Researchers at the Johns Hopkins Bloomberg School of Public Health have contributed to a special issue of Journal of Law, Medicine and Ethics, Including studies and comments supporting a national program to improve access to PrEP, a drug that prevents the spread of HIV.
The policy proposal for the national PrEP was released in December 2021 by researchers at Johns Hopkins University, including Bloomberg School, and national HIV policy experts. The proposal, “Funding and delivering PEP for HIV pre-exposure prophylaxis to eradicate the HIV epidemic,” outlines a new funding and delivery system that moves away from the use of expensive brand-name drugs and increases the number of access points to PrEP for the uninsured, underinsured individuals, and those covered by Medicaid.
President Biden’s 2023 budget proposal, released in March, includes $9.8 billion in funding over 10 years for the national PrEP program.
To maximize the benefits of the National PrEP, the academic proposal recommends the following:
- The government buys PrEP drugs for a steady supply at a low price
- Physicians have new options to deliver same-day PrEP on-site with improved access to lab tests
- Individuals without regular health care can access PrEP through community sites, such as domestic violence centers, street outreach programs and through telehealth.
The special issue, published online on July 29, 2022, includes research papers and commentary addressing important considerations outlined in the policy proposal. These include how private insurance and Medicaid cover PrEP, increasing access to vulnerable communities most in need of PrEP, and understanding how public options can offset the financial burden.
For more than a decade, PrEP has been available as a highly effective tool to reduce the HIV epidemic, but it remains elusive for many Americans. This is an issue of fairness. Until we address the huge gaps by income, race, ethnicity, age and location, we will fight to end the HIV epidemic.”
Joshua Sharfstein, MD, Vice Dean of Public Health Practice and Community Engagement and Professor of Practice in the Department of Health Policy and Management at the Bloomberg School
In 2012, the US Food and Drug Administration approved the use of prescription drugs to prevent the spread of HIV. PrEP-; which means pre-exposure prophylaxis-; They are taken by individuals at high risk of contracting HIV, and can reduce transmission of infection by up to 99 percent. However, only a quarter of individuals who could benefit from PrEP received a prescription in 2020. PrEP absorption is even lower in the black and Hispanic populations, with less than 9 percent of black individuals receiving a prescription and less than 16 percent of Hispanics/ Latin people. Significant difficulties in financing and delivering PrEP are the reasons for this disparity.
One study in the special issue, led by researchers from the Johns Hopkins Bloomberg School of Public Health, found that generic PrEP offers a promising solution by addressing financial barriers to accessing the drug. The researchers found that after generic PrEP was brought to market, the price of a dose of generic PrEP was only $1 compared to $28 per dose of branded PrEP. Total PrEP use was not shown to increase during the study period.
In their study, the researchers used IQVIA’s national sales perspective data and the national average drug acquisition cost database, maintained by the Centers for Medicare and Medicaid Services, to analyze the price and use of the PrEP brand name from part 1 of 2019 and part 1 of 2021.
“So far, it does not appear that increased access to low-priced generic PrEP drugs has significantly expanded their use,” says Jerome Balrich, PhD, assistant scientist in the Department of Health Policy and Administration and lead author of the study. “Policy makers now have the opportunity to purchase generic PrEP at a discount of more than 90% compared to branded PrEP. Bulk purchase can be implemented as part of a national strategy to increase use of PrEP.”
Another article suggests that the national PrEP could be a model for other public health responses such as the one in the late 1980s measles outbreak that led to the Federal Child Vaccine Program where the government purchased vaccines for children who were covered by Medicaid or who did not have insurance. The authors make an argument that the purchase of medical technology -; Medicines, devices, etc. – to the population, not on an individual basis, can ensure access to treatment, lower cost, and save lives.
Two articles were released in the special issue of the Bloomberg School website in April, prior to the journal’s publication, to inform the national conversation about creating a national PrEP. The first, by Kenyon Farrow, managing director of support group PrEP4All, explains the limitations of current patient assistance programs in reaching people at high risk of HIV. the second, by longtime community HIV advocates, Jeremiah Johnson, PrEP Program Director for PrEP4All; Asa Radix, MD, PhD, clinical assistant professor at New York University’s Grossman School of Medicine; Rania Copeland, MPH, Equity & Impact Solutions; Guillermo Chacón, chair of the Latin Commission on AIDS, describes the unique challenges facing transgender, heterosexual, black and Latino people, which lead to huge disparities in access to care.
Other articles can be found in the special issue over here, covering pathways to increase access to laboratory services for PrEP; international forms for PrEP access; key implementation issues; Medicaid role; And the possibility of establishing partnerships with public health.
Key collaborators on this special issue include Amy Killella, J.D. Jeremiah Johnson, director of the PrEP project at PrEP4All, Chris Perrier, MD, now director of the Duke Institute for Global Health, and Derek Dangerfield, PhD, now at the Milken Institute School of Public Health at George Washington University.