IfPA’s Health Policy Blog explores health policy news, reports, initiatives and events through the lens of a single question: What is the impact on patient access?

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What Will It Take to End HIV?

By Donna Sabatino, RN, ACRN

More than 30 years after the first World AIDS Day, medications for prevention and treatment of HIV remain out of reach for many people.

Increasing PrEP Awareness and Access for All

A daily regimen of two oral antiretroviral medications taken in a single pill can reduce the risk of acquiring HIV by up to 97%. The approach, called pre-exposure prophylaxis – or PrEP – is free to anyone who wants it. Obtaining a prescription is often the biggest challenge.

Historically, only a licensed medical providers could prescribe PrEP. Though, there are efforts underway to amend state laws so that pharmacists can directly dispense a limited supply of PrEP and counsel patients to connect with a provider or clinic for screening, labs and routine care.

Improving Access to HIV Care and Treatment

Just as there have been advancements in preventing HIV, there are antiretroviral therapies that, when taken as prescribed, can reduce a person’s viral load to an undetectable level. This allows people with HIV to live long, healthy lives and have no risk of transmitting HIV to a partner.  This is called Treatment as Prevention or U=U, which is short for “Undetectable equals Untransmittable.”

HIV medications are readily covered by public insurers and the Ryan White Care Act for people who are uninsured or underinsured. Some private insurers, in contrast, use co-pay accumulator adjustment programs, which can limit access to these lifesaving medications.

A Co-Pay Surprise

This tactic is being applied to almost every antiretroviral medication, whether it is an older oral medication or newer treatment, like a once monthly injectable medication. Instead of taking dozens of oral medications every day as was the case in the early days of the HIV epidemic, newer treatment options are simpler for patients to take and adhere to and have fewer side effects.

Co-pay accumulator adjustment programs are problematic because they keep people who use manufacturer-issued co-pay cards to cover their life-saving medications’ cost from getting credit for their use. Once the card’s value is depleted, patients are often surprised to learn they are no closer to meeting their annual deductible than they were at the beginning of the year. This means patients are responsible for their medication’s co-pay and their deductible, which can be thousands of dollars. Many patients can’t afford the cost, and they abandon the medication at the pharmacy.

This can have a negative impact on any patient, but it is particularly dangerous for people with HIV.

Once antiretroviral medications is stopped, one’s HIV viral load will increase and disease progression will most likely occur. This can lead to an increase spread of HIV and resistance to the specific antiretroviral medication regime can also occur, meaning the person most likely will not be able to take the same medications in the future.

An Evolving Purpose

World AIDS Day is an observance focused on increasing access to care, treatment and prevention of HIV while raising awareness and speaking out against HIV stigma. Advocates must also use the day to call for policies that will improve access to prevention and treatment. We will never end the HIV epidemic without all these components.

Donna Sabatino, RN, ACRN, is the Director State Policy & Advocacy at The AIDS Institute.

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