A new study adds to existing evidence that out-of-pocket costs curb people from taking pre-exposure prophylaxis (PrEP), the safe and highly effective meds taken to reduce one’s risk of contracting HIV, which in turn could result in a rise in HIV cases.

Published in Health Affairs, the study was led by researchers at the Perelman School of Medicine at the University of Pennsylvania and the Johns Hopkins Bloomberg School of Public Health, according to a UPenn news release.

The study sought to explore the potential consequences of out-of-pocket cost increases. Using a large database of medical and pharmacy claims, researchers analyzed the correlation between patients who failed to fill PrEP prescriptions and out-of-pocket costs.

Researchers found that even a small increase—for example, from $0 to $10 in monthly PrEP out-of-pocket costs—would double the rate of prescription abandonment, from 5.6% to 11.1%. An increase to between $100 per month to $500 per month resulted in almost one third of people failing to fill their PrEP prescriptions.

What’s more, in the year after PrEP was prescribed, those who never filled their prescriptions had a rate of HIV infection two to three times higher than those who did fill PrEP prescriptions.

The Food and Drug Administration has approved three PrEP medications in the United States—two different pills (Truvada and Descovy) and a long-acting injection (Apretude). The cost of PrEP extends beyond the medication itself. People who take PrEP must visit a health care provider for regular blood tests and screenings—for example, to check for HIV and sexually transmitted infections.

Federal guidelines have required insurers to cover PrEP under the Affordable Care Act since January 2021; later that year, the government clarified that this included the associated doctor visits and lab work. For details, see “Insurers Must Cover PrEP and Related Services to Prevent HIV.”

But these guidelines are hard to enforce. Worse still, some employers have sued to end the coverage of PrEP on the grounds of religious freedom. For details, see “Judge Blocks Insurance Mandate to Cover Prevention Services Such as PrEP and Cancer Screenings.”

In October 2023, the Centers for Disease Control and Prevention released new HIV surveillance data showing that 36% of the 1.2 million people who could benefit from PrEP were prescribed it in 2022, up from 23% in 2019.

While many urban white gay men have eagerly adopted PrEP, uptake has been slower among other groups. Indeed, while 94% of white people who could benefit received a PrEP prescription, only 24% of Latinos and just 13% of Black people who could benefit did so. In addition, about 40% of men who could benefit were prescribed PrEP, compared with just 15% of women.

“Our findings suggest that out-of-pocket cost increases for PrEP could upend the progress that has been made toward ending the HIV/AIDS epidemic in the United States,” said study senior author Jalpa Doshi, PhD, a professor of medicine at the Perelman School of Medicine, in the news release.

To read more, click #PrEP and #Prevention. There, you’ll find articles covering access to PrEP including: