PrEP and the HIV Continuum
This is a November 2016 update of the June 2016 Blog. Thanks for AIDS Foundation of Chicago for the nudge.
Federal guidelines released May 2014 put an official stamp on use of a daily antiretroviral drug regimen called pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection. Many jurisdictions around the nation have embraced PrEP as a component of the strategy to end AIDS. When adherence to the regimen (a single pill daily) is high, the benefits are significant. Activities to support use of PrEP are ongoing and varied. Below are highlights.
Ryan White and PrEP HRSA/HAB Policy Guidance
See the June 22 2016 HRSA/HAB Dear Colleague letter on PrEP as discussed in the August 2016 HRSA webinar, Ryan White HIV/AIDS Program and PrEP and an earlier 2010 HRSA HAB PrEP program letter. The June 2016 letter reiterates that Ryan White funds cannot be used for PrEP medications or medical services related to PrEP such as physician visits or lab tests related to PrEP. However, HRSA HAB states that Ryan White fund recipients and providers can provide services like risk reduction counseling and targeted testing that are part of a comprehensive PrEP program.
PrEP Policies and Plans
Policy papers were the typical first step of communities and states in establishing plans to explore PrEP use, such as review of data from clinical trials, and the pros and cons of the approach. See the sidebar for a sampling.
Coverage of PrEP
Health insurance coverage of PrEP is fairly common, although costs vary. On the public health insurance side, coverage under state Medicaid programs is common. See what Medicaid PrEP coverage is like in 10 states reviewed by HealthHIV. New York has developed a pre-authorization framework to guide its usage among its Medicaid population.
Many private health insurers cover PrEP. According to AIDS Foundation of Chicago, various communities, like Illinois and California, have prepared guides on health plans and their coverage of PrEP. Email AFC to share similar resources as they are compiling a list.
NASTAD has prepared a billing and coding guide to help providers get payment for PrEP services.
Those without insurance or unable to pay co-pays may apply through the Truvada PrEP patient assistance program (PAP). Learn more about PAP and other PrEP payment support from the Fair Pricing Coalition.
Finding a PrEP Provider
Beyond coverage, individual clinicians may not always be up to speed on PrEP. See the PrEP Locator for a searchable national database of providers who understand PrEP administration. Also, do a web search to see community-specific PrEP provider guides. However, widespread clinician preparedness might be the better long-term strategy. The HRSA-funded Clinician PrEPline is available to help clinicians become skilled PrEP prescribers. The Pacific AETC has also prepared PrEP: A Brief Guide for Providers.
See the sidebar for a small sampling of PrEP education resources. Also, do a web search for PrEP guides (e.g., search for PrEP and name of your state or city) as many areas have community-specific websites, counseling services and consumer information.
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