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From the Journals

HIV Prevention Landscape Shifts: PrEP Study Insights

Study reveals 50-fold increase in PrEP users over decade, with generic TDF/FTC dominating 53.4% of prescriptions by 2023 despite availability of newer branded options.

Conexiant

A research letter revealed significant shifts in human immunodeficiency virus preexposure prophylaxis prescribing patterns in the United States from 2013 to 2023. 

In the research letter, published in JAMA, investigators analyzed data from the IQVIA Real-World Longitudinal Prescription Data database, covering more than 95% of U.S. retail pharmacy and 75% of mail order pharmacy prescriptions.

Among the key findings were:

  • Annual preexposure prophylaxis (PrEP) users increased from 10,281 in 2013 to 505,730 in 2023.
  • Generic tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) became the most frequently prescribed PrEP medication since 2021, accounting for 53.4% of prescriptions in 2023.
  • A cumulative total of 1.1 million individuals were prescribed oral or injectable PrEP from 2013 to 2023, with 88.6% being male.
  • Injectable cabotegravir, approved in December 2021, was prescribed to 15,428 individuals by the end of 2023, representing 2.5% of PrEP users that year.

The study revealed notable differences in PrEP medication use based on demographic factors:

  • Sex: 29.3% of individuals prescribed branded TDF/FTC were female compared with only 2.5% for branded tenofovir alafenamide fumarate/emtricitabine (TAF/FTC).
  • Insurance: 70.9% of generic TDF/FTC users had private insurance compared with 54.6% for branded TAF/FTC and 28.6% for branded TDF/FTC.
  • Age: The 25 to 34 years age group represented the largest proportion of PrEP users across all medication types (38.6% overall), followed by the 35 to 44 years age group (26.1% overall).
  • Region: The South had the highest percentage of PrEP users (38.3% overall), followed by the West (25.2%), Northeast (20.9%), and Midwest (15.0%).

The investigators noted that the monthly use of branded TDF/FTC increased from January 2013 to September 2019 but decreased after branded TAF/FTC and generic TDF/FTC became available. From December 2021 to December 2023, generic TDF/FTC had the highest monthly share of users among all medications (74,319 vs 74,106 for TAF/FTC, 11,002 for branded TDF/FTC).

The investigators also found that 99% of the individuals prescribed PrEP from 2013 to 2023 were prescribed oral PrEP. The percentage of PrEP users prescribed injectable cabotegravir increased from 1.1% in 2022 to 2.5% in 2023.

Assistance programs played a significant role in PrEP access, with 53.4% of branded TDF/FTC users and 23.4% of branded TAF/FTC users utilizing manufacturer and government assistance programs.

The investigators attributed the dominance of generic PrEP to a 2021 federal guidance directing insurers to cover the cost of generic PrEP medication without patient cost-sharing.

The study's limitations included the exclusion of prescriptions from certain organizations like Kaiser Permanente and the Veterans Administration; a lack of information on current gender identity, preventing the identification of transgender users; an absence of race and ethnicity data for most users; and missing payer information for approximately 19.2% of the users.

The investigators emphasized the importance of studying PrEP prescribing patterns to monitor progress in human immunodeficiency virus (HIV) prevention efforts.

The authors declared having no competing interests.