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Difficulties You May Have Getting Access to PrEP, the HIV Prevention Pill

Apicha Community Health Center Dec 28, 2015  

Apicha CHC - Pixabay - drug-4718372_1920

Apicha Community Health Center is proud to provide PrEP, the HIV prevention pill,  to over 300 of our patients since 2012. 

 While both New York City and New York State have made accessing PrEP a priority, our medical providers and support staff have encountered several issues that stop people from gaining access to this powerful HIV prevention tool. 

We've put together this list of problems people to have run into when getting access to PrEP:  

PrEP insurance assistance:

Since Apicha CHC serves many patients who live below the  Federal Poverty Line (FPL), or are  ineligible for traditional insurance, many of our patients require enrollment into either Medicaid or PrEP-AP. These patients can have difficulty gathering necessary documents and need additional support before the applications can be submitted. After filling out time-consuming paperwork, a prospective patient must wait for approval before he or she can be provided PrEP, and staff needs to follow up to find out the status of the applications.

Medicaid and PrEP-AP approval can both take several weeks.  During this time consuming process some patients get frustrated and decide PrEP isn't right for them-- for some people, the hassle of gaining access to the drug outweighs its benefits.  

There are also barriers associated with commercial insurances. Staff needs to verify if PrEP is covered, if there is a deductible, copay or prior authorization needed. If a patient has a high deductible, staff needs to assess their eligibility for other resources, and if eligible they will assist with applications to the Patient Access Network. For patients with high copays they will apply for copay cards. To make sure this gets done, it is necessary for a medical provider to have sufficient staff. 

Additionally, we have noticed some young men have marketplace insurance plans that have high deductibles, and because of that, they frequently have to pay $3,000-$5,000 out-of-pocket for PrEP-related medical costs and the prescription drug. These patients do not have the option to change their insurance plans until the next open enrollment period.  Other patients are still on their parents insurance plans and are not eligible for any assistance due to family income.  

Since there is not much we can do to help this situation from a clinical and administrative position (other than paying for the medical and drug costs of these patients from internal funds), we are working at the policy level to try and fix these issues.  

In addition, Gilead, the manufacturer of Truvada, has a PrEP Assistance program.  The process of applying for this program is time-consuming and arduous, frustrating many who attempt to complete it. For example, it is necessary to provide evidence that the patient is not eligible for Medicaid or PrEP-AP. We are in discussion with our government partners in petitioning Gilead to streamline and simplify its application process. 

Interested in learning more about the HIV prevention pill PrEP? Check out this list of PrEP FAQ's!

PrEP education & outreach support:

Apicha CHC staff has found that many patients who are taking PrEP are not accustomed to taking a pill every day and require  additional support,  such as bi-monthly check-ins in the first three months of being on PrEP; that includes treatment and appointment adherence education to ensure people are actually taking the pill.

We have seen that typically, the greatest risk of drop-off in adherence occurs after 4-8 weeks of beginning the medication, generally among young gay men. To combat this, we had to build our capacity for care management and adherence education during this crucial period to keep PrEP users on their regiment. 

PrEP starter kits: 

From our experience of prescribing PrEP we learned that the likelihood of a patient starting and remaining on PrEP is directly correlated to their ability to start PrEP immediately or soon after being prescribed PrEP. Patients who had to wait weeks or even months before starting PrEP decided to forego PrEP and fell out of care.

For this reason, we see a need for a PrEP Starter Kit that includes a month’s supply of prescription, so the patient can start their treatment immediately while their insurance details are worked out. 

In our experience, a prescription costs approximately $450.00 for one month's worth of the drug. We anticipate that approximately 50% of our patients who are newly prescribed PrEP would benefit from receiving a PrEP starter kit.  Unfortunately, we have no way to fund this currently.  

How we're trying to meet your needs

As you can see, many patients face time-consuming barriers to accessing PrEP. Our staff does its best to make this process as stress-free as possible by providing insurance assistance and adherence education.

Anecdotally, we have heard this isn't the case at all medical providers, because hiring the necessary support staff is costly and many providers simply can't afford it.  We assume some of these patients get frustrated and decide not to go on PrEP.  

Apicha CHC is committed to providing PrEP to our patients who would benefit from it. To meet the current need, we are continuously looking for ways of funding a dedicated PrEP program.  

How can you get access to PrEP?

There are many resources to help make sure PrEP is accessible and affordable to you.

If you are in New York City, Apicha CHC provides screenings for all of its patients to see if PrEP is the right choice for you.  

To become a patient and find out if you qualify for PrEP, or to inquire about Apicha CHC’s other services such as HIV testing or comprehensive medical care, you can request an appointment with us here.

If you’re still considering PrEP, no problem.  We’ve created an eBook to help you decide if PrEP is right for you. Just click on the banner below.

This blog was last updated March 2018.

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