Insurance Barriers Block 4 in 10 From Injectable HIV PrEP

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Long-acting injectable HIV pre-exposure prophylaxis (LAI PrEP) could significantly reduce HIV infections, but disparate access, particularly due to insurance barriers, remains a significant hurdle for patients.

A study on the impact of insurance barriers on LAI PrEP was presented at IDWeek 2026, held October 21-24 in Washington, DC.¹ Using electronic health record data from a large Ryan White-funded clinic in St. Louis, Missouri, researchers found that of 170 individuals prescribed LAI PrEP, 4 in 10 desired it but were unable to receive it, primarily due to insurance-related barriers, Aditi Ramakrishnan, MD, MSc, assistant professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis, said in an interview with The American Journal of Managed Care^®.

“I think this really illustrates that the demand is there for LAI PrEP, but very much the real-world implementation of LAI PrEP is not set up to meet that demand at this time, and that access is very fragmented due to primarily insurance-related barriers,” she explained.

She went on to explain the nuances in the type of insurance coverage patients needed to receive LAI PrEP. Based on the clinic’s model of care, even patients with private insurance often needed a pharmacy benefit to be eligible for the injection, Ramakrishnan said. Even then, some insurers required prior authorization, which could be denied. Of the 70 individuals who did not receive LAI PrEP, 54.3% lacked a pharmacy benefit and 41.4% received prior authorization denials.¹

“We found that medical benefits rarely led to a successful injection in this clinic environment, and that even then, depending on the type of insurance, one needed prior authorization,” she explained.

Medicaid also posed a barrier. Although Missouri has expanded Medicaid, the state’s Medicaid program does not cover LAI PrEP, Ramakrishnan said, and policymakers should examine Medicaid policies state by state.

The study also found that LAI PrEP recipients were nearly 9 times as likely to be engaged in care at 12 months as those who were unable to receive it (8.94; 95% CI, 2.89-27.69).¹ One HIV seroconversion occurred in an individual with intermittent oral PrEP adherence who had received an LAI PrEP insurance denial in the year before diagnosis.¹

“We want to end the epidemic, and so if those barriers can be decreased, if we can increase insurance coverage and flexible models to support LAI PrEP, that can really improve access to care and actually end the epidemic in our population,” Ramakrishnan said.

Reference

1. Ramakrishnan A, Mukwekwerere E, Cardoza N, et al. Long-acting injectable PrEP interest vs. access in an Ending the HIV Epidemic priority state. Presented at: IDWeek 2026; October 21-24, 2026; Washington, DC.