Free Access to PrEP Drugs Promising for HIV Reduction; May Later Impact Pharmacy Benefit Plans

Free Access to PrEP Drugs Promising for HIV Reduction; May Later Impact Pharmacy Benefit Plans


Some recent developments point to good news for wider access to HIV prevention medications for at-risk, non-insured consumers. These same medications will also be more accessible to insured consumers by 2021, and employer pharmacy plan sponsors will be required to pay the costs.  Employers will need help figuring out how to cushion the possible impact on their drug benefit expenditures, while making these ground-breaking medications available to their members.

Ready, Set, PrEP

Gilead, the Big 3 retail pharmacy chains (CVS, Walgreens, Rite Aid), and the Department of Health & Human Services (HHS) recently announced their collaboration to offer free HIV Pre-exposure prophylaxis (PrEP) medications to consumers with no health insurance. When taken daily, PrEP, can be a new HIV prevention approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected if they are exposed to the virus. PrEP reduces the risk of contracting HIV, which could dramatically reduce HIV infections rates nationally.

The program, Ready, Set, PrEP, will allow HHS to work with Gilead to get 2.4 million bottles of its two HIV PrEP drugs, Truvada and Descovy, to 200,000 prospective consumers who qualify.  In order to get the medications, consumers can’t have any insurance coverage, must have a negative HIV test, and have a prescription for Truvada or Descovy from a doctor or healthcare provider.

Gilead will provide the medications at no cost, the three pharmacy chains will waive dispensing fees, and the federal government will pay for shipping.  The Ready, Set, PrEP program represents an innovative model of cooperation between manufacturers, pharmacy, and federal health agencies to address a national public health crisis.  There will still be costs, however, for non-insured consumers as they will still need to pay for their HIV test prior to receiving the free medications.

Employee Pharmacy Plan Access

Additionally, beginning in 2021, according to ACA rules, employee drug benefit plan members will also be able to get HIV PrEP for free. Under the ACA, employer plan sponsors will pay for the full cost of the drugs, at an average of $1,800 per month. With HIV drugs, diagnostic tests and treatment costs already at a high level, this new ACA mandate may increase pharmacy benefit costs overall.

Insured patients who need these HIV PrEP medications will welcome their $0 copays. Meanwhile, employers will welcome help to identify creative solutions to manage their pharmacy spend as they prepare for the possible budget impact of the impending ACA mandate. 

This development does not need to lead employers to cut workforce pharmacy benefits. Truveris helps employers find another way – providing solutions to reduce overall pharmacy spend without the traditional approach of increasing costs or restricting access for consumers. To find out more about how Truveris helps payers lower drug benefit plan expenses by removing unnecessary costs out of the “black-box” pharmacy supply chain, reach out to us at  info@truveris.com.

Image: Yakubov Alim | Getty

Topics: Trends, Insights & Analysis, Prescription Drug News & Regulations - Employers

Posted by

Michelle Gerlovin, PharmD.

Senior Client Services Director
Michelle is a clinical pharmacist with a passion for improving outcomes while controlling healthcare costs. She has worked in various pharmacy practice and pharmacy benefit management settings. Michelle's experience includes pharmaceutical rebate analysis, drug utilization management, and strategic pharmacy benefit support for government clients.