From Evidence to Implementation: Clarifications Around USPSTF Recommendations for HIV Pre-Exposure Prophylaxis (PrEP) - Episode 7

Implications of USPSTF Grade A Rating of HIV PrEP

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Carl Schmid discusses the implications of the USPSTF Grade A rating of HIV PrEP to patients, providers, and payers.

Ryan Haumschild, PharmD, MS, MBA: I want to pivot now and discuss what are the implications for a grade A rating, which is really strong, when we look at these facts of PrEP [pre-exposure prophylaxis] to patients and what was that impact in the implications to providers and payers? Hopefully, Carl, you can chime in on this. What was your response across the country when you saw this grade A recommendation and how did patients and providers react to these new implications?

Carl Schmid: This is something that I’ve been working on for many years. It was great to see it come to fruition. Because there’s been so many barriers. First with the cost of the drug. People said I can’t afford it. Then, even when we had the initial grade A and plans had to cover it, we still had the barriers of the labs and all the cost-sharing with all the office visits. To have that as well, really lifted the cost barriers to PrEP because it’s not just the drug, it’s all the lab services, the medical visits, and the testing that goes along with it, and the adherence as well. I want to emphasize this is only effective if you have health care coverage and private health care coverage in Medicaid. That’s really important. It’s only if you have access to health care. I’ve been getting fielding complaints from people. “Oh, I still have a huge cautionary for my drug,” and I find out that they’re on employer plan that may not be following the ACA [Affordable Care Act]. That’s their legal right but also Medicare. This does not cover Medicare. It also puts a responsibility on patients that they must find out. Is my plan required to do this or not? In terms of providers, again, it lifts a barrier for them but also there is a key component in this that you could have medical management of the drug. But if a provider says that you can’t be on this certain drug and you should be on another one, the plans must expeditiously process that. Then, once you get on that other drug, there’s 0 cost-sharing as well. There’s provider implications as well. Ryan did a good job already. They must do it. Finding that people are still facing some issues of pain, office visit cost-sharing, I field a lot of questions from people, but we still have some work to do to make sure that this is fully implemented. Everyone has a role in ending HIV, and we need to reduce those barriers. What this has done is reduce some of the cost barriers, but there’s still several barriers to get over.

Ryan Haumschild, PharmD, MS, MBA: Thank you so much.

Transcript Edited for Clarity