV Epidemic,” outlines a new funding and delivery system that moves away from the use of expensive brand name drugs and expands the number of PrEP access points for uninsured, underinsured, and Medicaid-covered people.
President Biden’s 2023 budget proposal, released in March, includes $9.8 billion in funding over 10 years for a national PrEP program.
To maximize the benefits of a national PrEP program, the academic proposal recommends that:
- Government buys PrEP drugs to get stable supply at low cost
- Clinicians have new options to provide same-day on-site PrEP with better access to lab testing
- People without regular health care can access PrEP in community settings, such as domestic violence centers and street outreach programs, and through telehealth
The special issue, published online July 29, 2022, includes research papers and commentary that address important considerations outlined in the policy proposal. These include how to approach private insurance and Medicaid coverage for PrEP, increase access for vulnerable communities that need PrEP the most, and understand how generic options can offset financial burdens.
For more than a decade, PrEP has been available as a highly effective tool to curb the HIV epidemic, yet it remains out of reach for many Americans. It is a matter of fairness. Until we close the incredible gaps in income, race and ethnicity, age and location, we will struggle to end the HIV epidemic. »
Joshua Sharfstein, MD, associate dean of public health and community engagement practice and professor of practice in the Department of Health Policy and Management at the Bloomberg School
In 2012, the United States Food and Drug Administration approved the use of prescription drugs to prevent the spread of HIV. PrEP – which stands for pre-exposure prophylaxis – is taken by people at high risk of contracting HIV and can reduce transmission by up to 99%. However, only about a quarter of people who could benefit from PrEP received a prescription in 2020. Uptake of PrEP is even lower in black and Hispanic populations, with less than 9% of black people receiving a prescription and less than 16% of Hispanics/Latinos. people. Significant challenges in funding and delivering PrEP account for this disparity.
A study in the special issue, led by researchers at the Johns Hopkins Bloomberg School of Public Health, found that generic PrEP offers a promising solution by addressing financial barriers to drug access. Researchers found that after generic PrEP was introduced to the market, the price per dose of generic PrEP was only $1, compared to $28 per dose of brand name PrEP. Overall PrEP use did not appear to increase over the study period.
For their study, the researchers used data from IQVIA’s National Sales Outlook and the National Average Drug Acquisition Cost Database, maintained by the Centers for Medicare and Medicaid Services, to analyze the price. and the use of generic and branded PrEP starting in the first part of 2019 and the first part of 2021.
“So far, better access to low-cost, generic PrEP drugs doesn’t appear to have much wider use,” says Jeromie Ballreich, PhD, science assistant in the Department of Health Policy and Management and lead author of the study. “Policymakers now have the option of purchasing generic PrEP at a discount of more than 90% compared to branded PrEP. Bulk purchasing could be implemented as part of a national strategy to increase the use of PrEP.”
Another paper suggests that the national PrEP program can model other public health responses like that of a measles outbreak in the late 1980s that led to the federal Vaccines for Children program where the government purchased vaccines for children covered by Medicaid or who were uninsured. The authors make the argument that the purchase of medical technologies – drugs, devices, etc. – for a population, rather than on an individual basis, can ensure access to treatment, reduce costs and save lives.
Two articles from the special issue were posted on the Bloomberg School’s website in April, ahead of the journal’s publication, to inform the national conversation about creating a national PrEP program. The first, by Kenyon Farrow, chief executive of the advocacy group PrEP4All, explains the limitations of current patient assistance programs in reaching those most at risk of contracting HIV infection. The second, by longtime community HIV advocates, Jeremiah Johnson, PrEP Program Manager for PrEP4All; Asa Radix, MD, PhD, clinical associate professor at New York University Grossman School of Medicine; Raniyah Copeland, MPH, founder of Equity & Impact Solutions; and Guillermo Chacon, President of the Latin American AIDS Commission, describes the unique challenges faced by transgender, mixed, black, and Latina communities that result in huge disparities in access to care.
Other articles from the special issue can be found here and cover pathways to increasing access to laboratory services for PrEP; international patterns of PrEP access; key implementation issues; the role of Medicaid; and the potential for partnerships with public health.
Key contributors to this special issue include Amy Killelea, JD, senior associate in the Department of Health Policy and Management at the Bloomberg School, Jeremiah Johnson, PrEP Project Manager at PrEP4All, Chris Beyrer, MD, currently Director of Duke Global Health Institute, and Derek Dangerfield, PhD, now of George Washington University’s Milken Institute School of Public Health.
Johns Hopkins University Bloomberg School of Public Health