Trends in Oral and Injectable HIV Pre-exposure Prophylaxis Prescription

Learn about the changing trend in pre exposure prophylaxis medication prescription for HIV patients in the US over the past decade.

Pre-exposure prophylaxis (PrEP) with antiretroviral medications is effective in preventing HIV infections. PrEP use has increased between 2013 and 2023. Multiple PrEP medications are available in the US including three oral medications with safety and efficacy.

A study published in JAMA Network() provides valuable insights into the trends of pre-exposure prophylaxis (PrEP) prescriptions in the US over a decade (2013-2023).

HIV-Preventive Drug-PrEP’s Usage Barriers Among Young Men
Young men involved in sexual activity with other guys are less aware and stigmatized to access PrEP, an HIV prevention drug.

‘Annual #PrEP users increased from 10,281 in 2013 to 505,730 in 2023, which shows a significant progress in #HIV prevention. #hivprevention #medindia’

PrEP Medication Used

The three commonly used oral medication are

Branded tenofovir disoproxil fumarate (TDF) [2012]
Branded tenofovir alafenamide fumarate (TAF) [2019]
Generic tenofovir disoproxil fumarate (TDF) [2020]

A long acting injectable cabotegravir was also made available in 2021. TDF and cabotegravir are prescribed for both genders but TAF is not recommended for female patients. The cost of branded medication and injectable medication is high compared to generic medication.

Trend in PrEP Medication Prescription Over the Decade

Annual PrEP users increased from 10,281 in 2013 to 5,05,730 in 2023, indicating substantial growth in HIV prevention efforts. From 2013 to 2023, a total of 11,26,878 persons were prescribed oral or injectable PrEP. 88.6% were male patients.

Use of branded TDF increased from 2013 to 2019 but its use decreased after branded TAF and generic TDF were approved for use. In the last two years from 2021 to 2023, the use of generic TDF was the highest among PrEP medications.

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Injectable PrEP use is limited because of the high cost of stocking this medication in clinics. Individuals with private insurance predominantly used generic TDF, while those with public insurance had similar rates of branded and generic PrEP use.

Prevalence of generic PrEP use over new PrEP is attributed to the 2021 federal guidance requiring insurers to cover the cost of generic PrEP medication without patient cost-sharing suggesting that effective health policy can result in lower health care expenditures.

Disparities in PrEP Prescriptions Still Remains in New York
Pre-exposure prophylaxis is more than 90 percent effective in reducing the risk of HIV infection and is recommended for everyone at very high risk.

Study limitations 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 the information was missing for most users, and payer information was missing for about 20%.

Studying PrEP prescribing patterns is necessary to monitor progress in the efforts to increase PrEP use and end HIV spread.

Pre-Exposure Prophylaxis (PrEP) for HIV Prevention is as Safe as Aspirin
By showing that PrEP might be as safe as aspirin doctors should feel more comfortable prescribing it, and patients should feel more comfortable using it.

Reference:

Trends in oral and injectable HIV preexposure prophylaxis prescriptions in the US - (https:jamanetwork.com/journals/jama/fullarticle/2825028)

Source-Medindia